“MRI targeted biopsies are a lot of my practice.
The study certainly raises the question of whether we should be doing fewer biopsies on patients with normal MRIs. AUA guidelines say that unless your institution has its own internal data showing you can either avoid a biopsy or, specifically, not do a systematic biopsy, the change shouldn’t be made. The study doesn’t specifically contradict the AUA. Those guidelines say if you’re only doing a targeted biopsy, your institution should confirm its accuracy.
At the University of Oklahoma, over time, our radiologists have become more proficient in making the right call—not missing something, or over-calling.
It won’t change my management of diagnosis without the knowledge that we can target an area and not miss something. It’s very provocative and will certainly make us rethink how we do our biopsies, but we’re not quite there yet. The PRECISION numbers are good, but because prostate cancer is such a long malignancy, I don’t feel the follow-up was long enough to determine that nothing would happen.
If a patient already had one negative biopsy and an elevated PSA and they want me to tell them what’s wrong with their prostate, I would probably do the entire biopsy, fusion-guided by the MRI, so I could say with certainty they had no cancer. Right now, the current recommendations for a new patient with an elevated PSA and no biopsy history is to have the standard 12-core biopsy. I think my incorporation of the MRI is another reason my practice would not change; I already get an MRI on every patient that comes in the door wanting a biopsy.
I’ll still do the standard biopsy until I can prove with my own institutional data that I don’t need it.”
Kelly Stratton, MD