Editing Prostate Biopsy (section)

== Advanced and investigational techniques for prostate biopsy ==

* Newer imaging modalities allowing for the potential of targeted biopsy include Doppler to determine vessel density, determination of the elasticity of an area, endorectal MRI with dynamic contrast enhancement and diffusion weighting, and MRI spectroscopy
* '''Targeted prostate biopsy of a visible lesion on mpMRI can be performed using real-time ultrasound with (2):[https://pubmed.ncbi.nlm.nih.gov/23659877/]'''
**'''Software-based registration of mpMRI images OR'''
**'''Cognitive registration.'''
***'''Software-based registration'''
**** Combines the familiarity of real-time TRUS guidance with detailed information from a diagnostic multiparametric MRI and superimposes both images via software image reconstruction
****Disadvantages of software based fusion biopsy program:[https://pubmed.ncbi.nlm.nih.gov/23659877/]
*****Technical issues (e.g., software bugs, system crashes)
*****Operator error
*****Unusual anatomy (e.g., large prostates, previous transurethral resections of the prostate).
******The ability to perform cognitive fusion techniques using anatomic fiducial markers such as intraprostatic cysts may augment software-based fusion approaches in some cases such as to minimize the risk of misregistration.
*** '''Cognitive registration'''
**** Requires no additional equipment and relies on an experienced operator reviewing a suspicious lesion on MRI and then directing the biopsy needle in the direction of suspicious lesions during the standard TRUS biopsy procedure.
**** A primary disadvantage of this technique is the inability to record and confirm biopsy needle placement as well as interuser variability. In expert hands, this has been shown to be as good as software fusion
****Clinicians who adopt the cognitive fusion technique exclusively should undergo advanced training in MRI interpretation to optimize cancer detection.[https://pubmed.ncbi.nlm.nih.gov/23659877/]
***Conflicting evidence on cancer detection rates comparing software-based vs. cognitive registration[https://pubmed.ncbi.nlm.nih.gov/23659877/]