Traditional vs Targeted Biopsy
Targeted biopsies for prostate cancer could increase detection of high risk disease and help to prevent over-diagnosis
Multiparametric magnetic resonance imaging (MP-MRI) could transform prostate cancer (PrCa) diagnosis by making tissue biopsies more targeted. But how does it measure up to traditional, well-established methods of obtaining a tissue sample? US National Institutes of Health (NIH) researchers decided to find out…
Currently, the “gold standard” diagnostic procedure for suspected PrCa is an ultrasound-guided, extended-sextant biopsy, which samples different areas of the prostate at random. In contrast, targeted biopsy – which uses MR/ultrasound fusion with MP-MRI images that are superimposed onto the ultrasound in real-time – allows abnormal or unusual areas of the prostate to be identified and selected for sampling. Previous studies have focused on using targeted methods alongside traditional biopsy, but the NIH scientists designed their study to directly compare the two platforms.
A prospective cohort study of 1,003 men showed that targeted biopsy provided increased detection of high-risk PrCa, diagnosing 30 percent more high-risk cancer than standard biopsy. It also diagnosed 17 percent less low-risk cancer, which could prevent diagnosis and overtreatment of patients with latent PrCa. The accuracy of targeted biopsy was 73 percent, compared with 59 percent for standard biopsy, and 69 percent for combination standard and targeted biopsy (1).
Although this was only a preliminary study that did not take certain factors into account (e.g. disease recurrence, PrCa-specific mortality), the NIH team are hopeful that MR/ultrasound fusion could significantly alter the risk estimate given to men at diagnosis, which has many obvious clinical benefits.
- MM Siddiqui et al., “Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer”, JAMA, 313, 390–397 (2015). PMID: 25626035.
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