Prostate Mapping is a modern prostate biopsy method
Prostate Mapping: man smiling after template prostate biopsy with MRI
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Prostate Mapping

Prostate Mapping is a new diagnostic process developed by leading urology and radiology consultants in London, UK, which is far more precise and accurate than traditional TRUS biopsies which are currently performed in both the public and private healthcare systems elsewhere in the world.

It involves a combination of the latest MRI imaging techniques and a template guided biopsy system which together produces a very precise and accurate diagnosis for men concerned about whether they have prostate cancer and, if they do, to help them choose the most appropriate treatment.

This precise and accurate prostate cancer diagnosis is available through Prostate Mapping Ltd. To make an appointment, please contact us at info@prostatemapping.com. You can also download our Patient Information Sheet in PDF format.

Imaging



Biopsies identify cancer within the prostate, but it is also important to know whether any cancer has spread beyond the confines of the gland into the surrounding tissue. The latest guidelines from the European Association of Urology highlight magnetic resonance imaging (MRI) as 'the most accurate non-invasive method' of identifying so called 'locally advanced' prostate cancer. It is important to know whether any cancer has spread to the surrounding tissue as it has an impact on the type of treatment you may be recommended.

Although MRI scans may be performed at any time before definitive treatment, there are several reasons why it may be best performed before biopsy:
  • Biopsies create 'artifact' within and around the prostate gland due to bleeding which may persist for several weeks. These make interpretation of the MRI images more challenging.
  • MRI may be helpful in localizing cancer within the prostate gland itself.
  • By having a 'multi-sequence' MRI taken as a baseline before biopsies, it may be possible to then go into one of the clinical trials assessing new therapies for prostate cancer. The aim of these trials is to reduce the side-effects experienced by men from traditional therapies.
On the right we show three of the sequences taken during a 'multi-sequence' MRI. Each gives the Radiologist different information. Some cancers are better seen on some sequences than others. In these cases the area of cancer is arrowed. This abnormality was confirmed as cancer on sebsequent biopsy.


Prostate Mapping Biopsies



Prostate mapping involves a multi sequence MRI scan and template prostate mapping biopsies. Both of these in combination give state of the art information about the disposition and burden of the cancer within the prostate to a high degree of accuracy that other diagnostics techniques currently do not.

(View some example cases)

multi-sequence MRI of prostate
Axial T2-weighted MR image taken through a prostate gland

multi-sequence MRI of prostate
Axial dynamic contrast-enhanced MR image
taken through the same prostate


multi-sequence MRI of prostate
Axial Apparent Diffusion Co-efficient (ADC) map
MR image taken through the same prostate


Ultrasound equipment

Why should I have this procedure?



There are a number of reasons why prostate mapping biopsies may be suitable for you:

Precision diagnosis:

  • If you have a raised PSA and need to have a prostate biopsy, but do not wish to undergo the procedure under local anaesthetic.
  • If you have a raised PSA or other risk factors for developing prostate cancer, but your prostate biopsy or biopsies have not detected any cancer so far.

Precision risk stratification:

  • If you have had a prostate biopsy which has already shown low risk prostate cancer which may be suitable for active surveillance and wish to have greater certainty about whether this is the correct option for you. In other words, you wish to make sure that the prostate biopsy has not missed areas of higher Gleason grade tumors or missed other areas of prostate cancer which would mean that active surveillance is not a good option for you.
  • If you have had a prostate biopsy which has already shown moderate risk prostate cancer of Gleason 3+4=7 or 4+3=7 and/or high volume of prostate cancer in the gland. You are not keen on having radical treatments. You wish to find out if the prostate biopsy may have over-called the prostate cancer as a higher risk than it actually is and you may actually be suitable for active surveillance.
  • If you have had a prostate biopsy which has already shown moderate or high risk prostate cancer of Gleason 3+4=7, 4+3=7 or 4+4=8 and/or high volume of prostate cancer in the gland. There is a possibility that the prostate biopsy has over-called the Gleason score of the prostate cancer and the amount of prostate cancer present in the prostate. You wish to avoid treatments such as radical radiotherapy and radical surgery and wish to be considered for newer treatments such high intensity focused ultrasound treatment (HIFU) or cryosurgery.
  • If you have had a prostate biopsy which has already shown moderate or high risk prostate cancer of Gleason 3+4=7, 4+3=7 or 4+4=8 and/or high volume of prostate cancer in the gland. There is a possibility that the prostate biopsy has over-called the Gleason score of the prostate cancer and the amount of prostate cancer present in the prostate. You wish to avoid treatments such as radical radiotherapy and radical surgery and wish to be considered for clinical trials that are looking at destroying only the areas of prostate cancer (focal therapy) rather than the whole prostate. Such treatments may lead to less side-effects, although these are trials so the outcome is not certain.
    (See treatment section).

What happens on the day of the procedure?



The procedure is carried out under general anaesthetic. You will be admitted to hospital for 1 or 2 days depending on when during the day the procedure is scheduled. You will be asked to not eat anything for at least 6 hours before the procedure and not drink anything for at least 4 hours before the procedure. You will be given a phosphate enema 1 or 2 hours before hand to clear the back passage of faeces, so that the prostate can be scanned by the ultrasound clearly. You will be assessed by a Consultant Anaesthetist who will discuss the anaesthesia. A plastic tube called a catheter is inserted through the penis into the bladder so that the water passage can be seen properly throughout the procedure and avoided. After the biopsies have been taken, the catheter is removed.

The procedure lasts for 30 to 45 minutes and involves taking 30-50 biopsies through the skin that lies in front of your back passage rather than through the back passage. Antibiotics are given before the start of the procedure through a vein and antibiotic tablets and pain killers will be given for 7 days after the procedure. A thick padding will be placed over the area of skin that the needle has gone through to prevent a lot of bruising. This padding should be left for at least 6 hours.

How are prostate mapping biopsies carried out?



Am ultrasound probe is inserted into the back passage and the prostate is scanned. Using a grid with holes placed every 5mm, a biopsy needle is inserted through each hole and the prostate is sampled every 5mm. Each biopsy we take is placed in a separate pot for a Consultant Histopathologist to examine each one separately under the microscope. A report is given telling us whether each biopsy has cancer in it or not. Other information is also given such as whether the tissue looked inflamed or whether there are other features such as precancerous areas in the prostate.

What are the potential side effects of prostate mapping biopsies?



Transperineal biopsies carry no extra risk than a normal prostate biopsy carried out through the rectum. Complications of both include:
  • bruising of skin in all men and occasionally bruising that spreads to the scrotum
  • prostatitis (inflammation or infection of the prostate) in some men
  • temporary discomfort or pain in the back passage area (most men)
  • bloody urine for the first few hours to a maximum of 2 days in most men
  • bloody semen in most men lasting for up to 3 months in a few men
  • retention of urine requiring a temporary catheter (2-10 in 100)
  • infection (requiring admission and intravenous antibiotics, 0-1 in 100)
  • a few men have experienced temporary poorer erections

What happens after the procedure?



One of the doctors will call you on the day following your discharge from hospital to see how you are doing. The prostate mapping biopsies results will be available in about 2-4 days. You will be able to check your results on a secure online server, so that you can view your results immediately and print out a copy of the multisequence-MRI and the prostate mapping biopsies. These reports will indicate where the cancer is, how much cancer and how aggressive it is by denoting the Gleason score of each focus and also tell you how many biopsies were positive in each location.

(View some example cases)