December 30, 2019

Prostate biopsies enhanced with state-of-the-art imaging system


The UC Davis Department of Urologic Surgery is now using a state-of-the-art ultrasound device that more precisely visualizes prostate tumors for patients undergoing prostate-specific antigen (PSA) screening and prostate biopsies.

Dr. Marc Dall’Era using new ultrasound system for prostate biopsies. Dr. Marc Dall’Era using new ultrasound system for prostate biopsies.

UC Davis Health is the only center in Northern California currently using the novel technology for patients with elevated PSA or low-grade prostate cancers.

Called ExactVu, the system allows for real-time, high-resolution imaging that guides the surgeon during the biopsy and produces images that allow the urologist to better distinguish cancerous tissue from normal tissue, which can enhance the quality of the biopsy.

“The big advantage here is that our standard prostate ultrasound resolution is about eight to 10 megahertz,” said Marc Dall’Era, vice chair of Urologic Surgery who began using the equipment in November 2019. “This has a mode that goes up to 29 megahertz, so it's got a very high resolution.”

Patients undergoing the procedure remain awake and receive only a local anesthetic. The urologist uses an ultrasound probe into the rectum and against the prostate gland. The images appear in real time on a console monitor to help guide the urologist to perform the biopsy. The procedure takes no more than 15 minutes.

Dall’Era added that because of its superior resolution, an accompanying MRI of the prostate may not always be necessary. Current practice suggests that to get optimal biopsy results, men with high PSA levels or suspected prostate cancer should get an MRI in addition to ultrasound. But many patients don’t have access to MRI, which is costly, and not all insurance companies will pay for it.

Dall’Era and the prostate cancer team are comparing results from both MRI and the new ultrasound machine to see if one or the other picks up malignant cells that the other modality misses. He also envisions some day using the ultrasound during actual prostate cancer surgery to provide so-called “focal therapy,” cryotherapy or high-intensity ultrasound.

Dall’Era reports that patients, for their part, seem happy with the new biopsy approach. “They like the idea that we are able to see the tumors better and track them better over time,” he said.

The ExactVu system was developed by Exact Imaging of Toronto, Canada.