Should systematic prostatic biopsies be discontinued?

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Systematic biopsies are used alongside targeted biopsies due to a 15-20% miss rate for clinically significant cancers.
• Concerns about missed cancers influence interventions like systematic biopsies and preference for whole-gland treatment.

Purpose of the Study:

• To review genomic and clinical data on MRI-invisible prostate lesions.
• To evaluate the clinical significance and genomic profile of MRI-invisible prostate cancers.

Main Methods:

• Review of recent genomic and clinical studies.
• Analysis of data linking genetic aberrations to cancer visibility, invasiveness, and metastasis.

Main Results:

• MRI-invisible prostate lesions, despite "clinically significant" histology, are genomically and clinically favorable.
• Genetic aberrations driving cancer visibility are also linked to invasiveness; invisible cancers are typically indolent.

Conclusions:

• Systematic biopsies can be abandoned for most patients.
• Monitoring with imaging and repeat targeted biopsies for MRI progression is a preferred strategy with patient benefits.