Fusion Prostate Biopsy

The diagnosis of prostate cancer has traditionally been based on the determination of the PSA value in blood and the performance of a digital rectal examination. When the PSA was elevated or an abnormal digital rectal examination was detected, a blind biopsy with ultrasound was performed. Currently, there are more advanced diagnostic methods to assess whether a man has prostate cancer and to determine its severity. This is the case of fusion biopsy, which takes the image from magnetic resonance imaging, which for the first time offers images of solid prostate tumors, and fuses it with an ultrasound scanner to perform targeted biopsies.

Fusion biopsy, the evolution of diagnostic tests

When there is a clinical situation of suspected prostate cancer, a multiparametric magnetic resonance imaging (mpMRI) of the prostate is performed. This is a high-resolution imaging test that will play an important role in performing the biopsy since, by fusing this information with the real-time ultrasound image, it allows samples to be taken from the suspicious areas and the state of the prostate to be analyzed in detail.

For the first time it is possible to see the tumor inside the prostate gland, which allows not only to know its local situation (size, location, capsular involvement or periprostatic structures), but also to direct the taking of biopsies to these lesions.

But we can still go a step further in performing fusion biopsies thanks to PET-PSMA (positron emission tomography). While prostate mpMRI helps in the static anatomical identification of suspicious areas of malignancy, PET-MRI-PSMA makes it possible to see dynamic areas of tumor activity. Previously invisible tumors can be diagnosed, even with PSA less than 1.

Of all the diagnostic tools available, this is the one that yields the most definitive information and allows greater precision in taking samples that will later be analyzed by a specialized pathologist.

Obtaining all these details will allow us to plan a focal therapy for prostate cancer, that is, to treat exclusively the area affected by the tumor plus a safety margin, being a less invasive treatment. For this purpose, we have the Hugo and Da Vinci robotic systems, which translate the surgeon's movements, improving ergonomics and reducing tremor. In addition, it allows a real three-dimensional vision of the operative field with a high image quality that guarantees clarity and precision of the details.

 How is fusion biopsy performed?

Fusion biopsy is performed in the operating room. After a short sedation, the puncture needle is introduced through the perineal area for greater precision and lower infection rate. Once the sample is removed, it is sent to the pathologist.

The test lasts about half an hour. Two hours after the procedure, the patient can go home. It is normal to feel a slight discomfort in the perineum during the first hours, which can be alleviated with local cold and anti-inflammatory drugs.