Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 4: Transperineal Magnetic Resonance–Ultrasound Fusion Guided Biopsy Using Local Anesthesia

Diagnostic Performance of a Magnetic Resonance Imaging-directed Targeted plus Regional Biopsy Approach in Prostate Cancer Diagnosis: A Systematic Review and Meta-analysis

“…With this recommended biopsy approach, both the ipsilateral and contralateral lobes are still biopsied in a predominantly random systematic fashion, which is unique in the diagnostic process for solid-organ cancers [2] , [3] . Most men benefit diagnostically from increased (perilesional/regional) sampling of the index lesion, while complementary SBx can increase unnecessary biopsy cores, potential harms, and patient burdens, and identify indolent cancers in men with false-positive MRI scans [4] , [5] , [6] , [7] , [8] .…”

Remote surgical education using synthetic models combined with an augmented reality headset

“…Although advanced training is still done in animal or cadaveric models, many centers have moved away from these in favor of simulators that attempt to mimic live surgical conditions [ 11 ]. A variety of surgical simulators have been developed and tend to use procedure-oriented platforms [ 3 ]. For task-oriented procedures, box trainers are favored.…”

“…Cadaver and animal laboratories can be used to enhance skills but lack disease-specific pathology and have limited usefulness for training on many of the newer medical devices recently introduced. For example, these models are not applicable to training on a prostate fusion biopsy platform where more realistic tissue with pathology is needed to accurately teach both image co-registration and the biopsy procedure [ 3 ]. While animal laboratories are often used for laparoscopy training, ethical considerations and the lack of disease-specific anatomy create significant barriers to their continued use and in optimizing the hands-on experience [ 4 ].…”

Quality checkpoints in the MRI-directed prostate cancer diagnostic pathway

“…The latter approach requires the prostate gland to be segmented on each modality for image fusion, and the target to be outlined on the diagnostic MR images 51 . When MRI is positive (PI-RADS ≥3), systematic sampling of the background gland is recommended in addition to 2-4 target biopsies, with 12 cores typically taken through transrectal biopsy and up to 24 cores taken through transperineal approaches 2,52,53 . When target cores are negative, tumours have been shown to be localised in areas adjacent to the target, supporting the benefit of taking additional "perilesional" or "focal saturation" biopsies around the tumour-suspicious region 8,51,54,55 ; thus, MRI-directed sampling could potentially limit the overall number of cores required.…”