Optimizing MRI Targeted Biopsy – Including Endorectal Imaging for Tumor Localization and In-Bore Biopsy for Tissue Diagnosis

Fergus Coakley, MD, discusses the use of MRI targeted biopsy for tumor localization and in-bore biopsy for tissue diagnosis. He begins by noting the changing paradigm of tumor diagnosis, moving away from the traditional systematic TRUS biopsy after an abnormal PSA or DRE, towards a multiparametric MRI and target-only biopsy after abnormal PSA or DRE. He discusses the benefits of multiparametric MRI over TRUS, addressing the issues of multifocality, overdiagnosis, and underdiagnosis in prostate cancer.

Dr. Coakley then discusses the benefits of including endorectal imaging as part of the multiparametric MRI to avoid underdiagnosis in patients. He presents a few examples of patients with known prostate cancer whose tumors were not visible through outside MRI alone.

Dr. Coakley addresses in-bore versus fusion biopsy for tissue diagnosis. He notes that fusion biopsy does not take into account prostate deformation during the procedure. He then presents evidence that in-bore biopsies are roughly as accurate as off-target fusion biopsies, and concludes that technical and interpretive variability is the biggest challenge facing clinicians in tumor diagnosis today.

Read More