MRI Targeted Prostate Biopsy Techniques: AJR Expert Panel Narrative Review.

Prostate cancer is the second most common malignancy in men worldwide. Systematic transrectal prostate biopsy is commonly used to obtain tissue to establish the diagnosis. In recent years, however, more clinically significant cancer and less clinically insignificant cancer have been detected with MRI targeted biopsy (on the basis of an MRI examination performed before consideration of biopsy) than with systematic biopsy. This approach of performing MRI before biopsy has become, or is becoming, a standard of practice in centers throughout the world. This growing use of an MRI-directed pathway is leading to performance of a larger volume of MRI targeted prostate biopsies. The three common MRI targeted biopsy techniques are cognitive biopsy, MRI-ultrasound software fusion biopsy, and MRI in-bore guided biopsy. These techniques for using MRI information at biopsy can be performed via a transrectal or transperineal approach. The purpose of this review is to describe the three MRI targeted biopsy techniques and their advantages and shortcomings. Comparisons among the techniques are summarized on the basis of the available evidence. Studies to date have had heterogeneous results, and the preferred technique remains debated.