MRI- and MRI/TRUS fusion-guided biopsy: an up-to-date review

The first issue of the new journal Urology Practice includes a very nice review of the use of MRI imaging in the evaluation, diagnosis, and biopsy of men with prostate cancer.

Raskolnikov et al. (the NCI prostate cancer research group headed by Peter Pinto) discuss the three basic types of method by which MRI imaging can be used to direct the biopsy process of men suspect to have localized prostate cancer. Because this is a new journal, the full text of their article is available to all potential readers (at least for a while), so support group leaders and other educators might like to take the opportunity to print out a copy of this review for their files.

Raskolnikov and his colleagues come clearly down on multiparametric MRI/TRUS fusion-guided biopsy as the technology of the future, but they are also clear that more research needs to be done in order to understand the accuracy of this technology and the degree to which it can demonstrate the presence of specific types of clinically significant prostate cancer (or clinically insignificant cancer) in specific individuals.

In the conclusion to their article they emphasize three critical points:

  • “The radiology community must develop a robust, uniform grading and reporting system” for prostate cancer when assessed using multiparametric MRI techniques.
  • “Prospective, randomized studies are needed to compare fusion platforms.”
  • “Existing models for [prostate cancer] prognostication based on the results of random biopsies may need to be revisited.”

In the last case, this means that things like the Kattan nomograms will need to be radically updated if most patients are going to start getting evaluated through the use of multiparametric MRI/TRUS fusion-guided biopsies … but we suspect that widespread use of this type of technology may be 10 to 15 years away in the future for the majority of American men at risk for prostate cancer.

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