Targeted Prostate Biopsies: The Complexity Behind a Simple Concept

Autor: Niccolò M. Passoni, Thomas J. Polascik
Rok vydání: 2014
Předmět:
Zdroj: European Urology. 66:30-31
ISSN: 0302-2838
DOI: 10.1016/j.eururo.2014.03.025
Popis: The price for the reduction in prostate cancer mortality brought about by prostate-specific antigen (PSA) screening [1] is the increase in overdiagnosis of indolent cancers, with the associated risk of exposure to overtreatment. PSA has taken the brunt of the criticism, but equally to blame is our current nontargeted, random, transrectal ultrasound (TRUS) biopsy. Random sampling at biopsy affects diagnosis and treatment planning. Biopsy Gleason score is upgraded in up to 40% of cases at radical prostatectomy [2], and because therapeutic management is dependent on accurate biopsy Gleason assignment, this could potentially result in undertreatmentdue to incorrect riskattribution.Technological and software developments in the past 10 yr have finally given prostate specialists the ability to identify cancerous lesions, with good diagnostic performance using multiparametric magnetic resonance imaging (mp-MRI). The sensitivity and negative predictive values of mp-MRI are >90% when assessing large and poorly differentiated cancers [3]. With the ability to pinpoint highly suspicious areas atmpMRI, the next logical step would be the targeted biopsy. As shown by Pokorny and colleagues [4] in the current issue of European Urology, targeted prostate biopsies outperform standard ultrasound-guided strategies. Overall, fewer cancer diagnoses were made, but almost all of them consisted of identifying intermediateor high-riskdisease. Similar results were recently reported by Siddiqui and colleagues [5], who, instead of conducting in-bore magnetic resonance imaging (MRI)-targetedbiopsies, relied on real-timeMRI-TRUS fusion performed in a clinic setting. To further support the use of MRI-guided biopsies, a recent modeling study in Europe estimated the cost of this strategy to be just 31 euros more expensive than the
Databáze: OpenAIRE
Externí odkaz: