Ep. 391 Building a Prostate Biopsy Service Line with Dr. Jamil Muasher
Dec 8, 2023
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Dr. Jamil Muasher, interventional radiologist, discusses the potential for radiologists to offer prostate biopsy work. He emphasizes the importance of MRI guidance and understanding grading systems. The doctors talk about various biopsy techniques, post-procedure care, and the future of biopsies.
Collaboration between urologists and radiologists in performing prostate biopsies leads to better patient outcomes in terms of diagnosis accuracy.
Fusion biopsies using MRI guidance and ultrasound mapping can improve targeting of lesions and reduce unnecessary biopsies.
MRI plays a crucial role in determining the need for prostate biopsies, helping in lesion identification and guiding the biopsy procedure.
Deep dives
The importance of urologists and radiologists collaborating in performing prostate biopsies
There is a need for collaboration between urologists and radiologists in performing prostate biopsies. Urologists are not trained to read MRIs, and interventional radiologists are already familiar with ultrasound-guided biopsies. This collaboration allows for better patient outcomes in terms of under-diagnosis and over-diagnosis of prostate cancer.
The development of a prostate biopsy service line using fusion biopsies
The episode discusses the development of a prostate biopsy service line using fusion biopsies. These biopsies are performed using MRI guidance and involve mapping ultrasound imaging to the MRI images. This approach allows for better targeting of lesions and reduces the risk of unnecessary biopsies. The use of fusion biopsies can be more cost-effective compared to standalone fusion biopsy platforms.
The role of MRI in prostate biopsy
MRI plays a significant role in determining the need for prostate biopsies. It helps in identifying lesions and guiding the biopsy procedure. MRI can also help in avoiding unnecessary biopsies, reducing the risk of over-diagnosis. However, the limitations of MRI should be considered, as some lesions, particularly infiltrative disease, may not be visible.
The technique of MRI-guided prostate biopsies
The podcast discusses the technique of MRI-guided prostate biopsies using software add-ons for existing ultrasound machines. Prior to the biopsy, the MRI is loaded into the machine and targets are identified based on the MRI images. During the biopsy, ultrasound mapping is performed to align the ultrasound images with the MRI images for accurate targeting of lesions. The procedure is relatively comfortable for patients and can be completed on an outpatient basis.
Post-procedure care and follow-up after prostate biopsies
After prostate biopsies, patients may experience blood in their urine, semen, and rectum for a few days to a few weeks. Patients are advised to watch out for complications such as sepsis, although the risk is low. Follow-up care may involve in-person visits or phone consultations to discuss biopsy results, and patients are given the opportunity to ask questions and seek further clarification if needed.
In this episode, Dr. Aaron Fritts and Dr. Jose Silva invite interventional radiologist Dr. Jamil Muasher to highlight the potential that interventional radiologists possess in offering prostate biopsy work alongside Urology colleagues.
Given the advancement in MRI guidance, the discussion addresses the opportunity for radiologists to step in and provide crucial expertise to optimize patient outcomes. Dr. Muasher talks about his approach of using an MR imaging to guide the biopsy procedure. He further expresses importance in understanding the grading, reading, interpreting systems like Prostate Imaging-Reporting and Data System (PI-RADS) and significant experience needed for accurate results. The doctors also explain various biopsy procedures, details about post-procedure care and follow-ups, and observations about billing for the services.
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SHOW NOTES
00:00 - Introduction
07:29 - Learning to Read Prostate MRI
09:43 - The Role of Radiologists and Grading Systems in Prostate Biopsies
24:00 - Techniques in Prostate Biopsy
31:16 - The Role of Antibiotics in Biopsy
32:34 - The Debate Between Transperineal and Transrectal Biopsy
40:36 - Post-Procedure Care and Follow-Up
45:49 - The Future of Biopsy
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RESOURCES
Decipher Prostate Genomic Classifier by Veracyte:
https://decipherbio.com/
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