TO MRI OR NOT TO MRI FOR PROSTATE BIOPSY?
Nikolay Mirinchev, Zlatka Cholakova, Zlatina Mirincheva and Boyko Mirazchiiski
ABSTRACT: Introduction: Prostate cancer is the most commonly diagnosed cancer in men, with approximately 1.1 million diagnosed worldwide in 2012, representing 15% of all diagnosed cancers. Transrectal ultrasonography (TRUS) with or without multiparametric magnetic resonance (mpMR)/ cannot diagnose prostate carcinoma without prostate biopsy.
Objective: To study and systematize the current indications and the place of MPMRI (multiparametric magnetic resonance imaging) of the prostate as an imaging study in the diagnostic process of prostate carcinoma.
Aims and Methods: A thorough literature review was conducted on the place of prostate MPMRI (multiparametric magnetic resonance imaging) as an imaging study in the diagnostic process of prostate carcinoma.
1. Theoretically mpMRI (Multiparametric Magnetic Resonance Imaging) before biopsy can be used in two ways:
-To improve the detection of clinically significant prostate carcinoma.
-As a pre-biopsy test. Thus, mpMRI targeted biopsy will be performed with a positive mpMRI result.
2.Patients with a negative mpMRI result will not be biopsied.
3. MpMRIcan be relied upon to prove the aggressiveness of the tumor.
4. When planning a repeat biopsy, it is performed before the prostate biopsy.
Patients with a negative mpMRI should also undergo a prostate biopsy.
5. Multiparametric magnetic resonance imaging has a good diagnostic value with a Gleason score>7.
6. PI-RADS-prostate imaging reporting and data system is a structured scheme for examining the prostate for prostate cancer. It is designed to be used before treating patients. The result is set based on mpMRI.
The score is from 1 to 5, with 1 considered benign and 5 highly suspicious for malignancy.
7. After mpMRI is performed, cognitive tests can be performed biopsies or fusion biopsies using mpMRI fusion software.MpMRI-targeted biopsies have a higher detection rate of prostate cancer compared to the detection rate of systemic biopsies.
2021 EAU Recommendations:
1. Not to use multiparametric magnetic resonance imaging as the main screening tool;
2. Using mpMRI before biopsy is recommended;
3. Repeat biopsy of the prostate gland by mpMRI fusion biopsy has a higher diagnostic ability for early diagnosis of prostate cancer and is the method of choice.
Keywords: prostate biopsy, multiparametric magnetic resonance, prostate carcinoma, fusion biopsy, prostate specific antigen