Optimizing performance and interpretation of prostate biopsy: a critical analysis of the literature

Abstract

Editorial CommentThe incorporation of combined MRI/MRSI and multiparametric MRI in the active surveillance program is still investigational. The possible application of these techniques is based on the fact that volumetric and metabolic data correlates with tumor aggressiveness (1).Recently study has been shown that combined MR imaging and MR spectroscopic imaging findings and Ki-67 (a proliferation marker), pAkt (a serine-threonine kinase), and androgen receptor values correlated with each other and with clinically insignificant and significant prostate cancers (2). In another study, MRI/MRSI models performed better than the clinical models for predicting the probability of insignificant prostate cancer (3). In the study by Fradet et al., patients presenting a hypointense focal area on T2-weighted image, suspicious for cancer at the time of diagnosis, had a greater risk of the Gleason score being upgraded at subsequent biopsy than did patients without such a lesion. Interesting is that MR spectroscopic imaging which is more specific for tumor characterization, than conventional T2-weighted images, was not useful to predict cancer progression. We agree with the authors that after appropriate validation, the MRI and MRI/MRSI models might help in counseling patients who are considering choosing deferred therapy. Dr. Adilson PrandoHead, Department of Radiology and Diagnostic Imaging, Vera Cruz Hospital Campinas, São Paulo, Brazil E-mail: adilson.prando@gmail Context: The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate. Objective: Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy.