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V. Scattoni

V. Scattoni. mpMRI of the prostate: Does it change indications for biopsy and repeat biopsy?. mpMRI : not only a tool for a targert biopsy. 1. Evolution in prostate cancer diagnosis. In 1980 sextant scheme was introduced to detect (all) the prostate cancers.

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V. Scattoni

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  1. V. Scattoni mpMRI of the prostate: Does it change indications for biopsy and repeat biopsy?

  2. mpMRI: notonly a toolfor a targertbiopsy

  3. 1. Evolution in prostate cancer diagnosis • In 1980 sextant scheme was introduced to detect (all) the prostate cancers. • In 1990 EPBx and SPBx were introduced to detect and, at the same time, characterize (all) the prostate cancers. • In 2015 we feel the need to detect and characterize only the significant prostate cancers.

  4. 2. mpMRI overcomes limits of random biopsy

  5. 3. Correlation between PI-RADAS and cancer

  6. Conclusions: • mpMRI is able to detect significant PCa in biopsy-naıve males and men with prior negative biopsies. • The negative predictive value of mpMRI is important to the clinician because mpMRI could be used to rule out significant disease. • This may result in fewer or no systematic or targeted biopsies in patients with PSA suspicious for prostate cancer.

  7. Potential tools of T-PBx • Initial biopsy (poorly defined) • Reduce false negatives • Improve risk classification • Reduce repeat biopsies • Reduce overdetection • Repeated biopsy • Increase cancer detection • Reduce further repeat biopsy • In AS • Improve risk stratification • Reduce need for repeat biopsy

  8. CONCLUSIONS Initial and repeated biopsy • Prebiopsymultiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. • Prebiopsy magnetic resonance imaging followed by MRF-TB decreases the detection of low risk cancers while significantly improving the detection and risk stratification of high grade disease. • The level of suspicion (Likert scale-PIRADS) in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted.

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