&ldquoControversies in Urologic Cancer” is a collection of “point-counterpoint” articles in which thought leaders in the field discuss today’s key issues in prostate, bladder, and renal cancer.
Advances in magnetic resonance imaging (MRI) technology have led to increased utilization of MRI for prostate cancer evaluation, and results from studies evaluating the performance of MRI fusion biopsy provide clear evidence to support its use as the gold standard for men at risk for prostate cancer diagnosis following an initial negative biopsy, according to Michael S. Cookson, MD, and Kelly L. Stratton, MD.
“In its most recent policy statement relating to MRI use in prostate cancer, the AUA supports fusion biopsy for men with a prior negative biopsy. And for biopsy-naïve men, it suggests that fusion biopsy may benefit those with uncertain clinical indications for biopsy, such as minimal PSA increase, abnormal digital rectal exam with normal PSA, or marginal indications based on age.1 The current NCCN Guidelines for Prostate Cancer Early Detection state that for initial and repeat transrectal ultrasound (TRUS)-guided biopsy, multiparametric MRI (mpMRI) followed by lesion targeting may maximize the detection of higher risk disease and limit the detection of lower risk disease,2” said Dr. Cookson, professor and chairman of the department of urology, University of Oklahoma College of Medicine, Oklahoma City.
“Although the NCCN guidelines also note that MRI is not recommended routinely prior to initial prostate biopsy, we believe that studies supporting the utility of prostate MRI will create the basis for its earlier use.”
Dr. Stratton, assistant professor of urology at the University of Oklahoma, said, “There is little debate that repeat biopsy following a prior negative biopsy is improved by using prostate MRI technology, and in the interest of controlling cost, some may argue that MRI fusion biopsy should be limited to this population. It makes more sense, however, to obtain the MRI when the prostate cancer diagnosis is first suspected, prior to any decision for biopsy.
“The fact that many men initially have a negative biopsy means that repeat biopsy is an inevitability for any urologist,” Dr. Stratton added. “Clinicians will have to determine how they want to handle that situation. As more and more urologists become familiar with the technology, the use of prostate MRI and fusion biopsy will continue to grow. Its benefits for improving cancer detection, clarifying anatomical detail, and potentially assisting in staging cancer spread make prostate MRI and fusion biopsy the new gold standard for prostate biopsy.”