Multiparametric MRI Fusion-Guided Prostate Biopsy for Detection of Clinically Significant Prostate Cancer Eliminates the Systemic Prostate Biopsy

Abstract

The primary objective of this study was to demonstrate the high accuracy of multiparametric magnetic resonance imaging and ultrasound fusion (mpMRI/US)-guided targeted prostate biopsy for the detection of clinically significant prostate cancer (PCa) and to show that adapted systematic biopsy (AdSB) does not provide additional benefit in detecting clinically significant prostate cancer (PCa). In total, 283 patients have been included in the study. All patients underwent the mpMRI/US biopsies, which have been performed with the “BioJet” fusion system (D&K Technologies, Barum, Germany) using the transperineal approach by a single interventional radiologist. Lesion-targeted and systematic biopsies have been done when 2–4 cores have been taken from each PI-RADS 3–5 lesion, followed by AdSB. This study demonstrated that targeted prostate biopsy is sufficient for safe and sensitive identification of clinically significant PCa in primary biopsy-naïve cases without the need to perform adapted systematic biopsy.

Combination of DNA methylation biomarkers with multiparametric magnetic resonance and ultrasound imaging fusion biopsy to detect the local spread of prostate cancer

“…Forty‐four patients with csPCa were included in the field cancerization research, and these patients were under radical prostatectomy (RP), all the rest were involved in the urine‐based test validation. Clinical and radiological characteristics of all study cohort were presented in 15 . Clinical and radiological characteristics of the radical prostatectomy cohort are presented in Table 1.…”

“…Clinical and radiological characteristics of all study cohort were presented in. 15 Clinical and radiological characteristics of the radical prostatectomy cohort are presented in Table 1.…”

MRI-Targeted Prostate Biopsy Introduces Grade Inflation and Overtreatment

“…There is compelling evidence that targeted biopsy has decreased the detection of low-grade cancers and increased the detection of higher-grade cancers compared to systematic biopsy [3,[5][6][7]. For instance, in the PRECISION trial, men randomised to the MRI pathway had a 13% absolute decrease in Gleason grade group 1 (GG1) cancers and a 12% increase in GG2 cancers [5].…”

“…Recently, MRI-guided targeted biopsies have gained popularity[2]. MRI targeting has been purported to improve both the sensitivity and specificity of biopsy, avoiding biopsy in men at low risk of high-grade cancer, thereby reducing the risk of overdiagnosis and biopsy-related complications [3, 4], and ensuring that regions of the prostate most likely to harbour aggressive disease are sampled. Currently, clinical guidelines, including those of the European Association of Urology, recommend routine use of MRI before diagnostic prostate biopsy.…”