Should imaging-guided prostate cancer biopsy be used for both first and repeat biopsies?

Jochen Walz, MD, from the Paoli-Calmettes Institute, Marseille, France, discusses the use of magnetic resonance imaging (MRI) in targeting prostate cancer biopsy at the European Association of Urology (EAU) conference 2017 in London, UK. He explains that magnetic resonance imaging (MRI) is currently the most well evaluated tool for prostate cancer diagnosis, and many studies are evaluating this imaging approach. Current recommendations are that an MRI should be carried out before a repeat biopsy, if a suspicion of prostate cancer persists after a negative randomized biopsy. Repeat biopsies identify cancer in 20 – 25% of cases. By using imaging as additional information in diagnostically challenging patients to target the tumor, the detection rate and diagnostic reliability can be increased when using an imaging-guided repeat biopsy rather than a repeat randomized biopsy. He argues that the evidence from repeat biopsies of increased detection rate and diagnostic reliability suggest that using imaging information would also be beneficial for the first biopsy. However, he points out that current studies do not show a higher detection rate with MRI-guided targeted biopsy alone without a randomized biopsy, with a risk of missing cancer if no randomized biopsy is also carried out. He explains that there is no consensus yet on whether a first biopsy should be targeted, randomized, or a combination of both. He concludes that it is clear MRI should be used before the repeat biopsy, but that the is no consensus on the use of MRI before the initial biopsy.
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