Patient Selection for Focal Therapy: What is an Optimal Biopsy Strategy?

Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS, Director of Urologic Oncology and Consultant Urologist at the Singapore General Hospital, discusses how and why to combine biopsies when determining patient suitability for focal therapy. He reviews the evidence guiding patient selection and how to achieve success through focal therapy, and argues that both systematic and fusion biopsies are necessary. Successful focal therapy requires accuracy in staging, grading, and intra-prostatic position determination, as well as the ability to ablate the lesion with a low rate of complications while preserving sexual and urinary function and also detecting recurrences. Dr. Tay reviews trials demonstrating the superiority of MRI-fusion biopsy to standard TRUS-biopsy, noting however that MRI has significant false positives. Research indicates that fusion biopsy alone misses 5-10% of clinically significant prostate cancer and that systematic biopsy can help make up this difference. Dr. Tay concludes that while MRI is the imaging modality of choice, confirmation of clinically significant disease through targeted biopsy is critical. Moreover, the number of cores taken will vary based on the patient and further research may determine how many cores are sufficient.

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