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The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
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Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
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[Systematic or targeted fusion-guided biopsy].

Analena Elisa Handke1,2, Peter Albers3,4, Lars Schimmöller5

  • 1Urologische Klinik, Universitätsklinikum Essen, Essen, Deutschland.

Urologie (Heidelberg, Germany)
|March 21, 2023
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Summary

Multiparametric MRI (mpMRI)-guided targeted and systematic biopsy is the recommended standard for prostate cancer diagnosis. Combining these methods improves detection of significant prostate cancer (PCa) while reducing detection of low-risk disease.

Keywords:
Multiparametric MRIOverdiagnosisProstate cancerProstate-specific antigenRisk stratification

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Area of Science:

  • Urology
  • Oncology
  • Radiology

Context:

  • Early prostate cancer (PCa) detection poses challenges, often leading to overdiagnosis of low-risk disease.
  • Systematic biopsy alone has limitations in detecting significant PCa and may increase detection of clinically insignificant PCa.
  • Recent data suggest similar issues in PCa screening contexts.

Purpose:

  • To review and discuss the efficacy of systematic biopsy versus combined multiparametric MRI (mpMRI)-guided targeted and systematic biopsy for PCa diagnosis.
  • To evaluate these methods in both clinically suspected cancer cases and PCa screening scenarios.
  • To assess the role of multivariable risk stratification in improving PCa diagnosis.

Summary:

  • Multiparametric MRI (mpMRI) as a reflex test with targeted biopsy alone can halve the detection of clinically nonsignificant tumors.
  • Combining mpMRI-guided targeted biopsy with systematic biopsy improves sensitivity for detecting higher-grade cancers (ISUP grade groups ≥2).
  • Similar improvements in detection sensitivity are observed in PCa screening with a PSA cut-off of 3 ng/ml.

Impact:

  • Current evidence does not support targeted fusion biopsy alone for PCa diagnosis.
  • The combination of mpMRI-guided targeted and systematic biopsy remains the recommended standard for accurate PCa diagnosis.
  • This combined approach optimizes the detection of clinically significant prostate cancer, improving patient outcomes.