Guillaume Ploussard1,2, Hendrik Borgmann3, Alberto Briganti4, Pieter de Visschere5, Jurgen J Fütterer6, Giorgio Gandaglia4, Isabel Heidegger7, Alexander Kretschmer8, Romain Mathieu9, Piet Ost10, Prasanna Sooriakumaran11, Cristian Surcel12, Derya Tilki13, Igor Tsaur3, Massimo Valerio14, Roderick van den Bergh15. 1. Department of Urology, Saint Jean Languedoc/La Croix du Sud Hospital, 20, route de Revel, 31400, Toulouse, France. g.ploussard@gmail.com. 2. IUCT-O, Avenue Joliot-Curie, 31000, Toulouse, France. g.ploussard@gmail.com. 3. Department of Urology, University Hospital of Mainz, Mainz, Germany. 4. Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy. 5. Department of Radiology, Ghent University Hospital, Ghent, Belgium. 6. Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands. 7. Department of Urology, University Hospital of Innsbrück, Innsbrück, Austria. 8. Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany. 9. Department of Urology, CHU Rennes, Rennes, France. 10. Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium. 11. Department of Urology, University College London Hospital, London, UK. 12. Department of Urology, Fundeni Clinical Institute, Bucharest, Romania. 13. Department of Urology, Martini Klinik, Hamburg, Germany. 14. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 15. Department of Urology, Antonius Hospital, Utrecht, The Netherlands.
Abstract
PURPOSE: The diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI. METHODS: A review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting. RESULTS: Evidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques. CONCLUSION: A pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.
PURPOSE: The diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI. METHODS: A review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting. RESULTS: Evidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques. CONCLUSION: A pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.
Entities:
Keywords:
Biopsy; Detection; Fusion; Magnetic resonance imaging; Prostate cancer; Targeted
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