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Prostate MRI in the early diagnosis of prostate cancer : bi- or multiparametric ?

66 y/o man. Raising PSA (4.4ng/ml). Hyposignal on T2W-MRI (A, arrows) with a low ADC value (B, arrows) and a mildly hyperintense signal intensity on DWI images at a b-value of 2000 s/mm² (arrows, C). Progressive suppression of the lesion signal intensity at higher computed b-values (D-E, arrows), and enhancement of the lesion on DCE Read more…

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Is it time to consider biparametric MRI in the diagnosis of significant prostate cancer ?

Is it time to consider biparametric MRI (bpMRI) in the diagnosis of significant prostate cancer ? 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 Read more…

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MRI-targeted prostate biopsies guided by micro-ultrasound and a transperineal approach

The debate on MRI-targeted prostate biopsies is active. The very recent meta-analysis by a Chinese university 1 evaluates the respective roles of targeted and systematic biopsies in the diagnosis of prostate cancer in an analysis of 39 studies including 4000 patients, with data collection up the end of December 2018. In patients with an abnormal Read more…

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MRI-targeted prostate biopsy : the limitations of MRI-TRUS image fusion

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 Read more…

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To what extent can the existence of significant prostate cancer be ruled out in case of a non-suspicious MRI ?

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. Tumor significance was defined by systematic biopsies Read more…

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Positive pre-biopsy MRI : are systematic biopsies still useful in addition to targeted biopsies ?

Ploussard et al (1) answered positively in a recent review with the argument that systematic biopsies (SB), in addition to targeted biopsies (TB), improved the detection rate of significant cancers (defined by the presence of Gleason 4 grade) by about 10%. The assumed reasons to explain this 10% gain are 1-the far lateral location of Read more…

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Prostatic MRI before biopsy : a point of no way back

The PRECISION trial The debate on to do or not to do a prostate MRI before biopsy is probably over. The PRECISION trial (1) is a multicenter study (25 centers, 11 countries) of 500 naïve biopsy men suspected of prostate cancer. All had a pre-biopsy MRI, performed by expert radiologists in each center. In case Read more…

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