Just a few years ago, there wasn't a lot of evidence that MR could be a valuable tool in improving prostate cancer care — but as technology and techniques have evolved, that is no longer the case.

Dr. Andrew Rosenkrantz, and his colleagues at NYU Langone Medical Center, are among the world's leading researchers showing that MRI-targeted biopsies can be used to improve patient outcomes. HCB News interviewed Dr. Rosenkrantz over e-mail to get a better understanding of the work he is doing and what it might mean for the future of prostate cancer.

HCB News: A few years ago MRI for prostate cancer was not something people saw a lot of value in — in what ways has technology changed that?

Dr. Andrew Rosenkrantz: Continual advances have occurred in both MRI hardware and software to facilitate MRI's improved role in prostate cancer evaluation. The technical advances have been coupled by better understanding by radiologists in how to optimally interpret and report the images. The development of technologies for MRI-targeted biopsy have also been a key part of the transformation.

HCB News: Recently, your work has highlighted the benefits of multi-parametric MRI as it pertains to prostate cancer biopsies. Can you describe some of your findings?

AR: Work from numerous centers, including our own, has shown that MRI-targeted biopsy can increase the detection of clinically significant prostate cancer compared with standard biopsy, which may be a primary motivation for adopting the technique. Also important is substantially reduced detection of tumors likely to be indolent or clinically insignificant, thereby addressing ongoing concerns regarding prostate cancer overdiagnosis. If adopting a biopsy scheme that entails only MRI-targeting, then the total number of biopsy cores can be greatly reduced.

HCB News: Are MRI targeted prostate biopsies being utilized more by clinicians? Is there special equipment required besides a standard MRI system?

AR: The incorporation of MRI-targeted biopsy is increasing in current clinical practice. While this can be performed using visual estimation by the operator to try and sample the MRI-defined lesion, it optimally is achieved using specialized technology for the targeting, either a real-time MRI/ultrasound fusion system or a system for direct in-bore biopsy within the MRI gantry.

HCB News: Which patients stand to benefit the most from MRI targeted biopsies?

AR: In our practice, we've found MRI-targeted biopsy to benefit numerous patient groups, including those with undergoing an initial prostate biopsy, those with a prior negative biopsy, and those undergoing pre-operative stating or active surveillance following a prior positive biopsy. Nonetheless, at the present time, there seems to be the largest amount of published literature in the prior negative biopsy setting, and our recent collaborative consensus statement addresses that specific context. We anticipate that is the setting in which MRI-targeted biopsy can achieve the greatest clinical adoption at the present time.

HCB News: Are you planning or conducting any new research to build on what you've already found?

AR: MRI-targeted prostate biopsy remains an active area of investigation. Current important areas include further improvements of the precision of MRI/ultrasound fusion algorithms, the development of non-invasive quantitative imaging biomarkers for predicting prostate cancer aggressiveness, and understanding how to optimally define clinical significance based on the results of MRI-targeted biopsy.

HCB News: What do you perceive to be the most important aspect(s) of your research?

AR: A critical aspect of ongoing research in the field is the extent to which MRI-targeted biopsy allows for a new paradigm for initial prostate cancer detection and evaluation incorporating high sensitivity for clinically significant cancer and reduced detection of insignificant tumors through a fewer number of biopsy scores. This ability in turn facilitates more optimal selection among an array of treatment options including surveillance, focal ablation, and whole-gland therapy.

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