Raoul S. Concepcion, MD, FACS, emphasizes the need for more effective biomarkers when determining adequate treatment for patients with castrate-resistant prostate cancer (CRPC). Concurrently, he compares the findings of studies exploring various options, including the AR-V7 splice variant.
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John C. Chang, MD, PhD, compares advantages and disadvantages of MRI-guided biopsy and transrectal ultrasound-guided (TRUS) biopsy. He emphasizes MRI-guided biopsy’s detection rates and its effectiveness in patients undergoing repeat biopsies, while acknowledging its relative inefficiency and limitations in low grade cancers.
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Michael S. Cookson, MD, discusses prostate MRI as an upfront assessment for targeting lesions in biopsy naive patients and the conclusion from PROMIS and PRECISION regarding this application. He also reviews the potential applications of MRI in patients with prior negative biopsy and in those on active surveillance.
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Erik P. Castle, MD, argues that while urologists should consider increasing the application of transperineal biopsy, the abandonment of transrectal biopsy is unlikely due to cost and convenience. He sites risk of infections, type of anesthesia, guided imaging modalities, as well as practical considerations to support this case.
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J. Kellogg Parsons, MD, MHS, FACS, discusses rising concerns of sepsis following transrectal ultrasound (TRUS) prostate biopsy. He then reviews the literature proving a reduction of infection-based complications with transperineal biopsy and argues for the transperineal approach superseding TRUS in clinical practice.
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