UH Seidman Cancer Center Performs New Image-Guided Prostate Biopsy

News Release

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MRI enables better visualization, more accurate biopsy for improved cancer detection

CLEVELAND-- University Hospitals Seidman Cancer Center physicians are among the first in the country to offer a promising new screening tool to detect prostate cancer – MRI (Magnetic Resonance Imaging) - guided prostate biopsy. Using sophisticated MRI imaging, the technology enables physicians to better visualize and biopsy cancerous cells within the prostate.

Performed inside the MRI gantry, this technology enables physicians to distinguish tumors from healthy tissue. Using the advanced MRI images, they are able to then perform a targeted prostate biopsy.

“The in-gantry MRI guided biopsy has the potential to revolutionize prostate cancer detection,” says Vikas Gulani, MD, PhD, Director of Magnetic Resonance Imaging at UH Cleveland Medical Center. “The MRI reveals the specific characteristics that distinguish between normal and diseased tissue. Visualizing the tumor’s location within the prostate enables physicians to more accurately target and biopsy the lesion.”

Currently, transrectal ultrasound (TRUS) guided biopsy is still the standard test to diagnose prostate cancer. Ultrasound can show the size and shape of the prostate gland but not the exact shape and location of a tumor. Thus physicians are “blindly” biopsying tissue in the gland without foreknowledge of the tumor. Fusing an MRI to the ultrasound is possible, and this is done at UH as well, but is an imperfect solution.

“The prostate is truly the last organ in the body that we are biopsying without hitting a visualized target,” says Lee Ponsky, MD, Chief of Urologic Oncology at UH Seidman Cancer Center and UH Urology Institute and Professor at Case Western Reserve University School of Medicine. “There have been some advances in how we treat certain cases, but prostate cancer has been relatively stagnant over the past 20 years.”

In addition to increased accuracy, the MRI technology may improve the safety of prostate biopsy. Due to its precise targeting, only two to four biopsy samples are needed for an accurate diagnosis, compared to 12 samples with the standard technique, thus reducing risk of infection, bleeding, pain and recovery time. Additionally, standard ultrasound biopsy has false-negative rates of up to 30%. There also can be a need for repeat biopsies when PSA continues to rise despite negative biopsies.

Patients who may benefit from an in-gantry MRI-guided biopsy include 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, prior negative biopsy, or increased prostate cancer gene expression, or low-risk prostate cancer being monitored by active surveillance (or watchful waiting).

The use of MRI-guided biopsy is the latest innovation adopted by Drs. Gulani, Ponsky and a multidisciplinary team of urologists, radiologists, radiation oncologists, medical physicists, pathologists and biomedical engineers.

The team has already developed a rapid, noncontrast screening exam that they have used in more than 100 research cases. This exam, which does not require an IV and is performed in under 15 minutes on the MRI table, has an extremely high negative predictive value for prostate cancer in patients who ordinarily would have gone straight to traditional nontargeted biopsy. In patients who have a suspicious focus on the MRI, a biopsy can be targeted at the suspicious area using one of several approaches available.

The team has also used magnetic resonance fingerprinting (MRF) in about 150 prostate cancer patients to date. This new technology, developed at Case Western Reserve University and UH and reported in the journal Nature in 2013, adds a quantifiable, reproducible aspect to traditional MRI. It uses highly unusual and novel MRI signal acquisitions to generate simultaneous measurements of multiple tissue properties, yielding quantitative maps of these tissue properties. These maps are used to noninvasively and definitively characterize tissue – both normal and abnormal. The application to prostate cancer is one of the earliest clinical uses of this technology. The hope is to provide a quantitative separation of prostate cancer from normal prostatic tissue, and perhaps even provide an estimate of the aggressiveness of the cancer.

“We’re using all the tools at our disposal to change how prostate imaging is done,” says Dr. Gulani, who is Associate Professor at Case Western Reserve University School of Medicine. “That includes current state-of-the-art MRI, developing screening methods with MRI, developing MR fingerprinting technology and developing advanced image analytics with the help of biomedical engineering. We want to achieve the goal of reducing the uncertainty and reducing the number of unnecessary biopsies, procedures and treatments against low-grade cancer.”

About University Hospitals
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 18 hospitals, more than 40 outpatient health centers and 200 physician offices in 15 counties throughout northern Ohio. The system’s flagship academic medical center, University Hospitals Cleveland Medical Center, located on a 35-acre campus in Cleveland’s University Circle, is affiliated with Case Western Reserve University School of Medicine. The main campus also includes University Hospitals Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; University Hospitals MacDonald Women's Hospital, Ohio's only hospital for women; and University Hospitals Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, including cancer, pediatrics, women's health, orthopedics, radiology, neuroscience, cardiology and cardiovascular surgery, digestive health, dermatology, transplantation and urology. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to Harrington Discovery Institute at University Hospitals – part of The Harrington Project for Discovery & Development. UH is the second largest employer in northern Ohio with 26,000 employees. For more information, go to UHhospitals.org.