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General medicine
MRI and MRI-targeted biopsy take precedence over systematic biopsy in primary prostate cancer diagnosis
  1. Ivo G Schoots1,2,
  2. Olivier Rouvière3,4
  1. 1 Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
  3. 3 Department of Urinary and Vascular Imaging, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
  4. 4 Faculté de Médecine, Université de Lyon, Lyon, France
  1. Correspondence to Dr Ivo G Schoots, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam 3000 CA, The Netherlands; i.schoots{at}erasmusmc.nl

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Commentary on: Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018;378:1767–77.

Context

Systematic transrectal ultrasound-guided prostate biopsy has been the recommended approach in primary prostate cancer (PCa) diagnosis for decades. An alternative diagnostic approach involves multiparametric MRI (mpMRI) that is highly sensitive in identifying clinically significant PCa (csPCa).1 Biopsy cores, targeting suspicious lesions identified on mpMRI, have shown to detect similar or higher rates of csPCa and lower rates of clinically insignificant PCa than systematic biopsy (SBx).2 Although the difference is clear in men with a history of negative biopsy, conflicting results have been published in biopsy-naïve men. The PRECISION trial3 is the first multicentre randomised controlled trial investigating non-inferiority of MRI-targeted biopsies (TBx) in biopsy-naïve men.

Methods

The PRECISION trial was conducted at 25 centres in 11 …

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