Cancer Detection

The act of discovery of a malignant neoplasm, and after treatment, the discovery of minimal residual disease.


Editorial Comment
Editorial Comment to "Fusion-targeted biopsy significantly improves prostate cancer detection in biopsy-na € ıve men" Blas et al. 1 reported that magnetic resonance imaging (MRI)/ ultrasound fusion-targeted biopsy (MRI-TBx) significantly outperformed 12-core standard transrectal ultrasonographyguided systematic biopsy (SBx) in terms of detecting clinically significant prostate cancer (csPC) and decreasing non-csPC detection in biopsy-naive men. Performing MRI-TBx without SBx would have missed some csPC, supporting that MRI-TBx synergizes with SBx to increase csPC detection. The widespread usage of robot-assisted radical prostatectomy (RARP) has enabled us to perform more precise surgical procedures. Therefore, the technique of accurately estimating the preoperative localization of csPC has become much more important than before to properly conduct personalized surgery for each patient such as extended resection or nerve sparing. In addition, the localization of csPC preoperatively needs to be evaluated for establishing focal therapy as a standard option for prostate cancer in the near future. Previous studies have shown that the introduction of MRI-TBx improves the accuracy of csPC detection compared with SBx. 2 The present paper further showed that MRI-TBx in combination with SBx can detect csPC with higher accuracy. The results of this study show that MRI-TBx has disadvantages compared with conventional prostate needle biopsy, such as the need for additional equipment and longer time required, but can provide significant benefits in terms of "accurate localization of csPC," which are necessary to achieve appropriate prostate cancer treatment using the new modality. Another advantage of TBx with SBx described in this paper was "exclusion of non-csPC." This suggests that TBx with SBx can contribute to reduce the number of patients who receive excessive treatment by suppressing the detection of non-csPCs that do not require treatment.
This study also shows the detection rate of csPC by site and by PIRADS category. It will be interesting to see the accuracy of csPC prediction by PIRADS category for each site in a higher volume study.
The consistency of biopsy-based pathology findings with those of surgical specimens was described in this paper.
Comparison with pathology findings in the surgical specimen is necessary to assess the accuracy of preoperative localization diagnosis. On the basis of the present results, it is hoped that a study focused on the surgical specimen will also reveal how combining MRI-TBx with SBx can improve the prediction of pathologic stages.

Editorial Comment
Editorial Comment to Fusion-targeted biopsy significantly improves prostate cancer detection in biopsy-na € ıve men Multiparametric magnetic resonance imaging, capable of combining anatomical and functional data, has been increasingly used to diagnose clinically significant prostate cancer (csPC), given its growing access. Previous studies have showcased the superiority of MRI-guided target biopsy, including MRI-transrectal ultrasound-guided biopsy for detecting csPC. 1,2 Another study reported that, compared with systematic biopsy, csPC detection in the target biopsy was significantly higher. 3 Furthermore, csPC detection from a target biopsy for the region with Prostate Imaging Reporting and Data System (PI-RADS) category ≤3 was found to be low. 3 csPC detection from the region with PI-RADS ≤3 is low, because the region includes adenoma of benign prostatic hyperplasia and chronic prostatitis. Recently, the utility of biomarkers, such as prostate health index 4 and the sugar chain of PSA, 5 to detect csPC has also been reported. These biomarkers can obviate the need for unnecessary biopsies in patients with highest PI-RADS category ≤3. In the present study, the combination of target and systematic biopsy has shown to improve csPC detection. 3 Although csPC detection based on MRI has been established and developed, the removal of systematic biopsy has still not been recommended for the detection of MRI-invisible csPC.
Owing to the further development of biomarkers and imaging for the detection of csPC, it would now be possible to perform the target biopsy with high accuracy requiring minimum number of biopsy cores.