Prostate cancer (PCa) is a singular disease owing to absence of imaging technique able to detect suspicious glandular area at higher risk of disease. Nowadays, Magnetic Resonance Imaging (MRI) has been used as a way to detect PCa and simplify targeting prostate biopsy (PB). The aim of this study is to review the most recent data regarding prostate biopsy and MRI guided PB.
A comprehensive systematic MEDLINE search was performed in December 2017 for English language reports by using the following terms: prostate biopsy, multiparametric magnetic resonance imaging, prostate cancer, transrectal and transperineal ultrasound, target biopsy. Previous published reviews and recent published original articles were preferred in order to meet our study scope.
Retrieved studies of greater interest were reported in two main sections: standard prostate biopsy and MRI guided prostate biopsy. Thus, the main items regarding PB were analyzed. Briefly, clinical suspicious of PCa is based on prostate specific antigen level and digital rectal examination findings although a PCa risk assessment through a nomogram risk calculator is nowadays advised. Ten-eighteen biopsy cores, depending on prostate volume, and peripheral sampling seem the suitable scheme for initial biopsy while a saturation template (>20 cores including transitional prostate area) is widely used in case of repeat PB. Performing a local anesthesia is now the standard of care with several available techniques. No difference exists in term of PCa detection rate between transperienal and transrectal approaches however the last one is mostly used. The use of MRI guided biopsy seems to be a promising imaging technique able to identify an index lesion at higher suspicious of PCa. In particular, MRI shows a higher accuracy than standard PB in the detection of clinically significant PCa. No general consensus exists on which MRI guided biopsy should be used with three different ways currently available to take biopsy core. However, the initial MRI cognitive PB has been replaced by fusion MRI technique to guide biopsy with reproducible results. Absence of standardization founded in initial MRI studies has been recently revised by introduction of common criteria to assess PCa presence on MRI.
PB is the cornerstone in diagnosis and management of PCa. Although ultrasound transrectal and transperineal prostate biopsy are still considered as the standard, emerging data confirmed the role of MRI guided biopsy, particularly in patients with a previous negative biopsy. However, MRI costs and the moderate inter-reader reproducibility of the exam are still significant concerns requiring further studies to define the right role of MRI in the PCa diagnostic pathway.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2018 Mar 28 [Epub ahead of print]
Antonio Cicione, Cosimo DE Nunzio, Stefano Manno, Rocco Damiano, Alessandro Posti, Estevao Lima, Andrea Tubaro, Filippo Balloni
Urology Unit, Ospedale Città di Castello, ASL Umbria 1, Città di Castello, Italy - ., Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy., Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy., Urology Unit, Ospedale Città di Castello, ASL Umbria 1, Città di Castello, Italy., Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.