learning curve for MRI guided Biopsy?

New to posting - thanks for all I've learned from lurking.

I've been watching my PSA climb for 15 years and recently had a 3T MRI that showed two regions of concern - the more troubling one in the "anterior aspect of the left central gland". I've had two TRUS biopsies that were negative. My Urologist is recommending an MRI guided biopsy in the only facility offering this in central Texas.

My question concerns the fact that they are new at this, having done 3, at most. The radiologist is quite experienced, but not at this procedure. Is the learning curve for this equipment an issue that should concern me?

Thanks, LeftyW. I am also in Austin and the facility is Central Park Imaging. I believe this may be a different device. There is no mention of ultrasound. The biopsy is done while in the 3Tesla MRI machine. It may be similar enough to the procedure you describe that previous experience is applicable. I hope so.

I agree with John T. There is tremendous inter-observer variability in reading multiparametric MRIs, and there is a huge learning curve. I hope you are talking about multiparametric MRIs (mpMRI) for targeting fused with a real-time 3D ultrasound for guidance. Because results have been so good at NIH, UCLA and a few other institutions, a lot of centers have been hopping on the bandwagon to offer them. But they do not necessarily have radiologists trained to identify suspicious lesions. There is a complex scoring system they use.

The mpMRI is usually done at a separate session. It may be possible to have the mpMRI done at one place and the fusion biopsy at another if the imaging is compatible. I would imagine that MD Anderson has a well-trained radiologist.

- Allen

Is the biopsy sampling done transperineally or transrectally; i.e., do they have the ability to sample suspected anterior tumors?

I will be very interested to hear how they can biopsy any anterior tumors by going in transrectally. They can't go through the urethra, and the needle would have to be super-sized. It doesn't seem geometrically possible, but perhaps they have some special technique. It's usually not a big issue, especially if you're not African-American. But your radiologist can't know where the suspicious areas are until you have the mpMRI. Transperineal biopsy has lower rates of infection as well.

Had my MRI guided biopsy today. It did use the Invivo DynaTRIM device and they had no real difficulty getting to my lesion in the "anterior aspect of the left central gland" transrectally. When it was over, I saw images of the lesion and the three needle locations for the upper, middle and lower cores. Another two were targeted at a second less ominous lesion in the periphery.

The process is a little cumbersome. It required a catheter to insure that the bladder didn't fill during the process and push on the prostate. They start with an abbreviated version of the mpMRI I had 3 weeks ago to precisely locate the targets. Then they first place the needle in position with me out of the machine, roll me in and leave the room for an image collection period of about 5 minutes, then a wait of about another 5 minutes while they process the images and verify the location, then roll me out for the sample shot, then repeat with the next target site. In only one case did the verification image show the position needed to be adjusted.

From the standpoint of comfort, it was not much different than a regular TRUS biopsy - many fewer punctures, but much more waiting between shots. I suffered more from the catheter, my first, than the biopsy shots. Recovery is supposed to be easier with fewer samples and I feel like the results should be much more accurate due to the precise placement. Overall I am pleased with the experience.