Discussion

Guidelines developed in partnership with

Cite this guideline

Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer. Sydney: Cancer Council Australia. [Version URL: http://wiki.cancer.org.au/australiawiki/index.php?oldid=122835, cited 2023 Jan 27]. Available from: https://wiki.cancer.org.au/australia/Guidelines:PSA_Testing/Prostate_biopsy_and_multiparametric_MRI/Discussion.

This resource has been developed, reviewed or revised more than five years ago. It may no longer reflect current evidence or best practice.

Published: 2015

National Health and Medical Research Council

These guidelines (recommendations) in the web-version of this guideline were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 2 November 2015 under section 14A of the National Health and Medical Research Council Act 1992 In approving the guidelines (recommendations), NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of five years. NHMRC is satisfied that the guidelines (recommendations) are systematically derived, based on the identification and synthesis of the best available scientific evidence, and developed for health professionals practising in an Australian health care setting.

This publication reflects the views of the authors and not necessarily the views of the Australian Government.

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.