MRI-guided biopsies and minimally invasive therapy for prostate cancer

Abstract

Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa). Its sensitivity in detecting clinically significant cancer and the ability to localize the tumor within the prostate gland has opened up discussion on targeted diagnosis and therapy in PCa. Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa. Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa. This review discusses the evidence and techniques for in-bore MRI-guided prostate biopsy and provides an update on the status of MRI-guided targeted focal therapy in PCa.

Percutaneous MR-guided whole-gland prostate cancer cryoablation: safety considerations and oncologic results in 30 consecutive patients

“…Percutaneous MR-guided whole-gland CA of PCa is a novel technique which aims to reduce complications and maintain oncologic efficacy compared with ultrasound-guidance. Unlike TRUS (where field of view is small, visualization of deep ablation-zone is limited by artifact, and recto-prostatic distance is narrowed to optimize image quality), 9,21 MR-guidance offers superior multiplanar ice-ball visualization over a wide field of view, improved precision of cryo-probe placement, and applicability to post-surgical cases (e.g. abdominoperineal resection) without need for transrectal access.…”

Initial Experience of Transperineal Biopsy After Multiparametric Magnetic Resonance Imaging in Korea; Comparison With Transrectal Biopsy

“…Until now, radical prostatectomy or radiation therapy have been performed for localized prostate cancer and active surveillance has been recommended in cases of low-risk prostate cancer. 18,19 However, recent studies have questioned this method of treatment. First, radical prostatectomy for prostate cancer could be an overtreatment in some cases of clinically insignificant prostate cancer.…”

“…21 In addition, there is the disadvantage of reducing the quality of life. 19,20,22 Radical prostatectomy can lead to functional complications such as urinary incontinence and erectile dysfunction after the operation, which appear at a high frequency. In a study of 2,625 patients from 14 centers, Haglind et al 23 found 21.3% and 70.4% incidence rates of incontinence and erectile dysfunction, respectively, at 12 months after robot-assisted laparoscopic prostatectomy.…”

Evaluating the Role of mpMRI in Prostate Cancer Assessment

“…FT uses a combination of imaging techniques and minimally invasive ablative methods to eradicate tumor cells while leaving surrounding normal tissue relatively unharmed [52]. Its goal is to minimize side effects of treatment while still treating the tumor successfully [53]. This makes FT an attractive alternative to radical prostatectomy (RP) in addition to being a strategy that could potentially reduce the complications of overtreatment of indolent disease [54].…”