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Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach?

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Abstract

Purpose

To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP).

Methods

We performed a literature search of peer-reviewed English language articles using PubMed and the words “prostate” AND “biopsy”. Web search was implemented by manual search.

Results

Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx–TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues.

Conclusion

The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.

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Acknowledgements

The members of the EAU-YAU Prostate Cancer Working Party: G. Ploussard, P. J. L. De Visschere, I. Tsaur, D. Tilki, P. Ost, G. Gandaglia, R. C. N. Van Den Bergh, C. Surcel, A. Kretschmer, I. Heidegger, M. Valerio, H. Borgmann, R. Mathieu.

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Authors and Affiliations

  1. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy

    Giancarlo Marra

  2. Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France

    Guillaume Ploussard

  3. Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Jurgen Futterer

  4. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Massimo Valerio

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  1. Giancarlo Marra
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  2. Guillaume Ploussard
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  3. Jurgen Futterer
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  4. Massimo Valerio
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Consortia

the EAU-YAU Prostate Cancer Working Party

  • G. Ploussard
  • , P. J. L. De Visschere
  • , I. Tsaur
  • , D. Tilki
  • , P. Ost
  • , G. Gandaglia
  • , R. C. N. Van Den Bergh
  • , C. Surcel
  • , A. Kretschmer
  • , I. Heidegger
  • , M. Valerio
  • , H. Borgmann
  •  & R. Mathieu

Contributions

Protocol/project development: GM, MV; Data collection or management: GM; Data analysis: GM, MV; Manuscript writing: GM; Manuscript editing and review for important intellectual contents: MV, GP, JF.

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Correspondence to Giancarlo Marra.

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All authors declare no conflict of interest.

Additional information

The members of the EAU-YAU Prostate Cancer Working Party are listed in acknowledgements section.

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Marra, G., Ploussard, G., Futterer, J. et al. Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach?. World J Urol 37, 277–287 (2019). https://doi.org/10.1007/s00345-018-02622-5

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  • DOI: https://doi.org/10.1007/s00345-018-02622-5

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