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  • Writer's pictureFrancesco Bruno Tagliaferro

What is the fusion-guided prostate biopsy?

Updated: Aug 24, 2023

Fusion-guided prostate biopsy is a bioptic technique that allows to merge (hence "fusion") the images of the multiparametric prostate MRI , performed before the biopsy, with the images of the transrectal ultrasound that is performed during the biopsy, thus displaying the MRI findings on the ultrasound images. This technique is used because MRI is clearly superior to ultrasound in recognizing prostatic areas suspected for cancer, which in this way can also be seen on ultrasound and can be biopsied with high precision.


Then RM and ULTRASOUND, superimposed, fused together, to ensure maximum precision during the biopsy.


Fusion-guided prostate biopsy is indicated in cases of suspected prostate cancer detected with multiparametric MRI of the prostate, so it cannot be performed without a previous prostate MRI exam.


Percorso diagnostico dalla RM alla biopsia fusion
From multiparametric MRI to biopsy

There are different approaches to perform prostate biopsy. The transperineal one allows to minimize the infectious risk, and should be used preferentially.


Transperineal fuison-guided prostate biopsy is performed on an outpatient basis, without hospitalization, with local anesthesia only.


Biopsia prostatica fusion con approccio transperineale
Transperieanl approach

The patient is placed in the gynecological position, the transrectal ultrasound probe is inserted, the prostate is identified and the ultrasound images are merged with those of the MRI, already loaded on the ultrasound machine.


This allows to precisely sample all suspicious areas, increasing the accuracy of the biopsy and thus reducing the risk of missing a tumor.


The approach is transperineal, through the skin between the rectum and the scrotum.


At least 4 samples are taken from each suspicious area and 8 to 12 routine samples from the rest of the prostate gland, depending on the size of the prostate gland.


Following the biopsy, after a period of observation and after urinating, the patient can go home.


OTHER BIOPTIC METHODS


Prostate biopsy can also be performed in other ways, with a transrectal approach and/or with a random technique, with or without ultrasound guidance.


Transrectal biopsy, as the name suggests, involves puncturing the prostate through the rectum.

Biopsia prostatica ecoguidata con approccio transrettale
Transrectal approach

The random biopsy provides for random, non-targeted, although systematic, sampling of the prostate gland. According to the various protocols, these can vary from 6 to 24.


These are the old ways in which prostate biopsy is performed.


Currently, the guidelines of international scientific societies define prostate biopsy with fusion technique (RM + ECO) and transperineal approach as the most reliable biopsy technique with the least complications among the various types of biopsy still in use.



This because:


  • the transperineal approach exposes to less infectious risks than the transrectal approach. The rectum is not sterile, it contains a large bacterial population. The skin, which is also non-sterile, can however be much more easily and effectively disinfected, and since the procedure is performed in a sterile environment with sterile material, the infectious risks are minimal.

  • Fusion biopsy has higher diagnostic accuracy than random biopsy. In fact, it allows you to effectively sample suspicious areas, guided by RM images.


COMPLICATIONS


Common

  • Blood in urine. In most cases it resolves spontaneously within a few days.

  • Blood in semen. It can last from a few days to 3 months.


Uncommon

  • Acute retention of urine requiring a urinary catheter. It is determined by the inflammation of the prostate subjected to the trauma of the biopsy. It often resolves within a few days.

  • Infection.

  • Temporary erectile dysfunction. It usually resolves within two months.

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