Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co ULTRASOUND MRI FUSION BIOPSY IN PROSTATE GLAND • 43  underwent standard prostate biopsy in combination with MRI/US fusion software-based target- ed biopsies in the same session. The first high-quality study with a very large sample size that examined the utility of MRI/US fusion software-based targeted biopsy against standard biopsy combined was published by Siddiqui et al . In this paper, there was little utility to include stand- ard biopsy in the protocol as 200 men would be needed to be additionally sampled in order to diagnose one additional high-risk PCa, missed by MRI/US fusion software-based targeted biopsy. Further, the two combined approaches lead to a change in Gleason score risk stratification in 15% of cases, of which 2% increased to high-risk PCa [35]. Two RCT were recently published compar- ing MRI/US fusion software-based targeted biopsy and standard biopsy. In the study by Baco et al . [36], including 175 patients, the 2-core MRI/US fusion software-based targeted biopsy was com- parable to 12-core standard biopsy in terms of clinically significant PCa detection (38% vs 49%, respectively, p = 0.2) and was more effective for MRI-detected PCa with a PI-RADS score of 4–5 [36]. They concluded that the traditional biopsy may be replaced by two-core MRI/TRUS targeted biopsy. Tonttila et al . reported similar results for one-/two-core MRI/US fusion software-based targeted biopsy and 12-core standard biopsy in terms of any cancer (64% vs 57%, respectively, p = 0.5) and clinically significant (55% vs 45%, respectively, p = 0.8) PCa [37]. Further evidence about the role of MR/US fusion software-based targeted biopsy in the pathway of PCa diagnosis will be acquired in the near future when the results of ongoing trials will be available [45–47]. The next aspect to evaluate before adopting the new procedure as a new standard of care will be cost-effectiveness. Certainly, the time spent to coregister MRI and US images and to perform the biopsy is longer for MRI/US fusion software-based targeted prostate biopsies compared to the standard approach. Recently, Shoji et al . reported that the number of cases to perform an MRI/US fusion software-based targeted prostate biopsy within 20 min was five [48]. With regard to cost, while the fusion biopsy itself has some intrinsic expenses, the greatest increase in cost is due to the necessity to perform MRI on each patient. Nevertheless, some initial studies have shown that the overall cost-effectiveness might be still in favor of a software-based approach [49]. Conclusions In men at risk with mp-MRI-suspicious lesion, the MRI/US fusion software-based targeted approach seems to have valuable features to be added in the standard diagnostic pathway of PCa for achieving accurate risk stratification. Although it seems to detect more clinically significant PCa as com pared to standard biops y, whether this approach should replace or support the TRUS- guided rando m biopsy will be d etermined by ongoing trials. References 1. Singh H, Canto EI, Shariat SF et al (2004) Improved detection of clinically significant, curable prostate cancer with systematic 12-core biopsy. J Urol 171(3):1089–1092. 2. Irani J, Blanchet P, Salomon L et al (2013) Is an extended 20-core prostate biopsy protocol more efficient than the standard 12-core? A randomized multicenter trial. J Urol 190(1):77–83. 3. Ukimura O, Coleman JA, de la Taille A et al (2013) Contemporary role of systematic prostate biopsies: indications, techniques, and implications for patient care. Eur Urol 63(2):214–230. Cutting EDGE_Urology(SUN)_final.indd 43 27-Mar-18 10:00:31 AM