In the entire world, prostate cancer is the second most frequently diagnosed cancer in men. According to data from the World Health Organization (WHO), as of 2022, prostate cancer was diagnosed in around 268,490 male Americans, leading to an estimated 34,500 deaths.

To contain the severe effects of this widespread disease, early detection of prostate cancer utilizing techniques such as serum prostate-specific antigen (PSA) diagnostics screening of healthy men has the potential to reduce cancer-related mortality and help in controlling the terrible impacts of this disease. 

Thus, driven by high investments in the field of cancer research and the rising prevalence of prostate cancer globally, the global prostate cancer testing market is expected to grow significantly.

According to the BIS Research report, in 2021, the global prostate cancer testing market was valued at $5.2 billion in 2022, and it is expected to reach $21.30 billion by 2032, growing at a CAGR of 13.68% during the forecast period 2022-2032.

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The ability to accurately assess the presence of clinically significant lesions, to accurately assess the extent of disease, and to characterize the risk of future progression are the main goals of advanced prostate cancer testing procedures.

By doing so, it has become possible to prevent unnecessary overtreatment in patients with a low risk of progression and undertreatment, which may lead to treatment failures, particularly in men who choose active surveillance.

However, studies have revealed that whereas one in seven men with prostate cancer had normal PSA levels, three out of four men with increased PSA levels do not have cancer. The PSA diagnostics have a high likelihood of misdiagnosing cancer and instilling false hope. It might also lead to useless worry and tests in circumstances where there is no malignancy.

As a result, several technologies, including magnetic resonance imaging (MRI) and ultrasound, are being integrated with conventional processes to increase the accuracy of prostate cancer screening procedures.

These technologies have demonstrated benefits as a way to improve patient selection for biopsy and facilitate direct targeting of lesions during biopsy because they provide increasingly trustworthy viewing of potentially major prostate tumors. MRI data can be used to stage tumor size and track therapy effectiveness.

In this article, the impact of MRI-ultrasound for prostate cancer testing accuracy and guidance of targeted prostate biopsy has been discussed further in detail.

What is an MRI-ultrasound fusion-guided prostate biopsy?

Magnetic resonance imaging (MRI) is a procedure that produces a detailed image of a region inside the body. An MRI produces a more accurate image than ultrasound and enables medical professionals to identify areas of the prostate that don't appear to be in good health and should be biopsied.

Doctors are now using "fusion-guided biopsy" procedures that combine MRI and ultrasound imaging. The image from an MRI is reviewed to search for any suspicious-looking regions. Later, the biopsy specialist "fuses" the MRI and ultrasound images into one image using a specific piece of software and an ultrasound probe, making it simpler to see the targets for the biopsy needles.

Current Scenario of the Biopsy Procedure for prostate cancer testing

Currently, there are an estimated one million prostate biopsies conducted annually in the U.S. to either diagnose or rule out cancer. The transrectal, ultrasound-guided approach is used in almost all cases. This procedure, which was demonstrated in 1989 to be equally accurate as when the operator utilized ultrasound to aim at a nodule, involves carefully taking tissue cores under ultrasound guidance all around the prostate.

The Stamey procedure was a significant improvement over earlier techniques in which biopsy needles were guided simply by the inspecting finger, even if it was performed blindly (i.e., without knowledge of the location of the tumor within the prostate). Prostate cancer (PCa) is the only major malignancy that is now routinely diagnosed by blind biopsy of the organs, owing to the broad adoption of the systematic approach.

However, a large number of prostate biopsies performed nowadays produce inaccurate results. Microfocal "cancers" with negligible clinical relevance are regularly found; however, up to 35% of initial biopsies may result in falsely negative results, which means dangerous tumors go undetected.

Clinically significant PCa can be found by prostate MRI, especially when multiparametric imaging is used. Although accuracy parameters are not yet known, localized PCa can now, for the first time, be discovered, measured, selectively sampled, and treated, or if necessary, followed.

Active surveillance programs have the potential to monitor and resample a large number of these malignancies, or they might even be focally ablated in the future. The ability to see some PCa on an MRI has opened up the possibility of fusing (or incorporating) MRI into a needle-aiming or targeting procedure in order to use those pictures as targets for a needle biopsy.

Recent Developments in MRI-Ultrasound Fusion Technology for Prostate Cancer Testing

Recent research has identified three techniques for fusing MRI for targeted biopsy, i.e., MRI-ultrasound fusion, MRI-MRI fusion ('in-bore' biopsy), and cognitive fusion. Emerging evidence supports the fusion devices, two of which, Artemis (Eigen, USA) and Urostation (Koelis, France), have been approved by the U.S. Food and Drug Administration in the last five years.

Research conducted on more than 600 people discovered that targeted biopsies are two to three times more sensitive than nontargeted systematic biopsies for the detection of PCa; nearly 40% of men with a Gleason score of at least 7 PCa are only diagnosed by targeted biopsy; nearly 100% of men with highly suspicious MRI lesions are diagnosed with PCa. Additionally, the ability to return to a prior biopsy site is highly accurate.

Conclusion

Using MRI-guided targeted biopsy or MRI-ultrasound fusion with PSA screening, it is possible to precisely pinpoint and sample suspicious tumors. A practicing urologist can diagnose and treat PCa in an office setting with accuracy and efficiency by using image fusion with specific instruments.

The outcomes of the fusion devices' biopsies for prostate cancer testing are comparable to those of the template perineal biopsy conducted in the operating room under general anesthesia. In the future, focused therapy-appropriate lesions may be targeted and followed using MRI/ultrasound fusion technologies.

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