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    Burnout, biopsy, BPH, and more: Post-AUA review




    Fusion biopsy and other new technology

    One technology I was interested in learning about was shockwave therapy for erectile dysfunction. I thought Ranjith Ramasamy, MD, did a wonderful job explaining the basic science behind the technology in his point-counterpoint debate and had me leaving his lecture with great hope for the technology.

    However, I think the case for shockwave for ED was best summarized by Irwin Goldstein, MD, who was presenting the pro side of the debate. At the end, he stated, “Shockwave therapy may be one day be considered as safe and effective disease modification strategy.” Not exactly a ringing endorsement and that was before Tom Lue, MD, started his con presentation.

    The other major technology I was interested in exploring was the MRI-ultrasound fusion technology for prostate biopsy. I started with the technology hall and was duly impressed by the look and feel of the technology. I spoke with numerous other urologists including the attending from Iowa who taught me about prostate cancer, and everyone seems to be buying a device. I recently saw a European Urology paper entitled, "Opening Our Eyes to Multiparametric Magnetic Resonance Imaging Before Prostate Biopsy" (in press) that further supports my developing opinion that I should start to use more MRIs in my practice (though if the Europeans know how I can get a private insurer to pay for a prostate MRI in a man who has not had a biopsy yet, I'm all ears).

    Unfortunately, my plan to learn more about the state of the MRI technology and to settle on a plan for my practice didn't pan out. As noted, the On-Demand Course Pass videos aren’t yet live, so I have not watched either the courses of interest (Courses 042I on prostate cancer diagnostics and Course 047IC on MRI-US fusion biopsy). I'll get back to you with the next blog about my thoughts.

    What I did learn, though, was that MRI-US fusion technology is not cheap. For a device that still does not have a unique CPT code, the costs are truly amazing. At approximately $140K plus disposables (yes, one of the manufacturers turned the needle guide into a disposable device) plus the cost of the CAD device the radiologists have to purchase, I’m amazed any small-town plumber can afford the device on their own.

    I’m all for better diagnostic accuracy, but the only option I can find to pay for this device is to receive a portion of the downstream revenue associated with the diagnosis and treatment of prostate cancer (ie, pathology, the MRI itself, radiation, or surgery), which, as an independent single-specialty practice, I don’t have. When you consider the additional time it takes to perform an MRI-US fusion biopsy, I am becoming more frustrated that the government hasn’t added a specific CPT code for that procedure.

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.


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