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Advanced Procedures

Not all radiation oncologists perform advanced procedures to improve their patients’ standard of care. Dr. Cavey performs hundreds of advanced procedures every year to help his patients improve their clinical outcomes and reduce their side effects.

MRI-TRUS Fusion Transperineal Biopsy

The MRI-TRUS fusion transperineal biopsy is an advanced technique for performing biopsies that is being used increasingly to improve the accuracy of prostate biopsy. Fusing real-time ultrasound images with pre-exam MRI data provides better guidance to help accurately target lesions identified on the MRI, potentially reducing the risk of missing high-grade tumors or under-staging tumors during active surveillance. This is an improvement over the traditional TRUS biopsy method, in which biopsies are taken from multiple standard cores throughout the prostate with no specific lesion target, making it possible that a biopsy could miss cancerous cells in the prostate.

An MRI-TRUS fusion transperineal prostate biopsy using bkFusion takes approximately 20 minutes, and patients usually spend less than an hour at the clinic. One reason for the short procedure time is that the MRI contours have been done beforehand, so the patient spends very little time on the table. During the transperineal biopsy, the needle passes from the skin below the scrotum into the prostate. Transperineal biopsies are much “cleaner” and are associated with an extremely low chance of serious bacterial infection.

 

MRI-Guided Prostate Brachytherapy

Dr. Cavey was the first physician in Tarrant County to be certified for SpaceOAR use and performs many cases each month for his prostate cancer patients. SpaceOAR is a bioabsorbable hydrogel that is implanted between the prostate and the rectum and the gel moves the rectum 5-10 mm from the prostate. Typically, the prostate and rectum are only separated by a tiny layer of fat. Therefore, even with the most advanced forms of radiation treatment, a small sliver of rectum receives the highest doses of radiation therapy.

Dr. Cavey performs MRI-guided brachytherapy, the next generation of prostate brachytherapy. MRI imaging is utilized to design and guide the placement of the radioactive seeds during the implant procedure, which leads to better and safer seed implants than without MRI-assistance. MRI-guided prostate brachytherapy has improved the visibility and accuracy of dose administration which has the potential to improve clinical outcomes by being able to identify the primary lesions.

By adding “space” between the prostate and rectum, the highest doses of radiation therapy instead occur in the gel and the dose that then reaches the rectum is dramatically reduced. The doses to the erectile structures are also reduced. This procedure allows modern day radiation therapy to be even safer and results in dramatically less complications. The gel breaks down after approximately 4-6 months and normal anatomic configuration is restored.

This procedure can be done in the office or in an OR setting and typically takes 30 minutes or less. At Texas Radiotherapy, this procedure is performed in the office with local anesthesia and sometimes a medicine to relax the patient, if needed.