Transperineal 3D Mapping Biopsy for Prostate Cancer Diagnosis Decreases Need for Prostatectomy

The diagnosis and treatment of prostate cancer (PCa) is currently undergoing a revolution similar to that seen over the past three decades with respect to the improvements made in breast cancer screening, diagnosis and treatment options. The long-standing gold standard for PCa diagnosis is the transrectal ultrasound (TRUS)-guided prostate needle biopsy. Whereas TRUS is still used to make an initial diagnosis, in recent years, the development of a staging prostate biopsy--the transperineal three-dimensional (3D) mapping biopsy--has been introduced, allowing physicians to understand better the stage and gravity of the cancer in order to make more informed treatment decisions.

“We have been working hard to bring prostate cancer diagnosis and treatment to more advanced states. Our approach follows similar efforts from breast cancer patients and advocates, which have led to the decline of radical mastectomies, an increase in research and better diagnostic test, treatment, and surgical options,” said Dr. E. David Crawford, chairman, Prostate Conditions Education Council (Centennial, CO, USA) and professor of urology and radiation oncology, University of Colorado (Boulder, USA).

Experts agree that prostate staging biopsies will yield better understanding of the extent and aggressiveness of the disease in patients. This information allows physicians to develop customized treatment plans for patients. “We expect to see a decline in the number of men who are undergoing unnecessary prostatectomies or radiotherapy,” said Dr. Crawford. “This, coupled with new focalized treatments that are the equivalent of the ‘male lumpectomy’ should help us see an increase in positive outcomes for men diagnosed with the disease.”

The TRUS needle biopsy is an outpatient surgical procedure in which a transrectal ultrasound is used to create an image of the prostate, allowing a physician to guide a small needle to take 6-12 samples of prostate tissue to test for abnormal cells and tissue. For many years, it has been the definitive way to diagnose prostate cancer. But under- and overgrading of the cancer is common, which can lead to patients undergoing treatments that are unnecessarily invasive or being subjected to the risk of associated morbidities from other treatment methods.

The prostate staging biopsies (PSB) procedure is performed as an outpatient procedure under general anesthesia. It allows physicians to create a 3D image of the prostate, including the location of the cancer within the organ. Because PSB can better determine the size and location of the cancer, it allows patients and their physicians to select a more appropriate treatment option, including ongoing evaluation.

In a recent study, 215 men underwent PSB. Of those, only 38 chose to have radical prostatectomy, while the majority of the remaining men underwent targeted therapy and 44 elected to watch and wait. No studies have reported a significant difference in the risks or complications between the two procedures.

Prostate cancer is the number two cause of cancer deaths in American men. According to the US National Cancer Institute (Bethesda, MD, USA), there were an estimated 217,730 new diagnoses and 32,050 deaths from prostate cancer in the United States in 2010. One in six men over age 40 will develop prostate cancer. It is typically diagnosed in men over the age 65, and African-American men are in the highest risk group.

According to the US National Institutes of Health (Bethesda, MD, USA), the US expenditure for prostate cancer care was expected to be US$12 billion, making it the fifth most expensive type of cancer behind breast ($16.5 billion), colorectal ($14.14 billion), lymphoma ($12.14 billion), and lung ($12.12 billion) cancers.

An organization committed to men’s health, the Prostate Conditions Education Council (PCEC)--formally the Prostate Cancer Education Council--is a US-leading resource for information on prostate health. The Council, which comprises a consortium of leading physicians, health educators, scientists, and prostate cancer advocates, aims to conduct nationwide screenings for men and perform research that will aid in the detection and treatment of prostate conditions.

Related Links:
Prostate Conditions Education Council
University of Colorado
National Cancer Institute - Prostate Cancer Page