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Prostate Cancer, Multiparametric Magnetic Resonance Imaging (mpMRI), MRI-Targeted Biopsy, In-bore biopsy
Clinical suspicion of Prostate Cancer (PCa) is largely based on increased prostate specific antigen (PSA) level and/or abnormal digital rectal examination (DRE) and/or positive imaging and, up today, biopsy is mandatory to confirm the diagnosis. The old model consisted of Standard Biopsy (SBx), that is random sampling of the prostate gland under ultrasound guidance (TRUS), in subjects with clinical suspicion of PCa. This involves the risk of not diagnosing a high percentage of tumors (up to 30%) and of an incorrect risk stratification. Multiparametric Magnetic Resonance Imaging (mpMRI) has transformed the diagnostic pathway of PCa, not only as an imaging method for detecting suspicious lesions, but also as an intraprocedural guidance for Target Biopsy (MRI-TBx), thus bridging the diagnostic gap. Several single and multicenter randomized trials, such as PROMIS, MRI first, PRECISION and that reported by Van der Leest et al. have confirmed the superiority of the “MRI pathway”, consisting of mpMRI and MRI-TBx of suspicious lesions, over the “standard pathway” of SBx in all patients with elevated PSA and/or positive DRE. MRI-TBx appears to be advantageous in reducing the overall number of biopsies performed, as well as in reducing the diagnosis of clinically insignificant disease while maintaining or improving the diagnosis of clinically significant PCa (cs-PCa). Moreover, it shows a reduction in the diagnosis of ins-PCa, and therefore, of overdiagnosis, when using MRI-TBx without sacrificing performance in the diagnosis of cs-PCa.
2. Brown LC, Ahmed HU, Faria R, et al (2018) Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone: The PROMIS study. Health Technol Assess (Rockv). https://doi.org/10.3310/hta22390.
3. Rouvière O, Puech P, Renard-Penna R, et al (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol. https://doi.org/10.1016/S1470-2045(18)30569-2
4. Kasivisvanathan V, Rannikko AS, Borghi M, et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777. https://doi.org/10.1056/NEJMoa1801993
5. Van der Leest M, Cornel E, Israël B, et al (2019) Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naïve Men with Elevated Prostate-specific Antigen: A Large Prospective Multicenter Clinical Study. Eur Urol. https://doi.org/10.1016/j.eururo.2018.11.023.
6. European Association Urology (2020) European Association of Urology Guidelines. 2020 Edition. European Association of Urology Guidelines Office, Arnhem, The Netherlands.
7. Sighinolfi MC, Rocco B (2019) Re: EAU Guidelines: Prostate Cancer 2019. Eur. Urol.
8. Costa DN, Goldberg K, Leon AD de, et al (2019) Magnetic Resonance Imaging–guided In-bore and Magnetic Resonance Imaging-transrectal Ultrasound Fusion Targeted Prostate Biopsies: An Adjusted Comparison of Clinically Significant Prostate Cancer Detection Rate. Eur Urol Oncol 2:397–404. https://doi.org/10.1016/j.euo.2018.08.022
9. Masperi A, Manual Versus Robotic Assisted MRI Guided Prostate Biopsies, RSNA 2018, SSQ10-03.
10. Drost FJH, Osses D, Nieboer D, et al (2020) Prostate Magnetic Resonance Imaging, with or Without Magnetic Resonance Imaging-targeted Biopsy, and Systematic Biopsy for Detecting Prostate Cancer: A Cochrane Systematic Review and Meta-analysis. Eur. Urol.
11. Goldberg H, Ahmad AE, Chandrasekar T, et al (2020) Comparison of Magnetic Resonance Imaging and Transrectal Ultrasound Informed Prostate Biopsy for Prostate Cancer Diagnosis in Biopsy Naïve Men: A Systematic Review and Meta-Analysis. J Urol 203:1085–1093. https://doi.org/10.1097/ju.0000000000000595.
12. Somford DM, Hoeks CM, Hulsbergen-Van De Kaa CA, et al (2013) Evaluation of diffusion-weighted MR imaging at inclusion in an active surveillance protocol for low-risk prostate cancer. Invest Radiol. https://doi.org/10.1097/RLI.0b013e31827b711e.
13. Vourganti S, Rastinehad A, Yerram NK, et al (2012) Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol. https://doi.org/10.1016/j.juro.2012.08.025.
14. D’Amico AV. (2013) Personalizing the management of men with intermediate-risk prostate cancer. Eur Urol 64:903–904. https://doi.org/10.1016/j.eururo.2013.03.038.
15. Padhani AR, Barentsz J, Villeirs G, et al (2019) PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway. Radiology. https://doi.org/10.1148/radiol.2019182946.
16. Pesapane F, Patella F, Fumarola EM, et al (2017) Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the Periferic Prostate Cancer Detection and Stratification. Med Oncol. 2017 Mar;34(3):35. doi: 10.1007/s12032-017-0892-7.
17. Pesapane F, Patella F, Fumarola EM et al (2018), The prostate cancer focal therapy. Gland Surg. 2018 Apr;7(2):89-102. doi: 10.21037/gs.2017.11.08.
18. Ahdoot M, Wilbur AR, Reese SE, et al (2020) MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med. https://doi.org/10.1056/NEJMoa1910038.
19. Hambrock T, Hoeks C, Hulsbergen-Van De Kaa C, et al (2012) Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. Eur Urol. https://doi.org/10.1016/j.eururo.2011.08.042
20. Hambrock T, Hoeks C, Hulsbergen-Van De Kaa C, et al (2012) Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. Eur Urol. https://doi.org/10.1016/j.eururo.2011.08.042.
21. Kılıc M, Vural M, Coskun B, et al (2019) Accuracy of Sampling Prostate Imaging Reporting and Data System 4–5 Index Lesions Alone by Magnetic Resonance Imaging–guided In-bore Biopsy in Biopsy-naive Patients Undergoing Radical Prostatectomy. Eur Urol Focus. https://doi.org/10.1016/j.euf.2019.04.010
22. Bass EJ, Orczyk C, Grey A, et al (2019) Targeted biopsy of the prostate: does this result in improvement in detection of high-grade cancer or the occurrence of the Will Rogers phenomenon? BJU Int. https://doi.org/10.1111/bju.14806