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Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies?

  • Ploussard, Guillaume1, 2
  • Borgmann, Hendrik3
  • Briganti, Alberto4
  • de Visschere, Pieter5
  • Fütterer, Jurgen J.6
  • Gandaglia, Giorgio4
  • Heidegger, Isabel7
  • Kretschmer, Alexander8
  • Mathieu, Romain9
  • Ost, Piet10
  • Sooriakumaran, Prasanna11
  • Surcel, Cristian12
  • Tilki, Derya13
  • Tsaur, Igor3
  • Valerio, Massimo14
  • van den Bergh, Roderick15
  • 1 Saint Jean Languedoc/La Croix du Sud Hospital, Department of Urology, 20, route de Revel, Toulouse, 31400, France , Toulouse (France)
  • 2 IUCT-O, Avenue Joliot-Curie, Toulouse, 31000, France , Toulouse (France)
  • 3 University Hospital of Mainz, Department of Urology, Mainz, Germany , Mainz (Germany)
  • 4 Vita-Salute University and San Raffaele Hospital, Department of Urology, Urological Research Institute, Milan, Italy , Milan (Italy)
  • 5 Ghent University Hospital, Department of Radiology, Ghent, Belgium , Ghent (Belgium)
  • 6 Radboudumc, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands , Nijmegen (Netherlands)
  • 7 University Hospital of Innsbrück, Department of Urology, Innsbrück, Austria , Innsbrück (Austria)
  • 8 Ludwig-Maximilians-University of Munich, Department of Urology, Munich, Germany , Munich (Germany)
  • 9 CHU Rennes, Department of Urology, Rennes, France , Rennes (France)
  • 10 Ghent University Hospital, Department of Radiation Oncology and Experimental Cancer Research, Ghent, Belgium , Ghent (Belgium)
  • 11 University College London Hospital, Department of Urology, London, UK , London (United Kingdom)
  • 12 Fundeni Clinical Institute, Department of Urology, Bucharest, Romania , Bucharest (Romania)
  • 13 Martini Klinik, Department of Urology, Hamburg, Germany , Hamburg (Germany)
  • 14 Centre Hospitalier Universitaire Vaudois, Department of Urology, Lausanne, Switzerland , Lausanne (Switzerland)
  • 15 Antonius Hospital, Department of Urology, Utrecht, The Netherlands , Utrecht (Netherlands)
Published Article
World Journal of Urology
Springer Berlin Heidelberg
Publication Date
Jul 02, 2018
DOI: 10.1007/s00345-018-2399-z
Springer Nature


PurposeThe diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI.MethodsA review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting.ResultsEvidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques.ConclusionA pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.

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