Buenos Aires, Argentina (UroToday.com) MRI use in prostate cancer has increased in recent years. Moreover, several organizations including the AUA have endorsed the utility of multiparametic MRI (mpMRI) in patients who have prior negative prostate biopsy with clinical suspicion of disease to then perform targeted biopsy if needed. Discussants argued the pros and cons of mpMRI and whether it can replace systematic biopsy in men with elevated PSA. Boris Hadaschik, University Hospital at Heidelberg, presented the PROMIS study which is a randomized controlled trial assessing utility of mp MRI mapping biopsy (up to 80 cores in some patients) versus systematic 12 core biopsy which determined increased detection of cancer and clinically significant cancer with increased number of cores obtained. Interobserver agreement for mpMRI was 80%. The sensitivity and specificity of mpMRI v standard biopsy was 48 v 93% and 74 v 89%, respectively. mpMRI can detect over 90% of clinically significant cancer. However, given multifocality of prostate cancer mpMRI may miss some of these lesions. It is imperative to have a dedicated team including dedicated urologists, pathologists and radiologists to optimize outcomes. Given the recent level one evidence, mpMRI aids in detecting clinically significant cancer when used in combination with targeted and standard biopsy, however, at present there is lack of level one evidence to recommend mpMRI alone to replace prostate biopsy.
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Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.