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MINERVA UROLOGICA E NEFROLOGICA

Rivista di Nefrologia e Urologia


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Minerva Urologica e Nefrologica 2018 Mar 28

DOI: 10.23736/S0393-2249.18.03048-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

An update on prostate biopsy in the era of Magnetic Resonance Imaging

Antonio CICIONE 1 , Cosimo DE NUNZIO 2, Stefano MANNO 3, Rocco DAMIANO 3, Alessandro POSTI 1, Estevao LIMA 4, Andrea TUBARO 2, Filippo BALLONI 1

1 Urology Unit, Ospedale Città di Castello, ASL Umbria 1, Città di Castello, Italy; 2 Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy; 3 Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy; 4 Life and Health Sciences Research Institute, University of Minho, Braga, Portugal


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INTRODUCTION: Prostate cancer (PCa) is a singular disease owing to absence of imaging technique able to detect suspicious glandular area at higher risk of disease. Nowadays, Magnetic Resonance Imaging (MRI) has been used as a way to detect PCa and simplify targeting prostate biopsy (PB). The aim of this study is to review the most recent data regarding prostate biopsy and MRI guided PB.
EVIDENCE ACQUISITION: A comprehensive systematic MEDLINE search was performed in December 2017 for English language reports by using the following terms: prostate biopsy, multiparametric magnetic resonance imaging, prostate cancer, transrectal and transperineal ultrasound, target biopsy. Previous published reviews and recent published original articles were preferred in order to meet our study scope.
EVIDENCE SYNTHESIS: Retrieved studies of greater interest were reported in two main sections: standard prostate biopsy and MRI guided prostate biopsy. Thus, the main items regarding PB were analyzed. Briefly, clinical suspicious of PCa is based on prostate specific antigen level and digital rectal examination findings although a PCa risk assessment through a nomogram risk calculator is nowadays advised. Ten-eighteen biopsy cores, depending on prostate volume, and peripheral sampling seem the suitable scheme for initial biopsy while a saturation template (>20 cores including transitional prostate area) is widely used in case of repeat PB. Performing a local anesthesia is now the standard of care with several available techniques. No difference exists in term of PCa detection rate between transperienal and transrectal approaches however the last one is mostly used. The use of MRI guided biopsy seems to be a promising imaging technique able to identify an index lesion at higher suspicious of PCa. In particular, MRI shows a higher accuracy than standard PB in the detection of clinically significant PCa. No general consensus exists on which MRI guided biopsy should be used with three different ways currently available to take biopsy core. However, the initial MRI cognitive PB has been replaced by fusion MRI technique to guide biopsy with reproducible results. Absence of standardization founded in initial MRI studies has been recently revised by introduction of common criteria to assess PCa presence on MRI.
CONCLUSIONS: PB is the cornerstone in diagnosis and management of PCa. Although ultrasound transrectal and transperineal prostate biopsy are still considered as the standard, emerging data confirmed the role of MRI guided biopsy, particularly in patients with a previous negative biopsy. However, MRI costs and the moderate inter-reader reproducibility of the exam are still significant concerns requiring further studies to define the right role of MRI in the PCa diagnostic pathway.


KEY WORDS: Prostate biopsy - Magnetic resonance - Transrectal - Transperineal

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Publication History

Article first published online: March 28, 2018
Manuscript accepted: March 12, 2018
Manuscript revised: January 8, 2018
Manuscript received: September 1, 2017

Per citare questo articolo

Cicione A, De Nunzio C, Manno S, Damiano R, Posti A, Lima E, et al. An update on prostate biopsy in the era of Magnetic Resonance Imaging. Minerva Urol Nefrol 2018 Mar 28. DOI: 10.23736/S0393-2249.18.03048-5

Corresponding author e-mail

acicione@libero.it