In Bore mpMRI
The “classic” diagnostic route is from PSA test to mpMRI scan to Guided Biopsy. In this scenario an Ultrasound image is overlaid on the previously saved mpMRI image so that the needle obtaining the biopsy specimen can be guided to a lesion within the Prostate Gland. Unfortunately the images may not overlay with exact registration so that there is a “hit and miss” potential when taking a sample from the lesion. This is ameliorated by taking several samples.
However, a number of centres now employ direct “In Bore mpMRI” guidance. This completely removes the potential registration errors of the Ultrasound Guidance as the person taking the biopsy samples is viewing the mpMRI image in real time and can place the biopsy needle in exactly the right place. Fewer biopsy samples will be required to obtain a Gleason Score. This is good for the patient.
But there is another way in which In Bore mpMRI is making marked improvements and it is to the treatment of Prostate Cancer. This is in the delivery of “Focal Ablation” which I deal with in the treatment section. Used in Focal Ablation the actual treatment modality can be delivered exactly to the lesion within the Prostate Gland thereby sparing good tissues. This is expected to be an expanding modality and could result in one or more of the Focal Ablation procedures being used as the primary treatment.
This is definitely a technology to “keep an eye on”. It engenders “millimetre” accuracy.