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Targeted biopsy is now being used at UCLA to diagnose prostate cancer. Targeted biopsy refers to direct tissue sampling of suspicious areas, as opposed to the older method of random, systematic sampling in use since the 1980s. The new method employs sophisticated MRI (magnetic resonance imaging) technology, developed at UCLA, to visualize prostate cancer, and fusion of the MR images with realtime ultrasound using the Artemis device. The result is a 20-minute procedure, done in the clinic under local anesthesia, much more accurate than the older method of prostate biopsy because of biopsy targeting.
Targeted prostate biopsy was brought to UCLA by a 4-person multidisciplinary team, including members of the urology, radiology, pathology, and biomedical engineering departments.
Our UCLA team of physician-scientists includes(from Left):
The team was recently awarded a $1.7M grant from the National Cancer Institute to help bring the new fusion biopsy technology to full fruition. The first results of fusion biopsy at UCLA were published last year (PDF), and this year, team member Shyam Natarajan received the PhD degree in biomedical engineering, based largely on his work with the new method.
|Targeted Prostate Biopsy|
The targeted approach calls for an MRI to be performed before the biopsy of the prostate.
Using techniques of diffusion-weighted imaging and dynamic contrast enhancement, in conjunction with a larger-than-usual magnet (3Tesla), many prostate cancers can be visualized on MRI images. By fusing these MRI images with real-time ultrasound, prostate biopsy can now be targeted directly toward specific areas of interest in the prostate. Results soon to be published show that targeted biopsy is several times more accurate than non-targeted, systematic biopsies.
This technology now allows our team of specialists at UCLA to find hidden tumors missed by conventional prostate biopsy. Unlike all other major cancers, prostate cancer has proven difficult to image when still localized. This new prostate-imaging technology offers a more exacting method to obtain biopsy specimens from suspicious areas within the organ. The targeted method has proven of great value for detection of tumors in men with prior negative biopsies, but persistently elevated PSA levels. It is also proving to be helpful in men enrolled in ASCAP, Active Surveillance of Cancer of Prostate (sometimes known as watchful waiting), providing the best possible information that a "low risk" tumor is just that.
|Work flow of targeted prostate biopsy in 59 y.o. male with PSA 7.4 ng/ml, no palpable prostate lesion, and prior negative biopsy|
|View Larger Workflow »|
As of April 2012, more than 500 men have had an Artemis-guided prostate biopsy at UCLA, performed by Dr. Leonard Marks, professor of urology at the David Geffen School of Medicine.
Patients who are suspected of having a prostate cancer diagnosis will receive a multi-parametric MRI of the prostate. An expert in prostate MRI will review the scan and provide an overall score to determine cancer risk. Using software created at UCLA, a 3-D image of the patient's prostate is then generated using the data and scores from the MRI prostate scans to clearly show the location of any suspicious areas. The information is then transferred to a CD (compact disc), ready for use in the clinic during a real-time ultrasound prostate biopsy.
During the prostate biopsy, the CD is loaded into Artemis, the 3-D prostate biopsy system that allows the stored MRI images to be electronically transferred and fused with the real-time ultrasound, providing a 3-D image similar to a roadmap to help guide the tiny biopsy needle into targeted areas.
|A presentation of the initial Artemis experience at UCLA, establishing the biopsy-tracking accuracy of the device, was presented at the Annual Meeting of the American Urological Association, San Francisco, CA, May, 2010.
View Larger Workflow | Artemis Presentation (PDF)
The work flow of Artemis-guided TRUS biopsy, from patient selection to final prostate cancer diagnosis, as currently practiced at UCLA, is shown here (at right) and in this video.
We are currently recommending it for men who are suspected of having prostate cancer, but who may have inconclusive tests results and have experienced any of the following:
- Persistent, unexplained elevated PSA, or
- Prior negative biopsy, or
- Increased prostate cancer gene expression (PCA3 urine test with an elevated score), or
- Apparent low-risk prostate cancer; interested in Active Surveillance (watchful waiting).
All targeted biopsies are performed in the UCLA Clark Urology Center on an outpatient basis.
To Schedule an appointment at UCLA Urology, call (310) 794-7700. For further information regarding targeted prostate biopsy at UCLA:
- Call program coordinator Malu Macairan at 310-794-3566
- or Email: firstname.lastname@example.org
UCLA’s Prostate Cancer Program, affiliated with UCLA’s Institute of Urologic Oncology and the Jonsson Comprehensive Cancer Center, is a multidisciplinary, comprehensive program offering the latest treatments for prostate cancer and compassionate care for its patients. Our program has a long-held team approach to treating prostate cancer that includes urologists, medical oncologists, radiation oncologists, pathologists, radiologists and clinical trial nurses that allows for specialized perspectives for deciding upon the best option for each individual patient.
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