New MRI/ultrasound imaging improves prostate cancer detection, treatment

The technology, called UroNav®, fuses images from magnetic resonance imaging (MRI) with ultrasound to create a detailed, three-dimensional view of the prostate. This improved view helps physicians perform biopsies with much higher precision, and increases prostate cancer detection, said Loyola University Medical Center prostate cancer surgeon Gopal Gupta, MD. Loyola is the first hospital in Illinois to use the system.

"This is revolutionizing how we diagnose prostate cancer and make treatment decisions," Dr. Gupta said.

When prostate cancer is suspected due to results of a PSA blood test or digital rectal exam, a physician performs a prostate biopsy. This typically involves sticking a needle into 12 different areas of the prostate. However, this traditional method can miss a tumor. Consequently, the physician either will falsely conclude the patient does not have cancer, or will perform one or more additional biopsies to find the suspected tumor.

In the new fusion method, the patient undergoes a MRI exam before undergoing a biopsy. The MRI can detect lesions in the prostate that may be cancerous. During the biopsy, the MR image is fused with ultrasound imaging. The system employs GPS-type technology to guide the biopsy needle to the lesions detected by the MRI, leading to significantly fewer needle biopsies. "Compared with traditional biopsy techniques that randomly sample the prostate, the new technology helps prevent physicians from missing hard-to-find and often aggressive prostate cancers," Gupta said. "This potentially will help provide greater certainty regarding the extent and aggressiveness of the disease. And it could enable patients to avoid multiple and unnecessary repeat prostate biopsies."

Traditional biopsies lack precision, which can lead to either too much treatment or not enough treatment, Dr. Gupta said. For example, if the biopsy fails to identify an aggressive tumor, the patient may be under treated. Conversely, a patient may undergo surgery or radiation for a tumor that likely would grow too slowly to endanger the patient during his expected lifetime.

Biopsies guided by MRI/ultrasound fusion will enable physicians and patients to opt for active surveillance, when appropriate. Under active surveillance, the patient holds off on having surgery or radiation and instead undergoes periodic digital rectal exams, PSA tests and ultrasounds to see whether the cancer is growing.

MRI/ultrasound fusion "is the next generation of MRI evaluation in the fight against prostate cancer," said Loyola radiologist Ari Goldberg, MD, PhD.

"These leading-edge imaging technologies will improve patient care by enabling physicians to detect and characterize abnormalities at the earliest possible stages," said Scott Mirowitz, MD, chair of Loyola's Department of Radiology. "The techniques also will give physicians better insight into whether, for example, a cancer has spread, and how effective a treatment has been."