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A biomedical engineering approach to mitigate the errors of prostate biopsy

Nature Reviews Urology volume 9, pages 227–231 (2012)Cite this article

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Abstract

The current protocol for detecting and ruling out prostate cancer involves serum PSA testing followed by sampling of the prostate using a transrectal ultrasonography (TRUS)-guided biopsy. Many specialists have discussed how PSA screening has contributed to underdetection of clinically significant prostate cancer, overdiagnosis of clinically insignificant disease and poor risk stratification; however, little consideration has been given to the role of TRUS-guided biopsy in these errors. The performance of TRUS-guided biopsy is constrained by the biomechanical attributes of the sampling strategy, resulting in suboptimal detection efficiency of each core. By using a biomedical engineering approach, a uniform grid sampling strategy could be used to improve the detection efficiency of prostate biopsy. Moreover, the calibration of the sampling can be adjusted by altering the distance between needle deployments. Our model shows that for any given number of needle trajectories, a uniform grid approach will be superior to a divergent, nonuniform strategy for the detection of clinically important disease. This is an important message that should result in a move away from divergent sampling to a uniform grid approach for prostate biopsy.

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Figure 1: Relation of the spherical tumor model volume to the detection grid formed by the four parallel cores.
Figure 2: Four evenly spaced parallel point cores spaced S cm apart, with the circumscribed circle of diameter D representing the model spherical tumor in cross-section.
Figure 3: A typical TRUS-guided biopsy approach, showing the 14-core sample sites (pink dots) in the initial biopsy and the 14-core rebiopsy sites (blue dots).
Figure 4: A potential uniform grid pattern for the 28 cores—biopsy and rebiopsy—distributed throughout the entire prostate volume.

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Acknowledgements

H. U. Ahmed and M. Emberton receive funding from the Medical Research Council, National Institute of Health Research-Health Technology Assessment programme, Pelican Cancer Foundation, Prostate Action, St Peter's Trust, Prostate Cancer Research Foundation, Prostate Cancer Charity and Prostate Cancer Research Centre. Mark Emberton receives funding in part from the UK National Institute of Health Research UCLH/UCL Comprehensive Biomedical Research Centre.

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Authors and Affiliations

  1. Division of Surgery and Interventional Science, 4th Floor, Medical School Building, University College London, 74 Huntley Street, London, WC1E 6AU, UK

    Hashim Uddin Ahmed & Mark Emberton

  2. Membrane Studies Project, PO Box 14180, Minneapolis, 55414, MN, USA

    Gordon Kepner

  3. MIT Computer Science and Artificial Intelligence Laboratory, The Stata Center, Building 32, 32 Vassar Street, Cambridge, 02139, MA, USA

    Jeremy Kepner

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H. U. Ahmed and G. Kepner researched data for the article. All authors contributed to discussion of content, writing the manuscript, and review and editing of the article before submission.

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Correspondence to Hashim Uddin Ahmed.

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Competing interests

H. U. Ahmed and M. Emberton receive funding from USHIFU, GSK and Advanced Medical Diagnostics for clinical trials, are paid consultants to Steba Biotech, and have received funding from USHIFU/Focused Surgery/Misonix Inc/UKHIFU (manufacturers and distributors of the Sonablate500 HIFU device) and Oncura for medical consultancy and travel to conferences. None of the funding sources had any role in the writing of this article. The other authors declare no competing interests.

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Ahmed, H., Emberton, M., Kepner, G. et al. A biomedical engineering approach to mitigate the errors of prostate biopsy. Nat Rev Urol 9, 227–231 (2012). https://doi.org/10.1038/nrurol.2012.3

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