Developments in MRI-Targeted Prostate Biopsy

Joseph M. Norris; Adam Kinnaird; Daniel J. Margolis; Anwar R. Padhani; Jochen Walz; Veeru Kasivisvanathan

Disclosures

Curr Opin Urol. 2020;30(1):1-8. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: MRI-targeted prostate biopsy may be an attractive alternative to systematic biopsy for diagnosing clinically significant prostate cancer. In this narrative review, we discuss the new developments that have occurred in the advancement of MRI-targeted prostate biopsy, over the past 24 months.

Recent findings: MRI-targeted biopsy offers enhanced diagnostic accuracy, when compared with the current standard of care of systematic transrectal ultrasound-guided (TRUS) biopsy, by decreasing the overall number of biopsies needed, maintaining or improving significant prostate cancer detection, and reducing the detection of clinically insignificant prostate cancer. The necessity of combining systematic prostate biopsy with MRI-targeted biopsy is still debated. The use of MRI--ultrasound fusion systems for lesion-targeting is promising for optimizing significant cancer detection, but recent evidence suggests that additional cognitive biopsy cores are still useful in detecting additional cancers.

Summary: MRI-targeted biopsy in selected men with positive MRI offers a number of benefits over systematic biopsy in all men, and as such, may emerge as the new standard of care for the diagnosis of clinically significant prostate cancer.

Introduction

Multiparametric MRI (mpMRI) has become an increasingly important element of the prostate cancer diagnostic pathway, enabling enhanced risk stratification compared with traditional approaches, such as systematic transrectal ultrasound (TRUS)-guided prostate biopsy.[1–13] MRI-targeted biopsy (MRI-TB) is where the conduct of a biopsy is influenced by knowledge of where suspicious areas are on a prior MRI scan, and biopsy cores are directed only at the MRI-suspicious areas (Figure 1). Potential advantages of MRI-TB include increasing rates of detection of clinically significant prostate cancer, decreasing the number of required biopsies, and reducing detection and treatment of clinically insignificant prostate cancer.[13–18] Recent publications of high quality of evidence compliant with the Standards of Reporting for MRI-targeted Biopsy (START) guidance[8] have enabled MRI-TB to be incorporated into national and international clinical guidelines for prostate cancer diagnosis in biopsy-naïve and prior negative biopsy men.[8,11,19–22] The aim of this review is to highlight the most important recent developments that have occurred with MRI-TB, and to consider key areas for future research.

Figure 1.

MRI-targeted biopsy using an MRI-fusion ultrasound platform. Identifying a suspicious prostate lesion with mpMRI, using the T2W sequence (a), ADC map (b) and the DWI sequence (c). Three-dimensional reconstruction (d) and contouring of the suspicious lesion on the T2W sequence (f), with image registration using real-time ultrasound (e–h) to enable MRI-TB.

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