EAU 2017: State-of-the-art lecture : What do urologists need to know about mpMRI targeted biopsy?

London, England (UroToday.com) Dr. Boxler presented his opinion on what urologists need to know about multiparametric MRI (mpMRI) targeted biopsy. According to his presentation, as urologists, we expect that the prostate imaging we use can effectively help us exclude cancer, provide us with a target which can be biopsied and enable us to follow patients on active surveillance in a safe and accurate manner. From the biopsy of the targeted lesion, we expect to have a higher detection rate of significant cancer with a lower upgrading and upstaging rate, with less cores taken and to lower the re-biopsy rate.

Results of the mpMRI target biopsy critically depend on the MRI radiologist, the fusion system urologist and the pathologist. Together, these three key players are essential for accurate, highly sensitive and specific results.

Studies have demonstrated that the negative predictive value of mpMRI is between 63-98% with an over 90% sensitivity rate, making it an overall reliable tool. Target biopsy can be done in 3 ways: cognitively (using US/MRI), using MRI (in-bore) and using MRI/US fusion.

In the MRI/US fusion modality, the route of the biopsy (trans-rectal or transperineal) does not have a major effect on the results with being able to reach every region in the prostate in both routes, including the anterior region. The type of needle does not change the results either and should not be a major factor in that regard. Specimens should be collected and stored separately for better localization and more accurate results. To date, targeted biopsies should still be done in addition to systematic biopsies until future trials show otherwise. Although mpMRI targeted biopsy takes longer time and costs more than a regular biopsy, a highly motivated team can reduce time significantly with considerably better results. Improvements in mpMRI targeted biopsies should include standardization of the mpMRI, comparison of different biopsy platforms and standardization of the routine interpretation of results.

In summary, mpMRI targeted biopsy allows us to detect and accurately target lesions with high likelihood of significant cancer, in all possible routes, with better pathological results and a better ability to confidently counsel our patients.

Speaker(s): Silvan Boxler, Bern (CH)

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto
Twitter: @GoldbergHanan

at the #EAU17 - March 24-28, 2017- London, England