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    Targeted prostate biopsy: Momentum grows, but questions remain

    Number of high-grade cancers missed by technique could raise red flag

    Use of targeted magnetic resonance (MR)/ultrasound fusion biopsy (“targeted biopsy”) resulted in the diagnosis of significantly more high-risk prostate cancers and significantly fewer low-risk cancers compared with a standardized systematic biopsy technique, reported the authors of a new study from the National Cancer Institute (NCI).

    The findings were published in JAMA (2015; 313:390-7).

    RELATED: MRI guiding future of prostate cancer diagnosis

    Given the strengths of the study, which include the size and prospective enrollment of its population (1,003 men), the research lends significant support to the idea that targeted biopsy is a promising technique for minimizing the problems of prostate cancer overdetection and overtreatment, according to lead author M. Minhaj Siddiqui, MD, and Samir Taneja, MD, a proponent of targeted biopsy.

    However, speaking to Urology Times, both urologists pointed out that the potential impact of the study must be considered in light of its limitations. As a bottom line, more work needs to be done to determine the role of targeted biopsy in prostate cancer detection.

    M. Minhaj Siddiqui, MDDr. SiddiquiDr. Siddiqui, assistant professor of surgery-urology at the University of Maryland School of Medicine, Baltimore, was involved in the study as a urologic oncology fellow at the NCI.

    “The findings of our study are consistent with the idea that findings on multiparametric prostate MRI better reflect the real disease in the prostate and therefore guide a biopsy that provides better risk stratification,” he said. “However, our study was not randomized; it looked at pathology results rather than clinical outcomes; and most of the men had undergone prior standard biopsy, often with negative results.

    “Ideally, prospective, randomized trials should be conducted to establish that targeted biopsy reduces risk of disease recurrence or prostate cancer-specific mortality, and we look to leading centers implementing this technique to design clinical trials that will give us the type of information needed to advance the field.”

     

    Next: Not ready for clinical practice

    Targeted Bx

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