Comparative effectiveness of techniques in targeted prostate biopsy

Abstract

In this review, we evaluated literature regarding different modalities for multiparametric magnetic resonance imaging (mpMRI) and mpMRI‐targeted biopsy (TB) for the detection of prostate cancer (PCa). We identified studies evaluating systematic biopsy (SB) and TB in the same pa-tient, thereby allowing each patient to serve as their own control. Although the evidence supports the accuracy of TB, there is still a proportion of clinically significant PCa (csPCa) that is detected only in SB, indicating the importance of maintaining SB in the diagnostic pathway, albeit with ad-ditional cost and morbidity. There is a growing subset of data which supports the role of TB alone, which may allow for increased efficiency and decreased complications. We also compared the literature on transrectal (TR) vs. transperineal (TP) TB. Although further high‐level evidence is neces-sary, current evidence supports similar csPCa detection rate for both approaches. We also evaluated various TB techniques such as cognitive fusion biopsy (COG‐TB) and in‐bore biopsy (IB‐TB). COG‐ TB has comparable detection rates to software fusion, but is operator‐dependent and may have re-duced accuracy for smaller lesions. IB‐TB may allow for greater precision as lesions are directly targeted; however, this is costly and time‐consuming, and does not account for MRI‐invisible le-sions.