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Detection of Prostate Cancer Increases with a Combination of Targeted and Systematic Biopsy

A study was conducted to assess the level of prostate cancer detection. The trial combined both targeted and systematic biopsy, which resulted in 11% to 33% increase in detection compared to using either method alone.

According to investigators, men who undergo their first biopsy should use a combination of systematic biopsy and targeted biopsy of the lesions visible on MRI, which is the optimal method for detecting grade 2 or higher cancer.

During the study:

  • A trial was conducted on men with high PSA levels and abnormal DRE. They had a multiparametric MRI, of which 79% showed suspicious lesions. Later they underwent transrectal ultrasound-guided systematic biopsy and then cognitive targeted biopsy and software assisted fusion targeted biopsy systematically. During cognitive biopsy, the MRI aimed at locations of interest while in software fusion biopsy, the MRI and ultrasound fusion produced a 3D image of the prostate, including the suspicious lesions to help in targeting.
  • The result was that 70.2% of significant cancers were identified through a combination of systematic and targeted biopsies. The cognitive targeted biopsy singularly detected 46.8%, the systematic sampling 60.1% alone, and either software assisted fusion or cognitive biopsy detected 62.1%. In all the biopsy methods, the distribution of Gleason scores was similar. As the density of PSA increased, the chances of significant cancer increased too.
  • The investigators noted that if a single biopsy method was used in the trial, a lot of clinically significant cancers would be missed. This research has observed that different biopsy methods can identify different types of tumors.

The study concluded that relying on targeted biopsy alone will not provide accurate results. It is also essential to use cognitive biopsy, most notably when a fusion machine is not available. Although there is still a long way to go, the results have proven that multiparametric MRI surpasses the other methods that have been used.