Updates in the Management of CRPC - Episode 5

3D Transperineal Prostate Mapping Biopsies

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Traditionally, following the discovery of an elevated PSA level, a TRUS guided biopsy of the prostate is usually conducted. However, suggests E. David Crawford, MD, it may be better to conduct an MRI before biopsy. In addition to MRI, biomarkers and novel imaging approaches are also available to help make a diagnosis and treatment decision, Crawford states.

One such option, the transperineal mapping biopsy, can provide an enhanced view of the prostate. In general, Crawford states, this approach is ideal following a negative TRUS guided biopsy when concerns still exist, or for patients categorized as “low-risk.”

This technique generally biopsies the entire prostate in 5 mm intervals, with approximately 2 biopsies per gram of prostate. In general, this approach detects cancer in 30% to 40% of cases were a diagnosis was originally missed, Crawford states. This approach provides greater details and a higher level of confidence compared to standard approaches.

The most substantial challenges facing the widespread use of the mapping biopsy are costs and side effects. In general, this approach is expensive and the entire procedure may not always be reimbursed, Crawford notes. The side effect profile is manageable, with the most common issue being urinary problems. By and large, Crawford states, sepsis does not commonly occur as a result of the procedure.

There is a clear need to optimize the initial sampling of the prostate, states moderator Raoul S. Concepcion, MD. It is likely that several factors will contribute to this process, whether it is the use of biomarkers or the mapping biopsy. Overall, it is important, Concepcion states, that urologists stay involved in this process.