Instructional Course - Requires Course Pass or Individual Course Ticket, Additional Registration Required
Trans-rectal ultrasound guided (TRUS) sextant prostate biopsy has been the gold standard for diagnosing prostate cancer (PCa). In recent years, multi-parametric magnetic resonance imaging (mpMRI)-TRUS image-fusion targeted biopsy has shown greater accuracy in cancer localization & sampling, resulting in more accurate diagnosis of clinically-significant PCa, either primarily or as repeat biopsy after a prior negative TRUS biopsy.
This course will discuss various clinically important facets of MRI-TRUS fusion biopsy in the setting of an interactive multi-disciplinary tumor board, using audience-response system. We will focus on practical issues of daily relevance, backed by current literature (rationale, protocols, outcomes data) and our personal aggregate experience in over 1,000 prostate biopsies. In this radio-patho-genomic course, a multi-disciplinary panel (urologists, MRI radiologist, pathologist, molecular biologist) will discuss 15-20 actual clinical cases, covering the entire disease spectrum from low-to-high risk non-metastatic PCa.
Clinical cases will be carefully selected such that all of the following issues are discussed in step-wise fashion:
a) Clinical PCa case history, including current FDA-approved molecular genomic tests (urine, serum, tissue) and biopsy indications (first-time vs repeat biopsy).
b) mp-MRI: how to read mpMRI (most important), practical tips, significance of each mpMRI parameter [T2-weighted (T2w), diffusion weighted (DWI), diffusion contrast enhancing (DCE), MR spectroscopy]; MRI reporting systems: Prostate Imaging & Reporting Data System Version 2 (PIRADS-v2) & Likert scale; MRI protocol (endo-rectal vs pelvic; 1.5 vs 3 Tesla); MRI limitations & fallacies.
c) TRUS: TRUS is a core component of fusion biopsy. As such, we will discuss: TRUS technique, interpretation of multi-parametric TRUS (gray-scale, color Doppler, elastography, contrast-enhanced, histoscanning), its role in MRI/TRUS fusion biopsy.
d) MRI-TRUS image-fusion: process of image registration (rigid vs elastic), various available platforms for MRI-TRUS fusion biopsy.
e) MRI-TRUS fusion biopsy: indications, technique of biopsy (how-to-do, pearls, tips, tricks), how accurate is fusion-targeting? (corroboration with step-sectioned RP specimens), biopsy types (confirmatory biopsy for Active Surveillance (AS), staging biopsy, repeat biopsy after prior negative biopsy); specific situations (large prostate, anterior tumors, mp-MRI post-primary treatment [HIFU, cryo, EBRT, brachy]).
f) Special issues: exporting MRI-TRUS fusion biopsy data onto focal therapy systems (HIFU platform); role of MRI for AS; 3D mapping of the prostate gland & cancer location for AS and focal therapy (FT), “per-lesion” based AS.
g) Prostate biopsy technique details: TRUS machine set-up, patient preparation, needle “sterilization”, antibiotic prophylaxis/augmentation, minimize/manage complications (infection, bleeding, retention).
h) Trans-perineal vs trans-rectal biopsy: Pros & cons, techniques, outcomes (cancer detection, complications).
i) Pathologic evaluation of biopsy cores: how-to-handle biopsy core samples (containers, inking the core for spatial orientation), how pathologists read the biopsy (cancer core percent/length, continuous vs discontinuous cores), what should comprise a pathology report (perineural invasion, Gleason score/Group, core length/percent positive, number of cores, etc)
j) Future directions: Emerging techniques & technologies of targeted prostate biopsy will be discussed.