Abstract
Simple SummaryProstate cancer is one of the most common cancers in men. Traditionally, prostate cancer is diagnosed via transrectal ultrasound-guided prostate biopsy, using a systematic random template. Using multiparametric magnetic resonance imaging, lesions suspicious for prostate cancer can be identified, and subsequently targeted on biopsy, allowing for increased diagnostic accuracy. This article reviewed the current literature surrounding various types of targeted biopsy, such as transperineal biopsy, allowing for comparison not only between targeted biopsy and systematic biopsy, but also between different varieties of targeted biopsy.In this review, we evaluated literature regarding different modalities for multiparametric magnetic resonance imaging (mpMRI) and mpMRI-targeted biopsy (TB) for the detection of prostate cancer (PCa). We identified studies evaluating systematic biopsy (SB) and TB in the same patient, thereby allowing each patient to serve as their own control. Although the evidence supports the accuracy of TB, there is still a proportion of clinically significant PCa (csPCa) that is detected only in SB, indicating the importance of maintaining SB in the diagnostic pathway, albeit with additional cost and morbidity. There is a growing subset of data which supports the role of TB alone, which may allow for increased efficiency and decreased complications. We also compared the literature on transrectal (TR) vs. transperineal (TP) TB. Although further high-level evidence is necessary, current evidence supports similar csPCa detection rate for both approaches. We also evaluated various TB techniques such as cognitive fusion biopsy (COG-TB) and in-bore biopsy (IB-TB). COG-TB has comparable detection rates to software fusion, but is operator-dependent and may have reduced accuracy for smaller lesions. IB-TB may allow for greater precision as lesions are directly targeted; however, this is costly and time-consuming, and does not account for MRI-invisible lesions.
Highlights
There is a large body of data, including a recent randomized trial, demonstrating superior clinically significant prostate cancer (PCa) detection for MRI-informed targeted biopsy (TB) compared to systematic biopsy (SB) [3] (Table 1)
For patients with a region of interest (ROI) grade ≥ 3 on an internal scoring system for multiparametric magnetic resonance imaging (mpMRI), they determined that TB alone identified clinically significant PCa (csPCa) (GG ≥ 2) in 229/825 cases
Gleason upgrading on SB compared to results on TB was seen in 32% of patients, of which 9% were upgraded to csPCa, compared to 26% of patients with upgrading on TB
Summary
With the advent of advanced imaging techniques and image-guided biopsy for the detection of prostate cancer (PCa), there have been innumerable series evaluating the efficacy of both multiparametric magnetic resonance imaging (mpMRI) and mpMRI-targeted biopsy (TB). The main three approaches to TB include cognitive fusion (COG-TB), software-based fusion (FUS-TB), and in-bore or in-gantry TB (IB-TB). COG-TB involves an operator cognitively evaluating previously obtained mpMRI images and using anatomic landmarks to target suspicious lesions on real-time transrectal ultrasound (TRUS). This strategy relies heavily on operator skill [1]. FUS-TB utilizes software to overlay previously obtained mpMRI images on real-time TRUS images, prior to sample acquisition. IB-TB is performed in the MRI suite with real-time MRI guidance [2]
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