Merely saturating the MRI target and its vicinity to diagnose significant prostate cancer (PCa)  in virtually 100% of cases is not yet a consensus. This is understandable since cancers with a Gleason 4 grade component are diagnosed in areas outside the lesion, but "outside" the lesion may correspond to a tumor distinct from the lesion visible on MRI and one increasingly questions the significance of an MRI-undetected Gleason 3+4 PCa.

F. Cornud, M.D., A. Lefèvre, M.D., Clinique de l'Alma, Paris France (August 2020)

Two German studies (1, 2) have recently demonstrated that modifications of the technique of targeted biopsies may make it possible to discard systematic biopsies.

F. Cornud F, M. Galiano, A. Lefèvre A, S. Regusci  (July 2020)

The concept of focal treatment of PCa comes from the increasing detection of indolent, small-volume, low-grade, low-risk PCa that do not require an immediate radical treatment, which aims at treating the whole gland and not the tumor itself. Radical treatments (total gland surgical ablation or radiation therapy) can have side effects (urinary incontinence, sexual impotence, rectal and/or bladder toxicity, radiation urethritis) resulting in a significant impact on quality of life (https://uroweb.org/guideline/prostate-cancer/).

 F. Cornud, M.D., A. Lefèvre, M.D., Clinique de l'Alma, Paris France (April 2020)

Zawaieh et al (1), from the University of Cambridge reports a series of 264 patients who underwent prostate multiparametric MRI (mpMRI), with T2 and DWI (biparametric MRI, bpMRI), at 1.5 and 3T, interpreted first, prior to full mpMRI using a Likert 1-5 scale. Readers were asked to give a prospective opinion on likely benefit of contrast prior reviewing the contrast enhanced (DCE) sequence, and a retrospective opinion following full mpMRI review.

F. Cornud, Arnaud Lefèvre, Clinique de l'Alma, Paris, France

Han et al. report the results of a retrospective single center series of 123 patients with suspicion of prostate cancer, a prostate specific antigen (PSA) serum level of 4-10 ng/ml, who underwent mpMRI, subsequent cognitive fusion TRUS guided biopsies and post-biopsy follow-up of more than one year (1). The authors compared the diagnostic performances of mpMRI to that of bpMRI in the diagnosis of significant cancer (any Gleason grade 4 component on biopsy cores) and evaluated the added value of PSA density, in particular in PI-RADS 3 lesions.

F. Cornud, A. Lefèvre, Clinique de l'Alma, Mai 2020

MRI-targeted prostate biopsies: should systematic biopsies be maintained and should the transrectal route be abandoned in favor of the safer transperineal approach?

The very recent meta-analysis by Tu et al¹, from the Chinese Sichuan University ¹ evaluates the respective roles of targeted and systematic biopsies (TB and SB) in the diagnosis of significant prostate cancer (sCa) in an analysis of 39 studies including 4000 patients, with data collection up the end of December 2018. In patients with an abnormal MRI (PI-RADS score>2), the combination of TB + SB resulted in a detection rate of sCa of 45%, higher than that of TB and SB alone. With TB only, the detection rate of sCa dropped by 13%, but by 25% with SB only. The logical conclusion of the meta-analysis is therefore that the TB+SB scheme should be maintained.

F. Cornud, M.D., A. Lefevre, M.D., Clinique de l'Alma, Paris France (April 2019)

Hamid et al, from the well-known UCL (University College London) (1), present the results of their own image fusion software (SmartTarget) used to perform MRI-targeted prostate biopsies. The software is a deformable (or elastic) fusion system, therefore not using real-time navigation. Three samples were taken from 129 patients with a Likert score 3, 4 or 5 lesion, involving the posterior sectors of the peripheral zone in 75% of cases. During the same biopsy session, a second operator performed three samples with cognitive fusion, consisting in mentally overlaying the area of the MRI target onto the corresponding area during TRUS, without specifying whether the lesion is visible on TRUS.

F. Cornud, M.D., A. Lefevre, M.D., Clinique de l'Alma, Paris France (May 2019)

To answer this question, Panebianco et al (1) followed-up 1255 patients with a non-suspicious MRI (PI-RADS Score <3) for 4 years. Follow-up included PSA assay, multiparametric MRI (T2W, DWI and DCE) and systematic biopsies whenever deemed necessary, mainly when PSA level increased and/or PSA density (PSA level/prostatic volume) >0.15.