We all love to see a dramatic win. Such moments are memorable. Who can forget the six NBA championships achieved by the Chicago Bulls “dream team” of Jordan, Pippen and Rodman? Or the perfect-10 Olympics vault that earned petite Mary Lou Retton a gigantic gymnastics victory?

Competition is the stuff that winners are made of. If a newbie outdoes a long-standing record, it gets people’s attention.

When it comes to diagnosing prostate cancer (PCa), a new record is being set by targeted biopsies guided by real time Multiparametric MRI (mpMRI). Prior to this, the long-time reference standard was a randomized, systematic 12+ core biopsy guided by transrectal ultrasound (TRUS). While many urologists still use this method, its detection rate is comparatively low.^[i]

When mpMRI first came on the prostate cancer scene, it was viewed as an upstart by holdouts in urology who felt that since TRUS biopsy had been around the longest, it had proven superiority. In 2015, however, a team of experts published a literature review comparing the detection rate of systematic vs. targeted biopsy. They found that targeted biopsy detected more clinically significant PCa using fewer cores, compared with standard biopsy methods.^[ii] Further studies have continued to reinforce the message that targeted biopsy is more accurate than randomized, systematic biopsy. However, the 2015 reviewers chose published studies in which MRI/ultrasound fusion had been the guidance system, not real time in-bore mpMRI.

Fusion-guided targeting is less accurate than in-bore MRI targeting

Fusion is a computerized merging of previously captured MRI with real time ultrasound imaging. For urologists who use it, it’s their newest darling because it brings MRI into their practice. It represents a triumph over ordinary TRUS because integrating the prior MRI helps identify the exact size, shape and location of a prostate tumor. However, the fusion process is not as accurate as in-bore MRI because of a flaw called registration error.

On the other hand, a study with actual patients shows that in-bore MRI wins a gold in the PCa imaging Olympics. in 2021 a research team designed a toe-to-toe comparison of real time in bore MRI targeted biopsy vs. fusion targeted biopsy. They assigned 268 patients to two groups: one group had in-bore MRI targeted biopsy, while the other had fusion targeted biopsy. The authors discovered that in-bore biopsy was better at detecting any PCa as well as clinically significant PCa.^[iii]

There is no substitute for live, real time mpMRI. Dr. Sperling and his experienced MRI and clinical staff are a true Dream Team for prostate imaging. The Sperling Prostate Center recommends following a suspicious PSA blood test with mpMRI of the prostate before having a biopsy. Our powerful state-of-the-art magnet, and Dr. Sperling’s incorporation of Artificial Intelligence, offer the most reliable way to identify and characterize prostate tumors. If a biopsy is needed, an in-bore targeted procedure uses minimal needles yet delivers maximum results.

For more information about our 3T mpMRI-based detection, diagnosis and treatment services, please contact us.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] D’Agostino D, Romagnoli D, Giampaoli M, Bianchi FM et al. “In-Bore” MRI-Guided Prostate Biopsy for Prostate Cancer Diagnosis: Results from 140 Consecutive Patients. Curr Urol 2020;14:22-31
[ii] Valerio M, Donaldson I, Emberton M, Ehdaie B, Hadaschik BA et al. Detection of Clinically Significant Prostate Cancer Using Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsy: A Systematic Review. Eur Urol. 2015 Jul;68(1):8-19.
[iii] Prince M, Foster BR, Kaempf A, Liu JJ et al. In-Bore Versus Fusion MRI-Targeted Biopsy of PI-RADS Category 4 and 5 Lesions: A Retrospective Comparative Analysis Using Propensity Score Weighting. AJR Am J Roentgenol. 2021 Nov;217(5):1123-1130.