{Reference Type}: Journal Article
{Title}: Should we perform systematic biopsies in case of suspicious MRI for prostate cancer in 2020? A review of literature.
{Author}: Vesval Q;Fiard G;Villers A;Norris JM;Olivier J;
{Journal}: Prog Urol
{Volume}: 31
{Issue}: 3
{Year}: Mar 2021
{Factor}: 1.09
{DOI}: 10.1016/j.purol.2020.09.025
{Abstract}: <B>BACKGROUND: </B>Multiparametric magnetic resonance imaging (MRI) is now recommended before performing prostate biopsies, looking for suspicious lesions to perform targeted biopsies (TB). However, the association or exclusive performance of systematic biopsies (SB), criticized for its morbidity and for the detection of insignificant cancers, remains debated.<BR><B>OBJECTIVE: </B>To perform a literature review to answer three questions: (1) In the presence of a suspicious MRI lesion, should we always perform SB in addition to TB? (2) Can we avoid SB when considering focal treatment? (3) Is there an increase in adverse events when associating SB with TB?<BR><B>METHODS: </B>A non-systematic literature review was carried out on Medline in April 2020 using the keywords "MRI", "PROSTATE CANCER", "SYSTEMATIC BIOPSY", "TARGETED BIOPSY", "ADVERSE EVENTS". The references of the selected articles were analyzed for additional articles. Selection of Studies published in the last five years were analyzed and retained if the available data made it possible to answer one of the three questions asked.<BR><B>RESULTS: </B>In biopsy-naive patients, the added value of SB to TB for detection of significative cancer varied from +5 to+7% and was reduced to +1 to +3% in the case of a previous series of negative biopsies. For patients under active surveillance, this added value was higher, ranging from +8% to +17%. MRI has a negative predictive value of 85 to 95%, but this value drops to 55% for the detection of secondary or tertiary foci. The use of SB is necessary if focal treatment is considered. Serious complications from biopsies requiring hospitalization range from 1.4 to 6.9% and are increased by the number of previous biopsy series performed more than by the number of biopsies per series.<BR><B>CONCLUSIONS: </B>In the presence of a suspicious MRI lesion, SB is indicated in addition to TB but can be discussed in patients with previous negative biopsies. They are necessary if focal treatment is considered to aid surgical planning. Severe complications from biopsies do not seem to increase when SB are associated to TB, but rather with the number of biopsy series performed.