The Straits Times (21 February 2017) - A new method of diagnosing
prostate cancer that is better able
to detect aggressive tumours is
more readily available here.
Since May last year, more than
80 patients at Tan Tock Seng
Hospital (TTSH) have undergone
an MRI (magnetic resonance
imaging) ultrasound fusion-guided
biopsy, which managed to detect
92 per cent of the intermediate- to
high-grade cancers.
In contrast, only 62 per cent of
these aggressive cancers were
detected through the traditional
ultrasound-guided biopsy, said
adjunct assistant professor Tan Yung Khan, a consultant at the
hospital’s urology department.
The remaining 38 per cent were
missed or undiagnosed.
Like the traditional method, the
fusion technique at TTSH is done
under local anaesthesia.
Since October last year, Parkway-
Health Radiology has also been
offering this fusion prostate
biopsy, which is available at Mount
Elizabeth Novena Hospital. It has
seen about60 cases so far.
Singapore General Hospital and
the National University Hospital
(NUH)both offer the fusion-targeted
biopsy, but they use a different
system where the biopsy is usually
done under general anaesthesia.
Prostate cancer, which occurs in
the small prostate gland which
secretes fluids that help in reproduction,
is very common in men.
However, Dr Tan said the standard
biopsy is done blindly as the
prostate tumour cannot be seen
with an ultrasound scan. A dozen
or more tissue samples are taken
randomly from the prostate to test
for cancer. This means mistakes
can occur – cancers can be missed
or an aggressive one can be mistaken
for a low-grade one.
Dr Low Kah Boon, a consultant
radiologist at ParkwayHealth
Radiology, said: “The fusion biopsy
incorporates MRI, which acts as a
roadmap to let the urologist know
where to take the biopsies.”
Assistant Professor Lincoln Tan,
a consultant at the NUH urology
department, said it was only in
recent years that the quality of
MRIs had improved, allowing for
suspicious cancerous areas within
the prostate to be better seen.
However, he added, the detection
of prostate cancer through
MRI fusion-guided biopsy is dependent
on factors such as the imaging
quality of the MRI scans and
the expertise and experience of the
radiologist in identifying suspicious
lesions; the accuracy of the
fusion software and biopsy platform,
and technical skill of the surgeon
running the biopsy platform.
TTSH’s Dr Tan set up a workgroup
at the hospital about two
years ago to look into adopting a
fusion method.
“We are getting excellent results
while performing the biopsies in
the clinic under local anaesthesia,
thus keeping costs down,” he said.
The new method helps to cut
down on the number of biopsies
done, as a patient who has undergone
a targeted biopsy is unlikely
to require further biopsies, he said.
TTSH, which carries out about
700 standard biopsies for prostate
cancer a year, now expects to use
the fusion-guided method on 200
to300patients a year, said Dr Tan.
These are patients who have
gone through a standard biopsy
but are still suspected of having
prostate cancer, he said. If not for
the fusion method, they would
have to repeat the standard biopsy,
which can be “traumatic” for some.
The simpler standard biopsy is
still the first type of biopsy offered
to men suspected of having the
disease.
Dr Low said: “The fusion method
is particularly useful in negative
biopsy cases, where the suspicion
of cancer is still high, or when the
cancer is in hard-to-reach areas.”
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Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
