Multiparametric-MRI-Guided Biopsy in the Era of Precision Medicine

Abstract

Objective: Technical improvements in prostate magnetic resonance imaging (MRI) have resulted in the use of MRI to target prostate biopsy. This allowed urologists to progress from blind biopsies to target biopsies with a better performance in prostate cancer (PC) diagnosis. We herein review the current status of Magnetic Resonance Imaging Guided Biopsy (MRGB) for the detection of PC.

Methods: A systematic review of the literature was conducted using PubMed, Embase and Cochrane using the search criteria: "PC and MRI/US fusion" or "PC and guided biopsy" or "PC and multiparametric MRI" or "PC and MRI guided prostate biopsy". Four reviewers coindependently assessed 8228 records and 38 records directly comparing MRGB with transrectal ultrasoundguided biopsy (TRUS) were chosen. However, a risk bias assessment was not performed.

Results: In naive patients, MRGB detected similar PC (51% vs 47.5%) than TRUS, more significant PC (SPC [41% vs 33%]) and less not significant PC (NSPC [7.7% vs 14.5%]) with less number of biopsies. In patients with previous negative prostate biopsy MRGB detected more PC (46.3% vs 26.6%), more SPC (32 % vs 16%) and less NSPC (9.5% vs 14.5%) than TRUS, with less number of biopsies. Besides, in previous biopsy patients group MRGB is better at detecting anterior PC than TRUS.

Conclusion: MRGB increased PC detection in patients with previous biopsies and also increased SPC detection at the expense of decreasing NSPC detection in both groups of patients with fewer biopsies when compared with TRUS. These results demonstrate the value of MRGB in PC diagnosis.