Targeted prostate biopsy using magnetic resonance imaging-ultrasound fusion

Prostate cancer is the second most common cancer among men worldwide, with an estimated 1.1 million new diagnoses and over 300,000 deaths reported in 2012 by the World Health Organization. A recent 5-year prevalence of the disease was nearly four million, far exceeding all other malignancies in men. Because of these numbers, efforts to improve early detection, accurate assessment of disease burden, and appropriate treatment options are important public health priorities. However, the basic tool for diagnosis, transrectal ultrasound (TRUS) guided biopsy, is flawed by failure to detect many serious cancers (>30% false negative rate)and over-detection of nonserious cancers. Multiparametric magnetic resonance imaging (mpMRI) of the prostate empowers the clinician to identify tumors that would otherwise be missed by conventional techniques and to record the precise locations of positive cores through targeted biopsy using MRI‑ultrasound (MRI‑US) fusion. As mpMRI advances and the level of experience for the user grows, the correlation between the level of suspicion for a prostate lesion and the MRI‑US fusion targeted biopsy revealing malignancy improves. Consequently, the concordance among the targeted biopsy and surgical pathology rises. This in turn, allows the patient and provider to be confident that the therapeutic plan decided upon is representative of the true disease state.