Using Multicore, Transperineal Prostate Mapping Biopsy to Detect, Localize, and Treat the mpMRI Invisible Lesion

Multiparametric magnetic resonance imaging (mpMRI) is used by clinicians for the diagnosis of clinically significant prostate cancer (csPCa) prior to biopsy in men suspected of having the disease. MRI has shown high sensitivity for identifying csPCa lesions and consequently MRI targeted biopsies (MRTB) have a superior cancer detection rate compared to systematic TRUS biopsy (STRB). However, some csPCa can remain invisible to mpMRI resulting in false negative interpretations because of inadequate negative predictive value (NPV) to safely rule out such lesions. False positive interpretations of mpMRI can also lead to misdiagnosis of csPCa because of anatomical structures and other benign prostatic conditions mimicking csPCa lesions. A subset of mpMRI invisible lesions may also remain undetected by STRB. PCa biomarkers have demonstrated their abilities to noninvasively diagnose some of these mpMRI invisible csPCa. However, the template-guided transperineal mapping biopsy (TPMB) technique is the only method currently available for accurate histopathological diagnosis and staging of csPCa, including those that remain invisible to mpMRI. This chapter examines the diagnosis, localization, and treatment of mpMRI invisible csPCa also remains undetected by STRB employing a shared decision-making approach between primary care physician, patient, and urologist.