MR-Guided Prostate Biopsy

Abstract

In men with an elevated prostate-specific antigen and/or abnormal digital rectal examination biopsy is the gold standard for prostate cancer (PCa) diagnosis. Random systematic transrectal ultrasound guided prostate biopsy (TRUSGB) is the most widely applied and available PCa diagnosis method. Detection rates of PCa in random systematic TRUSGB do not exceed 44 and 22% for the first and second biopsy session, respectively (Djavan et al. Eur Urol 42:93–103, 2002; Presti et al. J Urol 169:125–129, 2003). Consequently other biopsy methods have been explored. One of these methods is MR guided biopsy (MRGB) of the prostate which has detection rates after previous negative TRUSGB sessions of between 38 and 59% (Anastasiadis et al. Eur Urol 50:738–748; Beyersdorff et al. Radiology 234:576–658; Engelhard et al. Eur Radiol 16:1237–1243; Franiel et al. Radiology 259:162–172; Hambrock et al. Invest Radiol 43:686–694; Roethke et al. World J Urol (in press)). These rates are higher compared to repeat TRUSGB. MRGB typically consists of two sessions. In the first session a diagnostic multi-parametric MR of the prostate is acquired and subsequently cancer suspicious regions (CSR) are determined. In the second session these CSR will be targeted for MRGB. In conclusion, MRGB has a high PCa detection rate in patients with previous negative TRUSGB sessions. For this reason MRGB will probably become more and more available in daily practice. However, the lack of standard protocols for MR imaging of the prostate is an important issue. For the optimal biopsy technique there is still more research necessary. Robotics may optimize MRGB regarding target accuracies and procedure time.