A recent systematic review confirmed that, on a per core or a per patient basis, targeted biopsy is able to detect clinically significant CaP with fewer biopsies with a reduction in detection of insignificant disease [ 22].
The major advantage of the in-bore technique is that it offers the most accurate targeting of the MRI-identified lesions and reduced detection of insignificant tumors.
In men who receive a PSA test, use of risk calculators that take other clinical parameters (age, prostate volume, free to total PSA ratio) into account or a triage test may help identify men who could avoid a prostate biopsy and detection of clinically insignificant disease, while still detecting potentially lethal disease that requires intervention.
Hence, due to the relatively large number of clinically insignificant cancers that exist in men with previous negative biopsies, the goal in these men is to reduce the number of biopsies, reduce the detection of clinically insignificant or indolent disease, while still detecting the clinically significant cancers.
MRI-US fusion targeted prostate biopsies help to avoid detection of clinically insignificant tumors while allowing diagnosis of serious tumors difficult to detect by conventional biopsy techniques, such as tumors in the anterior, midline, and apex of the prostate, which are often undersampled by systematic biopsy procedures that only sample the lateral peripheral zone [ 41].
It has been observed that the detection of almost insignificant objects by all three methods do not match.
Although it may be less sensitive than angiography in the detection of clinically insignificant lesions such as small intimal defects or small vessel occlusions, it is as sensitive in detecting more significant lesions such as major intimal tears, pseudo-aneurysms, arteriovenous fistulas, thrombosis, and major vessel occlusions.
All of these differences were clinically insignificant unless combined with the detection of viruses.
Indeed, the detection of clinically insignificant prostate cancer should be regarded as an (underrecognised) adverse effect of biopsy.
Health-care standards in the United States vary from intense screening, with a high cancer detection of clinically insignificant tumours in centres of excellence, to more symptom-based treatments in the disadvantaged parts of the population.
