Login to Access Video or Poster Abstract: MP52-08
Sources of Funding: This research was supported by the Intramural Research Program of the National Cancer Institute, NIH

Introduction

MRI targeted biopsy has changed the evaluation paradigm of patients with elevated PSA. However, in patients without a rectum, the fusion platforms to target suspicious lesions on MRI cannot be utilized due to inability to use transrectal ultrasound. In-bore MRI guided biopsy is a potential alternative for targeting specific lesions in these patients. This report outlines the techniques used in a series of five patients undergoing in-bore MRI guided prostate biopsy using registration with the Visualase® (Medtronic) MRI guided laser ablation platform.

Methods

Patients without rectum with presence of suspicious lesions on prostate mpMRI were scheduled for biopsy in the MRI suite. Patients were placed under general anesthesia and prepped and draped on the MRI table in the frog-leg position. The biopsy grid was positioned to be flush with the perineum. T2W MR images of the prostate were obtained, transferred to the Visualase platform, and registered to the fiducials using the Visualase system. Serial T1W MR images were used to identify the location and depth of the lesion and then to confirm the location of the biopsy needles. A total of 2-8 cores were obtained from each patient. After completion of the procedure, patients were transferred to the recovery area in stable condition.

Results

Four patients with suspicion of prostate cancer on prostate mpMRI and surgical absence of rectum underwent prostate biopsy by above technique. The median age was 72 (58-77) years and median PSA was 4.28ng/ml (3.6-6.73). Patient 1 had ileoanal anastomosis and Patients 2-4 had APR, due to UC in Patients 1-3 and rectal cancer in Patient 4. Patient 1 was found to have Gleason 8 and patient 4 had Gleason 7(3+4). Patient 2 and 3 had negative targeted biopsy. No complications from in-bore biopsy were noted.

Conclusions

&[Prime]In bore&[Prime] MRI guidance as a technique during prostate biopsy has been in use since 2002. We report the technique of MRI targeted biopsy using the Visualase MRI guided laser ablation platform, which has traditionally been used for focal laser ablation. Use of this platform allows for accurate registration and targeting of the lesions in patients not eligible for MRI-TRUS fusion.

Funding

This research was supported by the Intramural Research Program of the National Cancer Institute, NIH