Novel Prostate Biopsy Technique Using Imaging Fusion in a Patient With Absent Rectum.

Area of Science:

• Urology
• Medical Imaging
• Oncology

Background:

• Elevated prostate-specific antigen (PSA) and PIRADS 4 lesion on MRI prompted investigation.
• Patient had a history of ulcerative colitis and total colectomy, complicating standard biopsy approaches.

Observation:

• A novel technique combined multi-parametric prostate MRI and intraoperative CT 3D/3D fusion for biopsy guidance.
• Ultra-low-dose cone beam CT and robotic-assisted fluoroscopy were utilized for imaging and biopsy.
• Transperineal prostate biopsy yielded 27 cores, identifying Grade group 5 prostate cancer in targeted and base regions.

Findings:

• The fusion imaging technique allowed precise identification of localized, very high-risk prostate cancer.
• The procedure obtained over three times the number of cores compared to typical CT-guided biopsies.
• The technique utilized a significantly lower radiation dose than conventional CT-guided biopsies.

Implications:

• This fluoroscopy-guided biopsy with imaging fusion represents a novel approach for patients lacking a rectum.
• The technique demonstrates potential for precise diagnosis of localized prostate cancer.
• This method may establish a new standard for targeted prostate biopsy procedures, improving accuracy and reducing radiation.