Successes and challenges in developing a magnetic resonance imaging-transrectal ultrasound machine fusion prostate biopsy service.

Prostate magnetic resonance imaging (MRI) is an integral part of the diagnostic pathway in patients with suspected prostate cancer. Patients with positive findings on MRI require targeted biopsy for histopathologic diagnosis, and machine fusion biopsy is emerging as an accurate and reliable technique for diagnosis; however, access to this service is lacking across Canada. Over the past three years, our institution has developed a successful MRI-transrectal ultrasound (US) machine fusion prostate biopsy program. The purpose of this article is to discuss operational and clinical aspects of the service, and how we've overcome challenges in implementation. We describe the technique and diagnostic yield of machine fusion biopsy at our institution, including the subset of patients undergoing concurrent systematic biopsy. Challenges in establishing this program have included having sufficient workforce, screening patients at high risk of post-biopsy urosepsis, implementing transperineal biopsy, and a growing waitlist. An avenue for future improvement is a formal radiology-pathology correlation process. The goal of our machine fusion prostate biopsy program is to provide early and accurate diagnoses of MRI findings, thereby enabling optimal treatment plans and ultimately improved patient outcomes.