Visual-estimation, image-fusion and in-bore targeted prostate biopsy: is there an optimal approach?

The diagnostic superiority of multiparametric magnetic resonance imaging (mpMRI) prior to targeted and systematic prostate biopsy over systematic transrectal ultrasound-guided (TRUS) biopsy alone in the detection of clinically significant prostate cancer (csPCa) has been proven by multiple level 1 studies.

When this is combined with the high reported negative predictor value (NPV) of prostate mpMRI it has resulted in a revolution in the established prostate cancer diagnostic pathway [2]. Routine pre-biopsy mpMRI in biopsy naïve men is now recommended in the most recent iterations of the European Association of Urology (EAU) and National Institute for Health and Care Excellence (NICE) prostate cancer diagnosis guidelines.

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