Fusions biopsy of the Prostate

The combination of MRI and ultrasound for the detection of prostate carcinoma:  Fusion biopsy of the prostate

If prostate cancer is suspected, a systematic ultrasound-guided prostate biopsy is recommended according to the guideline commissions.

Since transrectal ultrasound has only limited sensitivity for the detection of prostate cancer, it must be assumed that in a significant proportion of patients prostate cancer will not be detected by systematic biopsy alone and at the same time clinically insignificant prostate cancer foci will be diagnosed rather incidentally.

The hit rate for an existing prostate carcinoma with normal transrectal prostate biopsy is at most 30 percent, so that repeat biopsies are necessary later in many patients.

Multi-parametric magnetic resonance imaging (MRI) offers much higher accuracy than ultrasound in the diagnosis of prostate cancer, with acceptable sensitivity and specificity depending on tumour size and cancer location.

On the one hand, this improves and facilitates the detection of the cancer, but in the further course of the disease it is also helpful for optimised tumour classification and the subsequent therapy decision in the case of a confirmed prostate cancer diagnosis.

By combining transtrectal ultrasound and MRI, the advantages of both methods can be used:

Fusion biopsy of the prostate is the safest method for diagnosing prostate cancer. The fusion biopsy of the prostate is a state-of-the-art diagnostic procedure. It uses and combines the advantages of the uradiologist's multi-parametric MRI of the prostate with the advantages of the urologist's 3D ultrasound.

The multi-parametric MRI images of the prostate and the images of the transrectal 3D ultrasound are superimposed with computer support and fusioned with software.

The areas that are conspicuous in the MRI are thus also made visible in the ultrasound and can then be biopsied with pinpoint accuracy using live images in the ultrasound. In addition, unnecessary biopsies can be avoided.

This image-guided biopsy procedure makes it possible to better define the tumour location and local tumour extension, so that these tumour foci in the prostate can also be irradiated more intensively in a targeted manner and with a selectively higher focal dose (boost) during brachytherapy, with a simultaneous radiation dose reduction in the remaining prostate tissue (= focused brachytherapy).

In the case of a single, very small tumour focus with low aggressiveness, a targeted selective therapy of only this single focus (= ultrafocal therapy) or only of the affected side lobe of the prostate (= focal therapy) can be considered after a case-by-case decision.

The biopsy is performed via a sterile access route through the skin in the perineal area (transperineal).  Dangerous inflammation of the prostate, which is very common with biopsies taken through the intestine, can thus be avoided.

The procedure is performed on an outpatient basis under a light superficial general anaesthetic and is completely painless.

We would be happy to explain the possibilities of this specialised technique to you in a personal consultation.


3-D reconstruction of carcinoma lesions in the prostate for targeted fusion biopsy.