A 68-year-old man with a history of a previous negative prostate biopsy and rising PSA undergoes a multi-parametric MRI of prostate, which demonstrates a high-risk lesion in the transitional zone of the prostate.
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Multiparametric MRI of the prostate has been gaining significant clinical momentum in prostate cancer diagnosis, surveillance, and biopsy guidance. Indeed, recent data from the group at the National Cancer Institute suggest that targeted biopsies using ultrasound/MR-guided fusion technology affords unprecedented detection of high-risk prostate cancer.1
A targeted biopsy resulted in upgrading in 32% of cases when compared with results of a 12-core standard template performed during the same session. Only 8% of high-risk tumors, as defined by the investigators, were detected by the 12-core biopsy and not targeted biopsy.
Similar results have been demonstrated by other investigators. Indeed, a recent report from a multi-center trial in Europe and Australia indicates that diagnosis of low-risk disease can be reduced by nearly 90% in patients undergoing first time biopsy.2
These data are certainly not yet robust enough to abandon 12-core template biopsy completely; however, they do suggest that the field of urology is getting closer to identifying a strategy to minimize overdiagnosis of low-risk disease without missing high-risk tumors.
Answer: Chances of diagnosing high-grade disease are raised, while risks of overdiagnosing low-risk disease are lowered.
The case was prepared by Alexander Kutikov, MD, FACS, Associate Professor of Urologic Oncology, Fox Chase Cancer Center, Philadelphia.
- Siddiqui MM, Rais-Bahrami S, Truong H, et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus sytematic 12-core transrectal ultrasound biopsy.” Eur Urol 2013;64:713-719.
- Pokorny MR, de Rooij M, Duncan E, et al. Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. Eur Urol 2014 (Epub ahead of print).