Should Prebiopsy Multiparametric Magnetic Resonance Imaging be Offered to All Biopsy-naïve Men Undergoing Prostate Biopsy?

Abstract

Transrectal ultrasound-guided biopsy (TRUSB) is considered the gold standard in the diagnosis of prostate cancer in men at higher risk of prostate cancer according to nomograms. Many organizations including the European Association of Urology (EAU) recommend an extended systematic sextant biopsy in men at higher risk of prostate cancer, with an overall cancer detection rate of 30–40% [1]. Because the biopsies are not targeted, TRUSB can overdiagnose clinically indolent and insignificant prostate cancer while missing a large number of clinically significant cancers [2,3]. In the past decade, advances in imaging have enabled us to localize areas suspicious for prostate cancer, which can then be targeted during biopsy. One of these technologies, multiparametric magnetic resonance imaging (MP-MRI), has recently gained [1_TD$DIFF] popularity [3_TD$DIFF]for performing targeted biopsy (TB) using cognitive or MP-MRI/US fusion techniques [4,5]. The initial trials demonstrated superior cancer detection rates for TB used in combination with systematic TRUSB. While MP-MRI TB showed greater accuracy in identifying clinically significant prostate cancer when compared to systematic TRUSB in biopsy-naive men, this difference was not statistically significant [6,7]. Although these results are promising, there are concerns regarding the implementation of MP-MRI TB in clinical practice. First, themajority of published data have come from centers with high referral rates and extensive experience with MP-MRI. These results may not be reproducible in centers with less experience. Second, a standard universal definition of MPMRI–positive results is yet to be determined. Third, there is