A. Karim Kader, MD, PhD, presented “Is MRI Fusion Biopsy the New Gold Standard of Diagnosis? Pro Argument” during the 28th Annual Perspectives in Urology: Point Counterpoint on November 15, 2019 in Scottsdale, Arizona.

How to cite: Kader, A. Karim. Is MRI Fusion Biopsy the New Gold Standard of Diagnosis? Pro ArgumentNovember 15, 2019. Accessed Jul 2020. https://grandroundsinurology.com/is-mri-fusion-biopsy-the-new-gold-standard-of-diagnosis-pro-argument/

Is MRI Fusion Biopsy the New Gold Standard of Diagnosis? Pro Argument – Summary:

A. Karim Kader, MD, PhD, argues that MRI-guided biopsy followed by a systematic biopsy should be the gold standard in prostate cancer diagnosis. He reviews the PROMIS and PRECISION trials to compare prostate cancer detection with MRI guidance versus systematic and transrectal ultrasound-guided biopsy.

The “con” rebuttal to this presentation is “Is MRI Fusion Biopsy the New Gold Standard of Diagnosis? Con Argument” by E. David Crawford, MD.

Abstract:

Historically, prostate biopsies involved digital guidance along with systematic biopsy. Even with the introduction of transrectal ultrasound (TRUS), there was an unmet need in prostate visualization to guide biopsies.

In 2017, the PROMIS trial demonstrated that using multiparametric MRI as an initial triage for men with an elevated PSA could allow 27% of patients to avoid a primary biopsy and diagnose 5% fewer clinically insignificant cancers. When compared to using a standard TRUS-guided biopsy pathway, using multiparametric MRI to guide biopsy can allow urologists to detect 18% more cases of significant cancers. 

Furthermore, when observing the concordance between biopsy and radical prostatectomy pathology, multiparametric MRI-guided biopsy better predicted cancer grade than did systematic biopsy.

Famously, in the PRECISION trial, MRI with or without targeted biopsy detected clinically significant cancer in 38% of patients, as compared to standard biopsy, which detected clinically significant cancer in 26% of patients in a separate arm. Also, fewer patients received a diagnosis of clinically insignificant cancer in the MRI-targeted biopsy group compared to the standard biopsy group. 

Because of these results, it can be argued that not offering this technology to patients is unjustifiable.

About Perspectives in Urology: Point Counterpoint

Perspectives in Urology: Point Counterpoint (PCP)is an annual, multi-day, CME-accredited conference devoted to discussing and debating the latest topics in men’s health and general urology, as well as management of bladder, renal, and both localized and advanced prostate cancer. More than didactic lectures, the conference’s format includes debates, point-counterpoint discussion panels, and unique case-based presentations. Dr. Kader presented this lecture during the 28th PCP in 2019. Please visit this page in order to register for future PCP meetings.