Transrectal mpMRI Fusion Biopsy

Posted by Leonard S. Marks, MD | May 2021

Leonard S. Marks, MD, moderated “Transrectal mpMRI Fusion Biopsy” during the Southwest Prostate Cancer Symposium 2020 virtual conference in December 2020.

How to cite: Marks, Leonard S. “Transrectal mpMRI Fusion Biopsy” December 2020. Accessed Apr 2024. https://grandroundsinurology.com/transrectal-mpmri-fusion-biopsy/

Transrectal mpMRI Fusion Biopsy – Summary:

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, shares lessons from the first decade of transrectal multiparametric (mp) MRI fusion prostate biopsy at UCLA. Dr. Marks explains that while fusion biopsy of the prostate has been available since 2009, the AUA only endorsed it in 2020, and very few institutions have as much experience with it as UCLA, which assembled a multidisciplinary team for its first Artemis fusion biopsy unit in 2010. Dr. Marks follows this history with a brief summary of the fusion biopsy process, emphasizing the importance of having quality MRI and involving a radiologist and a pathologist, and noting that UCLA’s system is so efficient that they are able to perform approximately 15 of these procedures per week. He then goes over key lessons the UCLA team has learned from its first 4,000 fusion biopsies, which include: (1) targeted sampling of MRI lesions using PI-RADS is necessary; (2) systematic sampling is important for finding invisible lesions; (3) tracking of prior biopsy sites is extremely helpful in detecting upgrades; (4) MRI lesions do not necessarily indicate what the pathology is; and (5) fusion biopsy provides better security than ultrasound biopsy in predicting final pathology . Dr. Marks concludes by remarking on the advantages of the transrectal versus the transperineal approach, arguing that sepsis is easily preventable, patients find the transrectal approach more comfortable, and transrectal fusion systems are more mature.

About the Southwest Prostate Cancer Symposium 2020 virtual conference:
Presented by Program Chairs Nelson N. Stone, MD, and Richard G. Stock, MD, this virtual conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference, including the 2021 iteration, here.

About The Author

Leonard S. Marks, MD

Leonard S. Marks, MD, is Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles. He graduated from the University of Texas Medical Branch, where he received his MD with AOA honors and his MA in Physiology in 1969. He served an internship and surgical residency at UCLA/Harbor General Hospital. For the following two years, he served on active duty as Lieutenant Commander in the US Public Health Service. He was named a Post-Doctoral Research Scholar at UCLA School of Medicine in 1973-4. He completed his Urology Residency at UCLA and was a Lecturer in Urology there in 1978, following which he entered private practice in Los Angeles. He re-joined the UCLA faculty full-time in 2009. While in practice, Dr. Marks founded a non-profit research organization, the Urological Sciences Research Foundation, a 501c3 corporation, to further his academic interests. He became an original AFUD scholar in 1992 for work relating serum PSA levels to prostate histology. He received a Prostate Cancer Foundation (PCF) research award in 2000 for cross-cultural studies of prostate cancer. As an early advocate of multimedia in medical education, he served as Website Editor of Urology for The Gold Journal from 1998-2010. For his work in the scientific evaluation of alternative medicines, he was appointed to committees of the American Urological Association, the National Institutes of Health, and the National Academy of Sciences. Over the past decade, he has been Principle Investigator of three separate R01 Awards from the National Cancer Institute devoted to targeted prostate biopsy and focal therapy of prostate cancer. He has authored more than 150 scientific publications.

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