Top Line: MR-guided prostate biopsies detect more clinically-significant prostate cancers than the tried and true 12-core approach.
The Study: But does that mean the 12-core approach should be thrown out the window? The next iteration of this debate comes in the form of the paired-cohort PAIREDCAP study conducted at UCLA. A first cohort of 248 men with PIRADS ≥3 lesions on prostate MRI underwent three different (ouch) biopsy methods at the same time: [1] an MRI-blinded standard 12-core approach, [2] an MRI-”informed” biopsy where the radiologist helped guide the urologist to the TRUS-correlated area of suspicion, and [3] an actual MRI-fused biopsy. Someone didn’t play Battleship enough when they were younger because approach [2], i.e., “cognitive-fusion,” resulted in the lowest detection rate of clinically-significant prostate cancer (i.e., Gleason grade group ≥2) at 47%. Both the 12-core and MRI-fused approaches individually produced detection rates of 60%. And, alas, combining the 12-core and MRI-fused approaches yielded the highest detection rate at 70%. A second cohort of 52 men with elevated PSA and PIRADS <3 lesions on prostate MRI underwent the standard 12-core approach alone to demonstrate the false-negative rate of MRI here was 15%, similar to previously reported.
TBL: Combining both the 12-core and MRI-fused approaches to prostate biopsies has the highest likelihood of detecting clinically-significant prostate cancer. | Elkhoury, JAMA Surg 2019


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