Prostate Imaging

Ultrasound Guided Prostate Biopsy

Currently, a prostate biopsy is the only way to definitively diagnose prostate cancer. This test is performed by your EFW Prostate Radiologist.

Ultrasound guided prostate biopsy uses imaging guidance and a needle to remove tissue from the prostate in order to examine it for disease. The ultrasound probe is about the size of a finger. Once the probe placed delicately in the rectum, the prostate gland is inspected for any suspicious masses and the prostate is measured in three dimensions to obtain an accurate volume. Next a specialized prostate nerve block is performed to numb the prostate gland. Once frozen, the biopsy is performed with a spring-driven needle core biopsy device, or biopsy gun. The biopsy takes approximately 15 - 20 minutes and is very well tolerated. Once you receive an appointment time for your biopsy, you will receive a more detailed information sheet.

Ultrasound uses high-frequency sound waves to create two-dimensional images without the use of radiation. Ultrasound can be used to estimate the size of the prostate gland, however it is unable to accurately detect/exclude the presence of prostate cancer. Ultrasound is primarily used to guide transrectal ultrasound guided systematic biopsies as well as ultrasound guided MRI fusion biopsies, which are currently the gold standard in establishing a diagnosis of Prostate Cancer. EFW Radiology is the sole provider of both types of prostate biopsies, performed at the Prostate Cancer Centre. 

Fusion Prostate Biopsy

If you have had a prostate MRI showing a suspicious area(s) that needs targeting, you may be scheduled for a “Fusion Biopsy”.  Here targeted prostate biopsies are performed which utilize information from your prostate MRI, which provides more detailed images of the prostate than is possible with ultrasound. Before the biopsy, your Prostate Radiologist reviews your prostate MRI images and uses specialized software to pinpoint specific areas suspicious for cancer. EFW Radiology and the Prostate Cancer Centre were the first to purchase and utilize the UroNav MR/Ultrasound guided fusion biopsy system in Canada, which is a system widely trusted and used across most major academic centers in the United States. With this hybrid imaging method, the MRI images are fused with the real-time ultrasound images of your prostate gland. This approach has the advantage of using the superior imaging of the MRI coupled with easier-to-use ultrasound guidance and can still be safely done outside the hospital. This type of biopsy usually takes an additional 10-15 minutes to perform.  EFW Prostate Radiologists have performed over 300 of these fusion cases at the Prostate Cancer Centre.

How to Prepare for My Exam?

We recognize that many patients are anxious prior to their prostate biopsy and it can be a nerve racking procedure to prepare for. However, this biopsy is generally quick, and with the nerve block provided by your capable and skilled EFW Radiologist, it is a very well tolerated procedure. 

Please arrive 10 minutes prior to your appointment time to complete the check-in process and any necessary paperwork.

Take antibiotics as per Urologist/Pharmacist instructions. No aspirin or blood thinners 10 days prior to exam. Stop baby aspirin 5-7 days prior to the exam.

Take two Tylenol (only) one hour prior to exam.

Drink two 8-ounce glasses of water completed one hour before your appointment. Do not empty your bladder until the exam is completed. If absolutely necessary, bladder may be partially emptied.

We highly recommend that you have someone drive you and that you avoid travel for 10 days post biopsy.

What is a Prostate MRI?

A Prostate MRI is a safe, non-invasive method of visualizing the prostate gland and important surrounding structures. Prostate MRI, like other MRI exams, uses a powerful magnetic field to produce detailed images of the prostate without the use of radiation. Prostate MRI exams are fast, painless, and provide vital information on the health of your prostate gland. Injection of contrast is generally used for all prostate MRIs, and the entire study usually takes about 45 minutes to complete.

EFW Radiology uses the most advanced MRI machine for your prostate MRI – The Siemens Magnetom Vida 3T. This state of the art machine provides exceptional, high resolution pictures of your prostate gland and surrounding structures. Your Prostate MRI will then be interpreted by a fellowship-trained EFW Prostate Radiologist. EFW Prostate Radiologists work very closely with Calgary Urologists and work at the Prostate Cancer Centre performing all types of prostate biopsies.

