V. Scattoni mpMRI of the prostate: Does it change indications for biopsy and repeat biopsy?

mpMRI: not only a tool for a targert biopsy

1. Evolution in prostate cancer diagnosis I.In 1980 sextant scheme was introduced to detect (all) the prostate cancers. II.In 1990 EPBx and SPBx were introduced to detect and, at the same time, characterize (all) the prostate cancers. III.In 2015 we feel the need to detect and characterize only the significant prostate cancers.

2. mpMRI overcomes limits of random biopsy

3. Correlation between PI-RADAS and cancer

Conclusions: mpMRI is able to detect significant PCa in biopsy-naıve males and men with prior negative biopsies. The negative predictive value of mpMRI is important to the clinician because mpMRI could be used to rule out significant disease. This may result in fewer or no systematic or targeted biopsies in patients with PSA suspicious for prostate cancer.

Potential tools of T-PBx Initial biopsy (poorly defined) – Reduce false negatives – Improve risk classification – Reduce repeat biopsies – Reduce overdetection Repeated biopsy – Increase cancer detection – Reduce further repeat biopsy In AS – Improve risk stratification – Reduce need for repeat biopsy

CONCLUSIONS Initial and repeated biopsy Prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. Prebiopsy magnetic resonance imaging followed by MRF-TB decreases the detection of low risk cancers while significantly improving the detection and risk stratification of high grade disease. The level of suspicion (Likert scale-PIRADS) in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted.