Discussion
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Published: 2015
National Health and Medical Research Council
Chapter 3 Prostate biopsy and multiparametric MRI
Discussion
Unresolved issues
The following issues remain unresolved:
- the predictive value of histopathological features reported by the pathologist reviewing the initial biopsy
- whether the transrectal and transperineal biopsy approaches differ according to effectiveness in cancer detection, comparability of biopsy findings with subsequent prostatectomy findings, or rates of adverse outcomes
- comparative complication rates for various biopsy schemes. Few studies reported complication rates for various biopsy schemes and these were mainly immediate outcomes. Data for long-term follow-up findings were difficult to match to biopsy pattern.
- the role of multiparametric MRI, given that it cannot identify all prostate tumours, including all clinically significant tumours.
Studies currently underway
There is a large volume of studies assessing the role of multiparametric MRI in biopsy of the prostate and reporting on the use of new or existing biomarkers.
Future research priorities
Molecular signatures of cancer, including those for prostate cancer, are increasingly recognised. Further research is needed to establish the place of multiparametric MRI in the context of both evolving imaging technologies and the increasing understanding of molecular oncology – in particular, the use of multimodal MRI in combination with other imaging modalities like ultrasound and functional imaging (positron emission tomography). Such research will allow more precise image-guided targeted biopsies of the prostate in the determination of significant prostate cancers.