ONCOLOGY

This pairing shows the ultrasound and MR images "fused" together. The MR image is used to identify the target (blue dot). The ultrasound is used to guide the needle. UroNav lets the two "talk" to each other so that the ultrasound-guided needle can benefit from the information in the MRI.

A better way

New technology improves prostate cancer biopsies

issue 23 | spring 2015

The University of Michigan is the first center in the region to offer targeted prostate biopsies. UroNav, a new technology that combines highly specialized MRI and real-time ultrasound, helps guide a biopsy needle to the most suspicious areas of the prostate gland, helping urologists identify higher-risk prostate cancers.

In addition, the system can store the biopsy needle trajectory so that future biopsies can sample the same areas. U-M specialists have been using a similar system for research studies for nearly two years.

"The more information we can learn about a tumor — through better biopsies and better diagnostic tests — the more we will be able to personalize therapy. Our goal is to offer individualized treatment plans based upon patient-specific information," says Ganesh Palapattu, M.D., associate professor of Urology and chief of Urologic Oncology at the University of Michigan Comprehensive Cancer Center.

The technology is most useful for men with a concerning prostate MRI or an elevated PSA, or men considering or currently under active surveillance for prostate cancer.

Prostate MRI is primarily used to identify potential sites of prostate cancer when the standard workup does not identify disease — for example, a negative biopsy but a rising PSA. Modern MRI is sensitive enough to identify intermediate- and high-risk prostate cancers while minimizing the identification of non-aggressive prostate cancers.

"MRI has only become useful in stratifying prostate cancer risk over the last several years. Advanced MRI technique allows us to identify and target clinically significant prostate cancers. One of the nice side effects is that modern MRI tends to minimize the appearance of non-aggressive prostate cancers. So it really refines our ability to find the kind of cancer we want to find," says Matthew Davenport, M.D., assistant professor of Radiology at the U-M Medical School.

In addition to using MRI to help visualize the prostate, newer markers combined with PSA allow urologists to better gauge the risk of aggressive prostate cancer. A new test developed at the University of Michigan called Mi-Prostate Score combines PSA, PCA3 and the gene fusion TMPRSS2:ERG.

"PSA has been criticized as a poor marker for prostate cancer. We're developing advances that go beyond just an elevated PSA. A PSA test may be part of the picture, but it's no longer all we have available," says Jeffrey Montgomery, M.D., associate professor of Urology at the U-M Medical School.