I begin this month's article with a quote: "Meaningful image-guided prostate biopsy and intervention can indeed be challenging. Considerable expertise is needed, as is collaboration with an interested radiologist."1 For me, the key words to facing the challenge and implementing a Smart Biopsy are:
- Image-guided
- Expertise
- Collaboration
I attended the May 2012 meeting of the American Urological Association (AUA). I gained a sense of professional renewal by joining my colleagues in the exchange of ideas, and came away more convinced than ever of the need to match treatment to disease, such as I do using my Prostate Navigator. I also recharged my excitement over the future of medicine by visiting the technological displays in the exhibit halls, and saw innovations that place high definition image guidance within easy reach.
My opening quote is from a recent journal article by two respected urologists, Drs. Ukimura and Gill from the University of Southern California/Institute of Urology. They bemoan the "random image-blind nature of current biopsy protocols"2 that can miss tumors because of the lack of 3D imaging. This brings me to my first key concept: Image-guided. When a tumor is clearly visible, a needle can be precisely directed into it. The physician, like a military strategist, has gained "intelligence" that makes the biopsy smart, requiring far fewer needles - a benefit anyone who's had a 12-core biopsy can appreciate.
The next key concept, Expertise (as the authors say, "considerable expertise") is required for reading images. I have made it my goal to gain proficiency in reading MRI images. My clinical work with patients has advanced as I can take full advantage of such detailed information by not relying on ultrasound alone. While it's true that ultrasound imaging has come a long way, it simply cannot yet generate the 3D prostate maps that MRI can. To be honest, I encountered skepticism among some AUA colleagues who flatly stated that MRI was not valuable or superfluous. A skilled radiologist who specializes in weighted, multiparametric prostate MRIs would be shocked at such short-sightedness.
Which brings me to the third key concept: Collaboration. It's time to put an end to turf squabbles in medicine. Everyone benefits when urologists and radiologists each bring their clinical knowledge and technology together to serve patients' needs. In fact, the biopsy device I use, Artemis, now has FDA-cleared software that integrates, or fuses, their respective imaging abilities into images that even urologists not conversant with MRI imaging can clearly read and use to guide a smart biopsy.
Using these images as guidance, I can offer my patients the least invasive method of accurate diagnosis. For those using Active Surveillance to manage their prostate cancer, I have the means of monitoring the exact locations of the initial biopsy-something far more reliable than PSA alone!
I close with a final quote from the same article: "To compensate for insufficient imaging expertise on the part of the community urologist, computer-assisted 3D image-guidance platforms are being designed. This represents an important area of growth for urology."3 Yes indeed! Better imaging = smarter biopsy.
- Ukimura O and Gill I. The key to successful focal therapy: location, location, location. European Urology 62 (2012) p. 66.
- Ibid, p. 64.
- Ibid, p. 66.