Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 40 • CUTTING EDGE - UROLOGY Indications of MRI/US Fusion Software-Based Targeted Biopsy Main Indications zz Re-biopsy in men with persistent suspicion of PCa after first negative prostate biopsy: per- sistently increased PSA and/or positive digital rectal examination (DRE) [20–25] and/or diagnosis of extensive high-grade prostatic intraepithelial neoplasia (HG-PIN) or atypical small acinar proliferation (ASAP) of the prostate [26]. As expected, a number of studies have shown that in this subgroup of men, MRI/US fusion software-based targeted biopsy allowed the detection of more clinically significant PCa than standard biopsy [27]. zz Follow-up of patients under active surveillance (AS). Many authors evaluated fusion systems to perform confirmatory targeted biopsy in patients under AS. Hu et al . recently proved in a series of 113 patients that confirmatory MRI/US fusion software-based targeted biopsy resulted in reclassification in 36% of men, ranging from 24 to 100% according to the MRI score, from low to high grade, respectively [28]. Sonn et al . demonstrated that in a series of 171 patients, MRI/US fusion software-based targeted biopsy was three times more likely to identify cancer than standard biopsy (21% versus 7%, respectively), and of the men with clinically significant PCa initially enrolled for AS, 38% had disease detected only on targeted biopsies [29]. Moreover, MRI/US fusion software-based tar eted biopsy permits to track the location of all biopsy cores, allowing the urologist to perform a re-biopsy in the same suspi- cious areas, which is mandatory in the correct follow-up of patients under AS. Other Indications Other indications, as recommended by many authors but to be confirmed by further studies, could be: zz The follow-up of men suspicious for local recurrence after local treatment [30] zz The guidance of focal therapy [31] zz The characterization of suspicious lesions even at the first biopsy [32, 33] Results of MRI/US Fusion Software-Based Targeted Biopsy Standard B iopsy Versus MRI/US Fusion Software-Based Targeted Biopsy The two approac hes did not differ significantly in overall detection of PCa. When considering a core-by-core analysi s, R astinehad et al . reported an increased detection rate of MRI/US fusion software-based targeted biopsy with respect to standard biopsy (37.9% vs 12.5%, respectively, p < 0.001) [34]. The detection rate of clinically significant PCa seems higher performing a MRI/ US fusion software-based targeted biopsy than performing a standard biopsy. In the study of Siddiqui et al ., MRI/US fusion software-based targeted biopsy diagnosed 30% more high-risk cancers versus standard biopsy ( p <0.001) and 17% fewer low-risk cancers ( p = 0.002) [35]. On Cutting EDGE_Urology(SUN)_final.indd 40 27-Mar-18 10:00:31 AM