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MRI/Ultrasound Fusion Biopsy of the Prostate

The MRI/Ultrasound fusion biopsy begins with an MRI of the prostate performed in the Department of Radiology. This initial exam will be done a few days or weeks prior to the scheduled prostate biopsy.  Both appointments will be made through the Department of Urology. A specially trained Radiologist will analyze the images and identify areas that appear suspicious for prostate cancer.

Prostate MRI

To image the prostate, the patient will be placed on an MRI table. A series of images will be taken of the prostate and its surrounding area. For the best resolution of the images it is important for the patient to lie very still during the test. A special dye visible on the MRI will be injected intravenously toward the end of the exam. The MRI takes about 45 to 60 minutes.

Subsequently, the Radiologist will analyze the images and help create a three dimensional image of the prostate, indicating abnormal areas or suspicious lesions, marking these on the images. These images will then be transferred electronically to the Urologist’s procedure room, where the biopsy will take place.

MRI/Ultrasound Fusion Biopsy

Prostate biopsies are always being performed under transrectal ultrasound guidance. For this, the Urologist will insert an ultrasound probe into the patient’s anus; this allows visualization of the prostate. Before the MRI Fusion technology was available, all prostate biopsies had been performed in a random fashion with the collection of usually 12 biopsy cores from predefined areas within the prostate. However, the MRI/Ultrasound Fusion technology allows now for using the MRI images obtained as described above, and targeting abnormal areas that have been identified on those images by the Radiologist. While performing the biopsy, the Urologist will then have the annotated images of the MRI with the suspicious areas marked on these images available on his monitor. These images will then be fused with the real-time transrectal ultrasound image of the prostate. This will subsequently allow an MRI-targeted sampling of suspicious areas, under ultrasound-guidance.

In addition to the targeted biopsy, an additional standard sampling of the prostate (12 biopsy cores, as above) will be performed. If no suspicious areas were identified on the MRI, only the standard 12 core transrectal ultrasound-guided non-targeted biopsy will be performed.

Preparation for the biopsy

You cannot take aspirin or other blood thinners, such as Plavix, Eliquis, Brilinta, Pradaxa, Coumadin, Warfarin, Ibuprofen, Naproxen, Aleeve, Advil, Celebrex, Ecotrin, and many others for several days prior to your scheduled biopsy. If you take any of these or other anticoagulants please discuss this with your Urologist beforehand. It might be necessary that you also consult with your Cardiologist prior to stopping.

The day before the biopsy

The night before your exam, you need to take an antibiotic as prescribed by your treating Urologist before going to bed. If you have not received any prescription for an antibiotic please contact your Urologist immediately.

The day of the biopsy

The morning of the exam, give yourself a Fleet enema, which is available over the counter and follow the instructions on the packaging. The enema helps to clean out the rectum and to minimize the risk of infection.

You may eat a light breakfast and a light lunch before your biopsy, and you should take your usual medications, except for the above-mentioned blood thinners if applicable.

If you have undergone a recent artificial joint replacement (<6 months ago) you might need to take additional antibiotics about 1-2 hours prior to the biopsy. Please notify your Urologist if you have a recent history of such procedure, or if you usually take antibiotics before e.g. dental procedures. 

After Your Biopsy

Please be sure to continue the antibiotics as prescribed for a total of 5 days.

There are no restrictions on driving after the procedure, you may drive yourself home.

Biopsy results are typically available in a few days.  Your ordering healthcare provider will be notified of the results, who will then share them with you at your follow up appointment or by phone.

Possible side effects of the biopsy

Hematuria (blood in the urine) is the most common complication after prostate biopsy (20 to 63%), is usually only very slight, and subsides usually completely after a couple of days.

Hematochezia (blood per rectum) is common as well, and seen in 2% to 22% of patients. Typically, rectal bleeding is minor and easily controllable with the ultrasound probe or digitally applied pressure at the conclusion of the biopsy; rarely, persistent bleeding may require proctoscopic assessment.

Hematospermia (blood in the ejaculate) is of minor clinical concern and is found in up to 50% of men after their biopsy. It may persist for several months after prostate biopsy.

Most infectious complications after TRUS biopsy are limited to simple urinary tract infections and low-grade fever, which can be readily treated with antibiotics, but case reports of fatal sepsis after prostate biopsy have been published. With the routine use of antibiotic prophylaxis as described above 2% of patients will develop a febrile urinary tract infection, bacteremia, epididymitis or acute prostatitis that may require hospitalization for i.v. antibiotics. There is also the risk of increasing bacterial resistances to commonly used antibiotics (Fluoroquinolones).

Acute urinary retention requiring temporary intraurethral catheter placement occurs in up to 0.4%; mostly men with an enlarged prostate (BPH) at baseline are at increased risk.