June 2008

New Approach Optimizes Prostate Biopsy, Cancer Grading

Katsuto Shinohara, M.D.
Urologic Cancer Surgeon
UCSF Helen Diller Family Comprehensive Cancer Center

Since its development in the late 1980s, transrectal ultrasound (TRUS) has been the standard in visual guidance for prostate biopsy in men with an elevated serum prostate specific antigen (PSA), an abnormal digital-rectal examination (DRE) or both. Traditionally, six biopsies between the lateral edge and the midline of the prostate at the apex, mid-gland and base bilaterally were sampled with TRUS.

To improve prostate cancer detection using TRUS, urologists at the UCSF Prostate Cancer Center are performing biopsies that have a multiple, targeted approach. By gathering more biopsy cores and directing the biopsies more laterally to an extended area of the prostate, specifically the lateral aspects of the gland, the sensitivity of TRUS biopsy related to both overall cancer detection and grading accuracy has greatly improved compared to traditional TRUS.

In fact, doctors at UCSF have detected prostate cancer in men with elevated PSAs who have had repeated negative TRUS biopsies at other institutions. Research also shows that by increasing the number of TRUS biopsy cores sampled from 6 to 12 or more, the cancer detection rate increases by nearly one third.

UCSF urologic oncology experts are currently validating biopsies of the anterior aspect of the prostate gland, which should further improve prostate cancer detection rates.

Advanced Imaging

Urologic oncologists at UCSF also helped pioneer the use of power Doppler imaging (PDI), an advanced ultrasound technique, with the use of TRUS. Due to its increased sensitivity to blood flow, PDI has several advantages compared to conventional color Doppler ultrasound. PDI can help identify increased tumor blood flow and hypervascularity, which has been shown to significantly enhance prostate cancer detection. This powerful tool — available at select leading medical centers nationwide — is routinely used in prostate biopsies at UCSF.

Improved Patient Comfort

Traditionally, TRUS-guided prostate biopsies were performed with no local anesthesia. Research found that 65 percent to 95 percent of men report some discomfort during the procedure. Pain during a TRUS-guided prostate biopsy predominately occurs when the needle penetrates the prostatic capsule and stroma, which has a rich supply of automatic nerve fibers.

UCSF led a prospective, double-blind study to help develop techniques for the administration of local anesthesia prior to prostate biopsy. Subsequent trials at other medical centers validated greatly improved patient comfort with the use of anesthesia during TRUS-guided prostate biopsies.

For more information, contact the Physician Referral Service at UCSF Medical Center:

Phone (888) 689-UCSF or (888) 689-8273
Email referral.center@ucsfmedctr.org

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