Societies eye role for prostate MRI-guided biopsy

The American Urological Association (AUA) and the Society of Abdominal Radiology (SAR) are recommending the use of MRI and MRI-targeted biopsy in monitoring patients for prostate cancer after a negative biopsy.

In new consensus statements published in the Journal of Urology, a panel of urologists and radiologists from the AUA and the SAR has recommended the use of prostate MRI and MRI-targeted biopsy for any patient suspected to have prostate cancer despite a prior negative biopsy, and who is under evaluation for a possible repeat biopsy.

"The panel recognized a role for prostate MRI and MRI-targeted biopsy to increase the detection of clinically significant prostate cancer in the repeat biopsy setting," said lead author Dr. Andrew Rosenkrantz, of NYU Langone Medical Center in New York City, in a statement. "It also explored challenges facing the wider clinical implementation of MRI-targeted biopsy at this time."

While pointing out the growing body of evidence-based literature demonstrating the value of MRI-targeted biopsy in the repeat biopsy setting, the authors also noted that these techniques are relatively new and that there is a lack of standardization of image quality and interpretation abilities for individual radiologists. There is neither a formal mechanism currently to become certified in prostate MRI interpretation nor an established number of examinations that must be interpreted by radiologists to achieve sufficient experience, according to the panelists.

Rosenkrantz cautioned that a lack of expertise would limit the proposed clinical usefulness of prostate MRI and could also result in misleading information and harmful consequences. In addition, the decision of whether to perform MRI must take into account the results of any other biomarkers and the cost of the examination, the panelists said.

The panel's consensus statements also address cancer detection rates using MRI targeting and discuss topics such as which patients can benefit from MRI methods, specific methods and other considerations for MRI-targeted biopsy, when patients should undergo immediate repeat biopsies after MRI, and what follow-up should be performed after a negative MRI-guided biopsy result. Their key recommendations include adherence to Prostate Imaging Reporting and Data System (PI-RADS) version 2 and strict quality standards; the potential usefulness of MRI/ultrasound fusion or in-gantry MRI targeting technologies, even if visual targeting remains a reasonable approach in skilled hands; and the need for close clinical and laboratory surveillance when deferring repeat biopsy based on MRI findings, according to the panel.

The consensus statements can be found here.

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