The challenge of prostate biopsy guidance in the era of mpMRI detected lesion: ultrasound-guided versus in-bore biopsy

Abstract

The current recommendation in patients with a clinical suspicion for prostate cancer is to perform systematic biopsies extended with targeted biopsies, depending on mpMRI results. Following a positive mpMRI [i.e. Prostate Imaging Reporting and Data System (PI-RADS) ≥3], three targeted biopsy approaches can be performed: visual registration of the MRI images with real-time ultrasound imaging; software-assisted fusion of the MRI images and real-time ultrasound images, and in-bore biopsy within the MR scanner. This collaborative review discusses the advantages and disadvantages of each targeting approach and elaborates on future developments. Cancer detection rates seem to mostly depend on practitioner experience and selection criteria (biopsy naïve, previous negative biopsy, prostate-specific antigen (PSA) selection criteria, presence of a lesion on MRI), and to a lesser extent dependent on biopsy technique. There is no clear consensus on the optimal targeting approach. The choice of technique depends on local experience and availability of equipment, individual patient characteristics, and onsite cost-benefit analysis. Innovations in imaging techniques and software-based algorithms may lead to further improvements in this field.

An optimized prostate biopsy strategy in patients with a unilateral lesion on prostate magnetic resonance imaging avoids unnecessary biopsies

“…Although no clear advantage for either cognitive TBx or software-assisted fusion TBx, both can lead to inaccuracies due to registration errors. 25 It is advisable to take these factors into careful consideration before opting for a specific biopsy strategy. To ensure the best quality of care for an individual patient, biopsy strategies should be based on locally available expertise and site-specific biopsy outcome evaluation.…”

Prostate Cancer Diagnosis: Biopsy Approaches

“…Some evidence suggests improved detection of clinically significant prostate cancer and reduced detection of insignificant prostate cancer utilizing in-bore MRI compared with TRUS-MR Fusion (134). However, systematic reviews have shown none of the three above methods to be superior, though one did show a trend in favor of MRI-ultrasound fusion over cognitive targeting, at present there remains no clear consensus (135)(136)(137). Of note, there appears to be no additional complications seen in utilizing the fusion or in bore approach (138,139).…”

Prostate Cancer Detection Rate of Manually Operated and Robot-assisted In-bore Magnetic Resonance Imaging Targeted Biopsy

“…Magnetic resonance imaging (MRI) targeted prostate biopsy (MRGB) is based on MRI, by visualizing the exact lesion of interest, contrary to the systematic sampling with TRUS biopsy [4] . MRGB can be performed as cognitive MRI guided TRUS biopsy, MRI TRUS-fusion biopsy, or MRI in-bore biopsy, all of which have similar detection rates (DRs) for PC [5] , [6] . During in-bore MRGB, the patient remains prone in the MRI scanner, while the biopsy is performed transrectally [6] .…”

“…MRGB can be performed as cognitive MRI guided TRUS biopsy, MRI TRUS-fusion biopsy, or MRI in-bore biopsy, all of which have similar detection rates (DRs) for PC [5] , [6] . During in-bore MRGB, the patient remains prone in the MRI scanner, while the biopsy is performed transrectally [6] .…”