MR guidance may offer benefit in multiple scenarios

In clinical practice, experts told Urology Times, men who may benefit from MR-guided prostate biopsy generally fall into the following categories:

Men who have had multiple repeat negative biopsies, but rising PSA levels. “If you use MRI in that setting, it’s been shown that you can find cancers more reliably and reduce the need for repetitive or saturation biopsies,” said Samir Taneja, MD, of New York University Langone Medical Center, referring to a UCLA study published online in European Urology (March 17, 2013). “In doing so, there is the potential to reduce cost because you can reduce the number of biopsies and the number of cores sent to pathologists.”

Patients on active surveillance with low-risk cancers. “We use fusion biopsy in these patients to make sure we’re following the right men and not missing any serious cancers,” said Leonard S. Marks, MD, of UCLA.

Prostate biopsy-naïve patients. At UCLA, the fastest-growing group undergoing fusion biopsies is men whose urologists have told them they need their first biopsy. “If they’ve got to have a biopsy, they want the best. And they only want one. Probably half of our patients now are first-time biopsy patients. However, the targeting is not perfect. There are some cases-maybe 15% to 20%-where the MRI does not find cancer. So in addition to the targeted biopsy, we always do a mapping biopsy for all patients, at least for the first go-round.”

Post-focal therapy patients. MR-guided biopsies most likely will play an important role in identifying and monitoring this group of men, who require accurately MRI-identifiable lesions for treatment and who essentially return to active surveillance after focal therapy, said John Kurhanewicz, PhD, of the University of California, San Francisco.UT

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