MRI fusion biopsy: "The most accurate way to diagnose prostate cancer."

Written by: Professor Greg Shaw
Edited by: Karolyn Judge

Expert prostate cancer diagnosis requires the latest technology, and MRI fusion biopsy is currently the gold standard when it comes to accurately detecting this treatable condition.


We speak to highly-respected and globally-recognised consultant urological surgeon Professor Greg Shaw all about this biopsy method for the prostate, including why it’s required, what’s involved and if it’s painful.  


Young man who needs an MRI fusion biopsy, looking out of the window


What is MRI fusion biopsy?

MRI fusion biopsy uses state of the art MRI and computer technology to make sure the surgeon takes samples from the areas which look most suspicious for prostate cancer on the MRI scan. The process involves the making of a 3-D computer model of the prostate using the MRI. The computer model is built by expert prostate MRI radiologists. The computer model is then superimposed on a real-time ultrasound image of the prostate to guide where the samples are taken during the biopsy procedure.



Are there different types of MRI targeted biopsy?

MRI can be used to guide biopsies in several different ways. Some people interpret the MRI scans themselves and try to work out which areas of the prostate correspond to the areas of highest suspicion. This is dependent on their expertise in interpreting MRI scans. They then try to target those areas during the biopsy using cognition (or thinking) to guide them. This depends on their ability to translate their interpretation of the areas of highest suspicion, into placing the sampling needles in the right areas. MRI fusion biopsy does not require the surgeon to be expert in interpreting MRI or working out where the areas of most suspicion are on an ultrasound image.



Why is an MRI fusion biopsy required?

We now know that when interpreted by people who are expert radiologists, multiparametric MRI is very accurate in identifying areas which are suspicious for cancer. MRI targeting allows the focused sampling of those areas and has been shown to be more accurate in detecting significant cancer, whilst decreasing the amount of insignificant cancer (the sort that would not require treatment but causes worry nevertheless) that is detected. It is the most accurate way to define the type and extent of cancer within a man’s prostate.



What's involved in an MRI fusion biopsy? How long does it take?

During the procedure a small ultrasound probe is placed in the back passage. The computer model which has been built based on the patients MRI is superimposed on the ultrasound image and the surgeon uses this to show him when the biopsy needles, seen on the ultrasound, are in the suspicious area from the MRI, so that a sample can be taken. The needles are passed through the skin in between the anus and scrotum (the perineum) so no needles pass through the rectum. The procedure takes 30 to 45 minutes. It is performed as a day case procedure.



Is an MRI fusion biopsy painful?

I prefer to perform MRI fusion biopsy under a short general anaesthetic so that during the procedure the patient feels no pain, which might otherwise decrease my ability to sample the areas I need to. Patients need to take simple painkillers like paracetamol and ibuprofen for a few days after the biopsy.




If you’re interested in getting the most accurate diagnosis for prostate cancer, arrange an appointment with Professor Shaw via his Top Doctors profile.

By Professor Greg Shaw

Professor Greg Shaw is a highly-respected and globally-recognised consultant urological surgeon based in London who specialises in prostate cancer, in particular robotic surgery, prostatectomy alongside urinary tract infection and urinary problems. He practises at The Prostate Centre, near Harley Street, while his NHS base is University College London Hospitals NHS Foundation Trust.

Professor Shaw is highly qualified with a BSc, MBBS and MD from the University of London, as well as an MRCS, FRCS (Urol) from the Royal College of Surgeons of England. After developing an interest in prostate cancer whilst undertaking his MD, he began his specialist urologist training in North London where he was awarded his urology fellowship.

Following this, he completed a four year lectureship at The University of Cambridge where he worked in a world-class research team, generated important research findings and was awarded a fellowship in robotic surgery.

Professor Shaw has performed over 1,100 robotic radical prostatectomies to date and strives to evaluate and incorporate the best technical modifications to attain excellent results. He prides himself in his very low complication rate.

Furthermore, he has developed several research collaborations including an enhanced recovery program for radical prostatectomy at his NHS base, safely increasing the number of patients being discharged home the day after robotic prostate removal. He also has developed and presented a novel surgical technique called complete urethral preservation during robotic assisted radical prostatectomy (RARP) which gives many patients immediate urinary continence.

Professor Shaw, who is a spokesperson for The Orchid Cancer Appeal, is a Professor of Urology at University of College London where he is leading the NeuroSAFE PROOF study to evaluate the cost effectiveness of the NeuroSAFE procedure during radical prostatectomy and the C-PRO-META study to evaluate the prognostic utility of circulating tumour cells in men undergoing surgery for prostate cancer. He has been awarded prizes for lectures delivered at international and national conferences, and one research project he conducted led to significant media interest including a front page article in The Daily Telegraph alongside global press coverage.

Professor Shaw's reputation clinical research also extends to his work as lead for Urology for the National Institute for Health Research (NIHR) for North Thames, while he was also involved in staff training for the NHS Nightingale Hospital in London. Furthermore he is a research consultant for the Royal College of Surgeons of England and has been a Clinical Studies Group member for the National Cancer Research Institute (NCRI).

Professor Shaw has published over 85 PubMed-linked papers, authored several book chapters and various other peer-reviewed articles. Furthermore he's the Associate Editor for uro-oncology for the British Journal of Urology International Knowledge project, where the team has developed an online curriculum supporting urology trainees and established consultants in their continued professional development.

Professor Shaw is a member of various professional organisations including the British Association of Urological Surgeons (BAUS), the European Association of Urology (EAU) and the Royal College of Surgeons of England.

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