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Pre-biopsy MRI as an adjunct for cancer detection in men with elevated PSA and no previous biopsy

Uriburu-Pizarro, F; Kasivisvanathan, V; Puech, P; Villers, A; (2017) Pre-biopsy MRI as an adjunct for cancer detection in men with elevated PSA and no previous biopsy. Translational Andrology and Urology , 6 (3) pp. 387-394. 10.21037/tau.2017.01.19. Green open access

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Abstract

The role of magnetic resonance imaging (MRI) prior to biopsy in the diagnosis of prostate cancer in biopsy-naïve patients has been strengthened by recent developments such as the PIRADS V2 criteria, which cover acquisition, interpretation, and reporting for clinical practice and data collection for research. Important questions on the role of prostate MRI remain: can MRI be used as a triage test before first biopsy series? Can it be used to avoid the use of systematic biopsies (SB) and instead use only targeted biopsies (TB) to MRI-suspicious lesions? Studies to evaluate image guided TB compared to SB have started to accumulate. Objectives of these studies should be to reduce the detection of clinically insignificant disease, to maximize the detection of clinically significant cancer (CSC), to better assess disease size, grade and location. Accurate diagnosis will allow the choice of the most appropriate treatments options, minimising side effects and reducing overtreatment. Study results on MRI-TB detection rates are promising however some limitations should be considered. The majority of published and ongoing studies have been performed at expert centres, in order to demonstrate the optimal performance of MRI. Then, the validation of this strategy in less specialised institutions will be necessary before incorporating recommendations in international guidelines. It necessitates training for radiologists and urologists to perform and read MRI and MRI-targeted biopsy through education programs and standardization tools. All these advances will be consolidated with expected genetic screening tools to improve the detection of aggressive cancer.

Type: Article
Title: Pre-biopsy MRI as an adjunct for cancer detection in men with elevated PSA and no previous biopsy
Open access status: An open access version is available from UCL Discovery
DOI: 10.21037/tau.2017.01.19
Publisher version: https://doi.org/10.21037/tau.2017.01.19
Language: English
Additional information: This is an Open Access article published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Prostate cancer; prostate biopsy; multi-parametric MRI (mpMRI); magnetic resonance imaging (MRI); image guided biopsy; PIRADS v2.0
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10094396
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