3T Prostate MRI provides definition and resolution of the prostate gland and adjacent tissues. Prostate MRI has the ability to preferentially detect clinically significant prostate cancer, and has emerged as a powerful tool in screening low and intermediate risk patients for prostate cancer. It is also used to follow patients on active surveillance, stage patients with known prostate cancer, identify local recurrence post surgery/radiation therapy for prostate cancer, and to follow patients on active surveillance. Prostate MRI is also used to stage patients with known prostate cancer, as well as identify local recurrence post surgery/radiation therapy for prostate cancer. EFW Radiology has a dedicated 3T Prostate MRI available for the above indications and more. 

Who should get a Prostate MRI?

 Your doctor may order a Prostate MRI for the following reasons
-        Screening for prostate cancer if high PSA, abnormal digital rectal exam, family history of prostate cancer etc.
-        Screening for prostate cancer if you’ve had a previous negative prostate biopsy
-        Monitoring known prostate cancer (active surveillance)
-        Planning the treatment of your prostate cancer (via radiation and/or surgery)
-        Monitoring the treatment of your prostate gland following surgery and/or radiation
-        Measuring the size of the prostate gland
-        Evaluating pelvic pain and prostate related symptoms such as blood in semen, infertility etc. 

If I receive a Prostate MRI, do I still need to have a Prostate Biopsy?

Prostate MRI provides a high level of information on the health of your prostate gland, and if a cancer is suspected within the prostate gland on the MRI, then a biopsy is still required to confirm prostate cancer. At EFW, our Prostate Radiologists use a state of the art device called the UroNav Fusion Biopsy system, which allows the radiologist to accurately target and biopsy the prostate tumor seen on MRI. EFW Radiology was the first Canadian centre to use the UroNav Biopsy system, which is used in most major academic centres across the United States.
Termed “Targeted Software Based Fusion Biopsies”, the UroNav biopsy system is available for all eligible Albertans at the Prostate Cancer Centre. To date, EFW Prostate Radiologists have performed over 300 UroNav targeted prostate biopsies, gaining tremendous experience in performing this highly technical procedure.
 
A “negative” prostate MRI, meaning no tumor detected, may still require a prostate biopsy, as we know that some cancers may not be visible on MRI.
Your healthcare practitioner can help you decide whether a prostate MRI is a good choice for you.

Bone Scan

In prostate cancer, your doctor may order a special Nuclear Medicine test known as a bone scan. When prostate cancer spreads beyond the prostate gland, the first place it will typically go is the bone.  The bone scan confirms that prostate cancer has gone to bone, which can explain the bone pain experienced in prostate cancer as well as help doctors in treating the pain with radiation therapy.

For the bone scan, you will receive an injection of a very small amount of radioactive material.  This will be naturally picked up by all the bones in your body but deposit more in areas of bone that are abnormal. A camera is then used to take a photo of the bones in your body. There are no specific side-effects to having a bone scan. Although radioactive material is used for this study, there is minimal radiation exposure.

Nuclear Medicine is a diagnostic imaging specialty that uses clinically safe amounts of radioactive tracer to evaluate how bones are functioning. Nuclear medicine bone scans are routinely used in the setting of prostate cancer to stage the degree of bony metastasis, assess treatment response, and identify bony sites of recurrent disease. EFW Radiology’s affiliation with the Cancer Centre means we perform a high volume of bone scans and expertise in this area.  

CT (Computed Tomography)

In prostate cancer, CT is usually performed when there is concern that cancer has spread to lymph nodes far away from your prostate gland, or to other organs in your body.
CT scan uses x-rays and takes pictures of your body parts from different angles to then combine them to produce a 3-D image. CT scans for prostate cancer can be performed with or without contrast material which has the purpose of making certain structures stand out on the images. This helps with image interpretation.
Because CT scan uses x-rays, there is radiation exposure. However, this exposure is minimal and without any significant risk when CT scan is performed occasionally and only as needed. With normally functioning kidneys and no known allergy to CT contrast, no issues are typically encountered when contrast is given.