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January 27, 2015

MR/Ultrasound Fusion–Guided Biopsy in Prostate CancerWhat Is the Evidentiary Standard?

Author Affiliations
  • 1Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York
  • 2New York Presbyterian Hospital, New York, New York
  • 3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
  • 4Associate Editor, JAMA

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2015;313(4):367-368. doi:10.1001/jama.2014.17943

Although the benefits of prostate cancer screening have come into question recently,1 for men who are screened and have elevated prostate-specific antigen (PSA) levels, or those who present with symptoms, prostate biopsy remains the next step in the diagnostic workup. The objective of biopsy is first to determine whether any cancer is present and then to determine tumor grade (ie, Gleason score) because it predicts clinical outcomes. Lower-grade localized tumors are generally felt to be amenable to active surveillance, whereas higher-grade tumors are more commonly recommended for a definitive intervention.2 Moreover, for men undergoing definitive radiation therapy, the grade of the tumor is a key determinant in whether concomitant androgen deprivation therapy is recommended.3 However, biopsies underestimate tumor grade compared with subsequent prostatectomy up to 40% of the time.4 Therefore, any new technology that improves the ability of biopsy to distinguish between men with lower- and higher-risk cancers has the potential to influence clinical decisions and improve patient outcomes.

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