BK Mr fusion Prostate biopsy By Dr Mohan Keshavamurthy

A cancer prostate was the 4th commonest cancer amongst Indian males. Age greater than 45 in India. Got independence in 1947. At that point in time, the average lifespan of Indian male was also 47 years. Now Fast forward to 2023. Expectant average life expectancy of an Indian male is about 74 to 75 years and with this increase in life expectancy and the possibility that the life expectancy will increase to 8081 years by 20302031. Cancer prostate has become the commonest cancer in male age greater than 45. So, the burden of cancer prostate in a large 1.7 billion population 1/2 can suffer from the cancer is increasing on a daily basis aligned to this.

Is the fact that serum PSA, the basic blood test used to diagnose cancer prostate, is freely available and is inexpensive across the major and not so major metros of the country. So, when a cancer prostate is to be diagnosed with the increased PSA, we a course of antibiotics is given. And if the PSA does not come below 4 after being elevated above 4 despite a course of antibiotics.

Trans Guided Trans Rectal Ultrasound guided Prostate biopsy is considered. Now when you do a biopsy you take small bits of tissue, 7 or 8 or 10 bits of tissue and the cancer may be hidden between these needles and hence even if the cancer is there in the prostate, the transrectal ultrasound guided biopsy may miss it in about one out of five times. Now if the PSA does not come back to normal despite the biopsy done.

Transrectally, which is the gold standard at this point in time, we would then be unable to know whether this patient's PSA is elevated because of persistent infection or are we missing a cancer. In these instances of elevated PSA, despite a well done transrectal ultrasound guided biopsy being unable to pick up the cancer, the next step today is to do something we refer to as fusion biopsy. What is fusion?

We know MRI of the prostate is the most powerful way to find out small volume cancer in the prostate. We use a technique called Pirat's score. If the score is 3 or above, we suspect that there is a focus of cancer in the prostate. But as you know, we cannot do a biopsy under MRI because it is a magnet and it attracts the needle that is used to do the biopsy. However, we can use this information of MRI and fuse it a ultrasound machine so that the conventional transrectal ultrasound.

Now has a GPS. Suppose you want to go from point A to B and you do not know point B. Then you today use a GPS. It guides you and the all the driver who is driving you to the location. Similarly, the MRI information is used as a GPS by the ultrasound machine done transrectively with a transrective probe to find out where the cancer is. And these areas of interest are selectively biopsied. This technique is called Mr. ultrasound fusion biopsy.

We use the BK platform, which is the world's best platform for this particular methodology. We also have a 3.5 Tesla MRI to give distinct and pristine images of the prostate. Using this technique, the one in five which are missed despite doing an adequate biopsy can be picked up. You should understand here that most of this cancer are early cancers and correctly treated will a cure can be provided to the patient. One additional fact here is that Fortis Hospitals Bannerghatta Rd. has one of the largest robotic neuro oncology programs in the country with extraordinary outcomes. Nerve sparing robotic radical prostatectomy is a technique of choice for organ confined cancer, prostate intermediate grade and using the BKMR fusion biopsy technique when early cancers are picked up, we can offer nerve sparing robotic radical prostatectomy for these patients. Wherein not only a cancer cure but continence and potency which are common side effects of this procedure are done in the past using the open or the laparoscopic method can be obviated. Again, I would request those patients who would require this technique or require our information to obtain information about us on the diagnosis and management of cancer prostate. We would welcome queries and suggestions. It is a pleasure to share this interesting piece of information.

The fusion biopsy equipment has been deployed for the first time at Fortis Hospitals, Bannerghatta Road. Thank you.