Transrectal mpMRI Fusion Biopsy

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, shares lessons from the first decade of transrectal multiparametric (mp) MRI fusion prostate biopsy at UCLA. Dr. Marks explains that while fusion biopsy of the prostate has been available since 2009, the AUA only endorsed it in 2020, and very few institutions have as much experience with it as UCLA, which assembled a multidisciplinary team for its first Artemis fusion biopsy unit in 2010. Dr. Marks follows this history with a brief summary of the fusion biopsy process, emphasizing the importance of having quality MRI and involving a radiologist and a pathologist, and noting that UCLA’s system is so efficient that they are able to perform approximately 15 of these procedures per week. He then goes over key lessons the UCLA team has learned from its first 4,000 fusion biopsies, which include: (1) targeted sampling of MRI lesions using PI-RADS is necessary; (2) systematic sampling is important for finding invisible lesions; (3) tracking of prior biopsy sites is extremely helpful in detecting upgrades; (4) MRI lesions do not necessarily indicate what the pathology is; and (5) fusion biopsy provides better security than ultrasound biopsy in predicting final pathology . Dr. Marks concludes by remarking on the advantages of the transrectal versus the transperineal approach, arguing that sepsis is easily preventable, patients find the transrectal approach more comfortable, and transrectal fusion systems are more mature.

[@jimjohngirard]

How painful to the patient is it during the biopsy sampling phase of the procedure. Even with lidocaine injections, I heard it can be brutal. Why is a colonoscopy done under a general anesthetic and this procedure targeting 12 to 15 needle (18 gauge) penetrations not done under general anesthesia.....let me guess.....you don't make as much money.....cheaper and more lucrative to do it in the office under local anesthetic.... of course, the last one who figures into this process is the person who has to experience it.....

[@jerseyjim9092]

I think if u ask for it u can get it but insurance may not cover that portion. There are those who elect not to have anesthesia for colonoscopies.