Prostate Cancer Detection – A more targeted approach

Early detection makes successful treatment more likely, and outcomes for men with prostate cancer have improved substantially over the past decades, largely due to screening. Recent advances have made the chances of finding prostate cancer early even better. 

Initial Screening

The first steps in detecting prostate cancer are a PSA (protein specific antigen) blood test and an internal digital rectal exam. PSA levels often increase when prostate cancer is present, so if repeated blood tests reveal high PSA levels, further examination is warranted. 

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If cancer is suspected, the next step might be taking biopsies to look for malignancy. Typically, ultrasound imaging is used to guide the insertion of biopsy needles into different sections
of the prostate to obtain cells for examination. The problem is that with ultrasound images, it is not always possible to differentiate cancerous from non-cancerous prostate tissue. As a result, some samples are taken from areas that appear suspicious and additional samples are sometimes taken randomly in a pre-planned pattern. With this approach, small cancerous areas might be missed or a suspicious finding might be treated unnecessarily. 

Zeroing in with Fusion-Guided Prostate Biopsy

Advanced MRIs, such as the new system at Phelps, can perform fusion-guided prostate biopsy, which blends ultrasound with MRI images to get a clearer view of the prostate, making it possible to differentiate more accurately between potentially cancerous and normal prostate tissue. With a higher level of detail than can be obtained from ultrasound alone, the physician is able to more precisely target suspicious areas for biopsy, evaluate a patient’s risk level and determine the best treatment. 

How It Works

Fusion-guided prostate biopsy begins with the patient undergoing an MRI scan of his prostate. A radiologist reviews the scan and marks any suspicious areas. Later, an ultrasound
probe is used to examine the prostate, and special computer software overlays the MRI image on top of the ultrasound image. As the ultrasound image shifts, the MRI image shifts with it, providing a 3-D view that can be turned on the computer screen and examined from every angle. This “fused” image is used to guide needle insertion into specifically targeted areas that have been identified as potentially cancerous – eliminating the random placement of needles associated with using ultrasound alone. More accurately identifying suspicious lesions means that fewer biopsies are needed, the process is quicker and there is less bleeding. 

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As you can see in these images, an MRI scan (right) provides much more detail of the prostate than an ultrasound scan (left) does, showing a dark area (arrow) that suggests a tumor. 

When the MRI and ultrasound images are fused, we get an even clearer target to biopsy. Above is the fusion-guided image we see during the biopsy procedure, with the prostate outlined in red, the suspected tumor in green and the biopsy needle in yellow.

Who Can Perform Fusion-Guided Biopsy?

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Special training is required for a urologist to be able to read prostate MRIs and identify areas where there are suspected tumors. The urologist must also be an expert in the advanced software that is used. Only a small number of urologists in the US currently have the knowledge and access to necessary technology to perform fusion-guided  prostate biopsy.


Jack Hershman, MD, FACS, chief of urology at Phelps, is experienced in performing fusion-guided prostate biopsy. He has advanced training in urological oncology (bladder, kidney, prostate and testicular cancer) as well as training in infertility and vasectomy reversal. Dr. Hershman is board certified in urology and is a Fellow of the American College of Surgeons. He received his medical degree from the Mount Sinai School of Medicine. He then completed a general surgery internship and residency at Lenox Hill Hospital and a urology residency at Montefiore Hospital and Medical Center at the Albert Einstein College of Medicine. Dr. Hershman is a clinical instructor and an assistant attending urologist at New York Medical College and a member of the American Urologic Association, the American Association of Clinical Urologists and the New York Urologic Association.

In the near future, urologists Arno Housman, MD, and Christopher Dixon, MD, will also be performing fusion-guided prostate biopsy at Phelps.


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