Journal: World Journal of Urology
Published: June 10, 2020
Author: Johansen et al.
Hospital: Ronald Reagan UCLA Medical Center, Department of Radiology, Los Angeles, USA
DOI: https://doi.org/10.1007/978-3-030-45935-2_10
Multiparametric MRI has revolutionized the imaging in the diagnostic pathway of prostate cancer. Multiparametric MRI followed by MR-targeted biopsy of suspicious lesions may preclude biopsy in at least a quarter of at-risk men. Over the past 10 years, various strategies have been developed for performing MR-targeted biopsy of prostate. A direct in-bore MR-guided biopsy allows real-time MR imaging and prostate sampling while patient is lying inside MR gantry, while MR-ultrasound fusion-targeted biopsy registers previously acquired MRI data with the real-time ultrasound images at the day of biopsy to simulate an MR-targeted approach. MR-ultrasound fusion-targeted biopsy and in-bore MR-guided biopsy have been shown to be safe and outperform traditional systematic 12-core transrectal ultrasound-guided (TRUS) biopsy, with significantly higher detection of clinically significant prostate cancer and lower detection of clinically insignificant cancer. Cost-effectiveness assessments have shown both MR-based approaches to have higher quality-adjusted life-year benefits. This chapter reviews the technical aspects, the current literature, and future directions for MR-ultrasound fusion and in-bore MR-guided biopsy of prostate. While there is no consensus on the preferred MR-targeted approach for sampling prostate, each MR-targeted biopsy technique provides its advantages and disadvantages. The selection of the preferred method needs to be tailored per patient basis and considering the availability of the technique and expertise of the center.