Guidelines developed in partnership with
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 2019 Oct 17]. Available from: https://wiki.cancer.org.au/australia/Guidelines:PSA_Testing/Prostate_biopsy_and_multiparametric_MRI/Discussion.
National Health and Medical Research Council
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.
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.