All patients (n=235) were biopsy naïve and underwent targeted plus standard biopsy if a region of interest was identified or standard biopsy alone if no region of interest noted on mpMRI. A total of 68 (69%) patients underwent radical prostatectomy for which histopathology results were available. Median age was 54 years, median PSA 6.1 with mpMRI results identifying suspicious lesions (PIRADS 4-5) in 52 (79%) patients. Interestingly, targeted biopsy resulted in 89.4% of patients having clinically significant disease at 89.4% with sensitivity and specificity of 94.5% and 57.1%, respectively. Based on this albeit limited series of patients with potential for inherent selection bias due to retrospective design, mpMRI improved the detection of clinically significant disease and supports the recent randomized controlled trial suggesting benefit to mpMRI followed by targeted with standard vs. standard biopsy alone among patients with high index of clinical suspicion for prostate cancer. This begs the question of what are determinants for clinical suspicion and the need for standardization based on the level one evidence of who should be screened but also which patients should then be considered to undergo further evaluation to discern if they harbor clinically significant rather than indolent prostate cancer. Combining comorbidity evaluation and life expectancy are other important factors. Notwithstanding, cost effectiveness studies are needed in addition to comparative effectiveness research among different targeted biopsy platforms in order to determine the platform which has the highest likelihood of detecting clinically significant cancer, can be standardized and is most cost effective modality at detecting prostate cancer.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
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.