The 8th Meeting of the EAU Section of Urological Imaging (ESUI19) kick-started with the session “The MRI corner” which was moderated by ESUI Chairman Prof. Georg Salomon (DE), Prof. Dr. Tillmann Loch (DE), and Prof. Arnauld Villers (FR).
In his lecture “MRI first: Always necessary before initial biopsy?”, Dr. Massimo Valerio (CH) underscored performing an MRI first as it “provides better accuracy.” He added, “There’s a major impact on patient outcome, and it’s cost-effective in many places here in Europe.” Dr. Valerio asked the audience who would perform an MRI first before initial biopsy and majority of them raised their hands.
According to insights shared by Dr. Lars Budäus (DE) in his presentation entitled “Conventional TRUS Biopsy vs. MRI-TB Biopsy based Active Surveillance: Different inclusion criteria necessary?”, MRI-targeted prostate biopsy (MRI-TB) precisely defines risk groups and outperforms conventional Transrectal ultrasound (TRUS). However, historic Active Surveillance (AS) series demonstrate excellent overall survival and cancer-specific survival rates. Dr. Budäus added that quantification of Gleason scores adds further diagnostic value.
The lecture was followed by Dr. Gianluca Giannarini (IT), who presented “The MRI informed focal saturation biopsy”. He said, “The optimal way to biopsy MRI-derived targets is currently unknown. ‘Saturation’ biopsy has been revived right in the era of MRI-targeted biopsy to optimize the targeting.”
Dr Giannarini stated that the higher the individual risk of clinically significant prostate cancer (csPCa)/high-risk MRI lesions, the greater the relative benefit of systematic biopsy to MRI-targeted biopsy.
In “Evolution of prostate MRI: From multiparametric standard to less-is-better and different better strategies”, Prof. Dr. Jurgen Futterer (NL) said that abbreviated MRI prostate protocols are appealing and biparametric prostate MRI is gaining more evidence.
Concluding the session, Prof. Villers presented his lecture “Detection of extraprostatic extension of cancer on MRI: Feasible and safe?” and stated that MRI cannot detect microscopic extraprostatic extension (EPE). According to Prof. Villers, although MRI is not perfect for local staging, it may improve the prediction of the pathological stage when combined with clinical data. Given its low sensitivity for focal (microscopic) EPE, MRI is not recommended for local staging in low-risk patients. He underlined the use of prostate MRI for local staging in intermediate and high risks.