MRI/TRUS Fusion Guided Prostate Biopsy- An Improved Way to Detect and Quantify Prostate Cancer

The efficacy of targeting lesions for surgery may be limited by the visibility of a target
during the procedure. The successful outcome of surgical intervention depends upon accurate
device placement, which may be very challenging in certain settings, such as when a kidney
tumor only is visible for a brief moment during the transient arterial phase of a contrast
injection, and soon disappearing on dynamic imaging.

Historically, prostate cancer was diagnosed by digitally guided trans-rectal prostate
biopsies. With PSA (Prostate SPecific Antigen) screening and improvements in
ultrasonography, trans-rectal ultrasound (TRUS) guided prostate biopsy have become the
standard of care to screen and diagnose localized prostate cancer. Standard US 12-14 core
prostate biopsy is now common practice, detecting cancer in 27% to 44% of patients.

Prostate MR imaging with the addition of an endorectal-coil probe and a 3 Tesla magnet
dramatically improves diagnostic utility dramatically but biopsies are difficult,
time-consuming, and require specialized equipment, which increases the cost significantly.

To meet this challenge TRUS images are overlaid on a previously obtained prostate MRI,
combined with an electromagnetic tracking system. The urologist then performs directed
prostate biopsies at MR-identified targets in addition to the standard 12-14 core biopsies.

This study will consist of comparison of the standard of care (TRUS guided prostate biopsy)
with the protocol biopsy which consists of a TRUS guided prostate biopsy and a MR/US fusion
tracked prostate biopsy. Each patient will act as their own control.

Inclusion Criteria:

1. All patients must have a pre-operative MRI performed in accordance with our
NSHSLIJ/NIH MR prostate imaging guidelines.

2. Age greater than 18 years.

3. No serious concurrent medical illness that would preclude the patient from making a
rational informed decision on participation.

4. The ability to understand and willingness to sign a written informed consent form,
and to comply with the protocol. If in question, an ethics consult will be obtained.

5. Ability to tolerate conscious sedation (if procedure to be performed with conscious
sedation, and without general anesthesia).

6. PSA > 2.5 or Abnormal digital rectal exam or current recommendations for biopsy from
the American Urological Association

7. Pre-biopsy prostate MRI as described above, showing targetable lesions within 2
months of biopsy

8. Able to tolerate a TRUS guided biopsy

Exclusion Criteria:

1. Patients with an altered mental status that precludes understanding or consenting for
the biopsy procedure will be excluded from this study.

2. Patients unlikely able to hold reasonably still on a procedure table for the length
of the procedure.

3. Inability to hold breath, if procedure will be performed with conscious sedation, and
without general anesthesia.

4. Patients with pacemakers or automatic implantable cardiac defibrillators
(contraindications to MRI)

5. Patients with uncorrectable coagulopathies.