Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy of the Prostate—An Update

The Micro-ultrasound Guided Prostate Biopsy in Detection of Prostate Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

To compare the detection rate of micro-ultrasound with multiparametric magnetic resonance imaging targeted biopsy (mpMRI-TB) for prostate cancer diagnosis.

METHODS

The studies on micro-ultrasound prostate biopsy for prostate cancer diagnosis were searched in PubMed, Cochrane library and EMBASE databases from inception to April.2021. we performed a systematic review and cumulative meta-analysis based on search results using Software Rev-Man 5.3.

RESULTS

A total of 11 studies involving 1081 patients were included. The Meta-analysis showed that no significant difference was found between micro-ultrasound and mpMRI-TB in the total detection of prostate cancer(OR:1.01, 95%CI:0.85~1.21, p=0.89), of Grading Groups(GG)=1(OR: 0.92, 95%CI:0.68~1.25, p=0.59),of GG≥2(OR:1.01, 95%CI:0.83~1.22, p=0.92), and of GG≥3(OR: 1.31, 95%CI:0.95~1.81, p=0.10).

CONCLUSIONS

Micro-ultrasound guided prostate biopsy provides comparable detection rates for prostate cancer diagnosis with the mpMRI-TB, which is expected to challenge mpMRI-TB in the diagnosis of prostate cancer.

ECCO Essential Requirements for Quality Cancer Care: Prostate cancer

BACKGROUND

ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey.

PROSTATE CANCER

Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.

Prostate biopsy: when and how to perform

Prostate cancer, unlike other cancers, has been sampled in a non-targeted, systematic manner in the past three decades. On account of the low volume of prostate sampled despite the multiple cores acquired, systematic transrectal (TRUS) biopsy suffered from low sensitivity in picking up clinically significant prostate cancer. In addition, a significant number of cancers of the anterior, lateral peripheral zone, and the apex were missed as these areas were undersampled or missed during this biopsy protocol. Subsequently, the number of cores acquired was increased with special focus given to targeting the previously undersampled areas. These procedures led to an increase in the complication rates as well as detection of more clinically insignificant cancers. The advent of multiparametric magnetic resonance imaging (MRI) and its high intrinsic tissue contrast enabled better detection of prostate cancer. This led to the introduction of MRI-targeted biopsies with either MRI-TRUS fusion or under direct (in-gantry) guidance. MRI-targeted biopsies increased the percentage of positive cores and detection of clinically significant prostate cancers; however, these are expensive, time-intensive, require significant capital investment and operator expertise. This article describes the indications, workflow, complications, advantages, and disadvantages of TRUS-guided biopsy followed by MRI-guided biopsies.