The combined biopsy targeting improves prostate cancer detection


Visual registration in combination with image fusion may offer the highest detection rate of clinically significantly prostate cancer (PCa) and thus could aid in risk stratification

Studies have shown that multiparametric magnetic resonance imaging (mpMRI)-targeted prostate biopsies can improve detection of clinically significant PCa while decreasing the risk of overdetection of insignificant cancers. Still, controversy remains regarding whether visual-registration targeting (mentally translating mpMRI targets onto real-time ultrasound images) is sufficient or whether augmentation of this approach with image-fusion software may be optimal.

The Authors examined the concordance between both methods in a randomized, prospective, within-person study that included 129 men who had undergone a prior transrectal ultrasound biopsy and had a discrete lesion on mpMRI (score 3-5) requiring targeted transperineal biopsy.

The mpMRI-directed or targeted biopsies included in-bore targeted biopsies, visual-registrationand software-based MRI/ultrasound image-fusion systems overlaying MRI targets onto real-time ultrasound images.

None of these methods previously has been studied for superiority in a clinical setting. The current study, found that both strategies detected 80/93 of University College London (UCL) definition 2 clinically significant disease (Gleason pattern 3+4=7 or higher and cancer core length of 4 mm or greater in any core), with an overall detection rate of 80/129 (62%). Each method identified 13 cancers that the other missed. The combination of the methods resulted in a significant 14% improvement in the detection of clinically significant PCa.

This study alone does not establish care standards, but taken together with other studies, there is a growing body of evidence that supports the use of MRI imaging prior to biopsy, and this study speaks to how the images might be best utilized.

Cost is a big issue in the US, where MRI scans are far more expensive, and many insurance companies do not cover them unless the patient has had a prior negative biopsy but still has a rising PSA


Hamid S, Donaldson IA, Hu Y, et al. The Smarttarget Biopsy trial: A prospective, within-person randomised, blinded trial comparing the accuracy of visual-registration and magnetic resonance imaging/ultrasound image-fusion targeted biopsies for prostate cancer risk stratification. Eur Urol. 2018; published online ahead of print.