Gerald L. Andriole, Jr., MD, presented “Image Guided Prostate Biopsy” during the 39th Annual Ralph E. Hopkins Urology Seminar on January 30th, 2019 in Jackson Hole, Wyoming.

How to cite: Andriole, Jr., Gerald L. “Image Guided Prostate Biopsy” January 30, 2019. Accessed Jul 2024. https://Image-Guided-Prostate-Biopsy/

Fluciclovine (18F) PET/CT Impact on Clinical Management of Recurrent Prostate Cancer

Gerald L. Andriole, Jr., MD, reviews the history of conventional transrectal ultrasound (TRUS) guided biopsy and the limitations of this technique that remain in the modern era. He then discusses current and emerging efforts to improve image guided prostate biopsies.


With the advent of ultrasound technology, the use of ultrasound guidance for prostate biopsy began in the mid 1960s. The description of distinct zones in the prostate and the ability to visualize them also informed the conventional TRUS guided biopsy. Initially, there was an expectation that ultrasound could identify prostate cancer as a hypoechoic lesion, but it quickly became clear that this was not so. 

There have not been many refinements to conventional prostate ultrasonography since then, except for the addition of cores taken on systematic biopsies. Because of this, TRUS biopsy remains subject to limitations in the modern era. These limitations include the fact that this method is operator dependant and misses significant pathology which often leads to the need for re-biopsy, the issue of under- and overestimating disease grade and extent, as well as the nature of randomly arrayed cores. There is no unified consensus as to the number of cores required for prostate cancer detection, despite efforts to develop nomograms adjusting for patient-specific factors. Furthermore, there are serious complications associated with TRUS biopsy.

This presentation reviews recent efforts to improve image guided prostate biopsies, such as an in-office transperineal biopsy system, an under-development 3D mapping biopsy system with an enhanced needle design, and micro-ultrasound technology

As these technologies are not yet widely available, this presentation also discusses current topics in MRI, including the value of cognitive MRI-targeted biopsy, integrating MRI findings into risk calculators, gallium 68 PSMA–11 PET/MRI, as well as the variability of MRI interpretation across radiologists and other unresolved issues. 

About the Ralph E. Hopkins Urology Seminar

The Ralph E. Hopkins Urology Seminar, or Jackson Hole Seminars (JHS), is a multi-day conference that focuses on patient safety and cutting-edge updates in the assessment, diagnosis, and treatment of urologic conditions. The topics discussed include urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. In addition to didactic expert lectures, this conference features a unique interactive critique panel. Dr. Andriole presented this lecture during the 39th Annual JHS. Please visit this page in order to register for future JHS meetings.


Gerald L. Andriole, Jr., MD, is the global Chief Medical Officer at Prostatype Genomics. He previously was Professor and Director of Urology in the National Capital Region at the Brady Urologic Institute at Johns Hopkins University. He also formerly served as the Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri. Dr. Andriole received his medical degree from Jefferson Medical College in Philadelphia, Pennsylvania. He trained in surgery at Strong Memorial Hospital and the University of Rochester and completed his Urology Residency at Brigham and Women’s Hospital and Harvard Medical School. Subsequently, he was a Fellow in Urologic Oncology at the National Cancer Institute in Bethesda, Maryland. Dr. Andriole has over 40 years of consistent contributions in the areas of prostate cancer screening and prevention research as well as BPH. He has contributed over 450 peer-reviewed publications. He chaired the Prostate Committee of NCI’s PLCO Cancer Screening Trial, the Steering Committee of the international REDUCE Chemoprevention Trial and the Prostate Committee of the SUO Clinical Trials Consortium. He is a member of the American Urological Association, the Academy of Master Surgical Educators of the American College of Surgeons, the American Surgical Association, the American Association of Genitourinary Surgeons, and the Clinical Society of Genitourinary Surgeons, among other societies.

He has received the Outstanding Achievement Award from the Urologic Oncology Branch of NCI, the Distinguished Clinician Award from Washington University, the Alumni Award from Jefferson Medical College and the Williams Award for Prostate Cancer Research Excellence from the AUA Urology Care Foundation, among others.