Two Out of Five Prostate Biopsies Unnecessary
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The end is near for unnecessary and risky prostate biopsies as a new, safer and 25% more effective technique for detecting cancer has been unveiled in the largest-ever study of its kind at Britain’s oldest surgical Royal College.
This year the annual President’s Meeting at the Royal College of Surgeons of Edinburgh (www.rcsed.ac.uk); which in early 2014 opened its first-ever centre of operations in Birmingham to cater for the 80% of its UK membership based in England and Wales; saw dozens of presentations from a variety of specialties on the theme of surgical oncology.
Manchester native and young (F2) doctor Saad Fyyaz presented groundbreaking research compiled at Russells Hospital in the West Midlands. The data, spanning over 80 patients, is the widest-ever collated. Saad says;
“Prostate cancer is the 2nd commonest cancer in the UK. There are two types: ‘clinically significant’ which can be life-threatening, and ‘docile’, which would take more than 10-15 years to become life threatening and will not be the cause for mortality in most. We know that 30-40% of traditional biopsies come back negative, meaning that the same percentage have undergone an unnecessary intervention which, as any procedure, carries risks of complications.
“Currently, tissue samples for analysis are obtained via a quarter-century old technique, known as TRUS (trans-rectal ultrasound) guided biopsy. This technique images the prostate by real time ultrasound, using a high frequency probe. The actual suspicious areas cannot be clearly defined, but the ultrasound is used to guide a needle through different areas on each side, to obtain tissue to be examined under microscope for cancerous areas. This is a kind of random, systematic sampling – therefore the accuracy of this test is limited. It may fail to reveal any cancer that may be present in a very small area missed by the needle. Moreover, different grades of prostate cancer can coexist in variable amounts in small different areas. The needle sample can, for example, show low grade cancer yet miss the more significant cancers.
“Recently, this method has been further refined with the use of magnetic resonance (MRI) technology. This is a form of non-invasive imaging of the prostate which defines tissue characteristics in a more accurate way. Trained radiologists are able to identify suspicious areas in the prostate before a biopsy takes place. In our centre and some centres in the UK we are then able to use the information obtained from MRI to target suspicious areas by a ‘fusion’ of transrectal ultrasound (TRUS) and MRI guided targeted biopsies. In our experience this has resulted in far better diagnostic yield where less biopsies need to be taken, whilst identifying more significant disease.”
The study; which was undertaken under the supervision of consultant urological surgeon and clinical lecturer in urology Aniruddah Chakravarti; analysed over 80 cases where MRI guided fusion biopsies were taken in patients. This method of biopsy has been shown to diagnose clinically significant prostate cancers more effectively using less amount of biopsy.
The study presented at the College’s Research Symposium; which took place on 20 March during the President’s Meeting; was titled “Does Magnetic Resonance Image (MRI) Guided Transrectal Ultrasound (TRUS) Fusion Biopsy Improve Prostrate Cancer Detection?” According to Mr. Chakravarti;
“Our method was simple, we used multi parametric MRI and had them graded by trained radiologists. We then got the suspicious areas on MRI pictures marked by those radiologists. The new technology allowed us to visualise and identify those areas on real time transrectal ultrasound (TRUS), in an outpatients setting. We were then able to target those areas through the fusion of MRI and real time ultrasound to obtain tissue samples. These samples were of much higher diagnostic value than samples obtained by the standard method of prostate biopsies that we have done in the past.
“While obtaining samples from MRI-Ultrasound fusion targets we also obtained standard biopsies from the same patient in the same sitting for comparison, and the preliminary data on 65 patients confirmed that targeted biopsies have more diagnostic yield revealing significant cancers. We subsequently tested 15 more patients and the results correlated.”
According to the RCSEd President Mr. Ian Ritchie, who is also a consultant trauma and orthopaedic surgeon;
“This is a significant development and one of many presented at the College at our Annual Meeting. Cancer care, diagnosis and treatment was at the top of the agenda this year, providing a common platform for various specialties to share knowledge and good practice.”
About The Royal College of Surgeons of Edinburgh
RCSEd was first incorporated as the Barber Surgeons of Edinburgh in 1505, and is the oldest surgical corporation in the world with memberships approaching 25,000 professionals in over 100 countries worldwide. The College promotes the highest standards of surgical and dental practice through its interest in education, training and examinations, its liaison with external medical bodies and representation of the modern surgical and dental workforce. It is also home to the UK’s only Faculty of Surgical Trainers, open to all those with an interest in surgical training regardless of College affiliation. Find RCSEd on Twitter www.twitter.com/RCSEd and on Facebook www.facebook.com/rcsed
The College is based at Nicolson Street, Edinburgh, EH8 9DW and can be reached on (0)131 527 1600 or firstname.lastname@example.org. In March 2014, a new base opened in Birmingham, catering to the 80% of the College’s UK membership who are based in England and Wales.
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