Padma-Nathan H. PDE-5 inhibitor therapy for erectile dysfunction
secondary to nerve-sparing radical retropubic prostatectomy. Rev
Urol 2005;7(Suppl 2):S33–8.
[4] Zelefsky MJ, Shasha D, Branco RD, et al. Prophylactic sildenafil
citrate improves selected aspects of sexual function in men treated
by radiotherapy for prostate cancer. J Urol. In press.
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction
with outcome among prostate-cancer survivors. N Engl J Med 2008;
Gavin M. Langille, Jason R. Kovac, Ranjith Ramasamy,
James M. Dupree, Larry I. Lipshultz
Department of Urology, Baylor College of Medicine, Houston, TX, USA
*Corresponding author. 6624 Fannin Street, #1700,
Houston, TX 77030, USA.
E-mail address:
(L.I. Lipshultz).
Re: A Prospective, Blinded Comparison of Magnetic
Resonance (MR) Imaging–Ultrasound Fusion and Visual
Estimation in the Performance of MR-targeted Prostate
Biopsy: The PROFUS Trial
Wysock JS, Rosenkrantz AD, Huang WC, et al.
Eur Urol 2014;66:343–51
Experts’ summary:
In this single-center prospective, blinded study, the authors
compare magnetic resonance imaging (MRI)-ultrasound fu-
sion targeted biopsy (MRF-TB), MRI-visual estimated targeted
biopsy (VE-TB, also known as
MRI-targeted biopsy),
and standard 12-core biopsy in the detection of prostate
cancer (PCa). Patients with suspicious lesions on 3-T MRI were
included. Per patient, overall PCa detection was similar be-
tween MRF-TB and cognitive biopsy (36% vs 32%;
= 0.36). In
addition, Gleason sum
7 PCa detection was similar between
MRF-TB and cognitive biopsy (23% vs 19%;
= 0.27). Com-
bined MRI targeted biopsy results were compared with stan-
dard biopsy. Standard biopsy detected PCa more often than
targeted biopsy (55% vs 40%;
0.01). However, detection of
Gleason sum
7 PCa was equivalent between standard and
targeted biopsy (33% vs 33%;
= 0.68). On multivariate anal-
ysis, diameter of MRI suspicious region (mSR) was a predictor
of positive MRF-TB and negative VE-TB (odds ratio: 0.83;
Experts’ comments:
The overdiagnosis of low-risk and potentially clinically insig-
nificant PCa and the associated overtreatment of these patients
has led to controversy regarding PCa screening
our diagnostic approach is an important step in refining our
PCa detection strategy. With recent improvements in MRI
technology, imaged-guided biopsy—the paradigm for diag-
nosis of many other solid organ cancers—has become possible
for PCa.
Early experiences with MRI-targeted prostate biopsy
have demonstrated equivalent detection rates of clinically
significant PCa compared with standard biopsy while
simultaneously decreasing the number of patients under-
going biopsy and the detection of clinically insignificant PCa
. The present study adds the following observations: (1)
software fusion (MRF-TB) and cognitive registration (VE-TB)
perform similarly, and (2) either MRI-targeted strategy
refines the detection of PCa toward clinically significant
disease. This underscores the benefits of a MRI-targeted
strategy in reducing overdiagnosis of clinically insignificant
PCa. The unavailability of software fusion at some centers
should not stand as a barrier to adoption of a MRI-targeted
strategy because cognitive MRI-targeted biopsy represents a
near-equivalent improvement over standard biopsy.
Further clinical follow-up of patients with no mSR is
required. A recent prospective study of MRI-targeted biopsy
in biopsy-naive men reported 6% (5 of 81) of those with no
mSR were found to have a Gleason sum
7 on standard
. The rate of underdiagnosis of clinically signifi-
cant PCa with a MRI-targeted strategy must be defined
before widespread recommendations are made to only
biopsy men with mSR. Also, mSR diameter is not currently
mentioned in the standards of reporting for MRI-targeted
biopsy studies (START) recommendations
but should be
included in future studies.
Conflicts of interest:
Gerald L. Andriole is a compensated consultant/
adviser for Augmenix, Bayer, Genomic Health, GSK, and Myriad Genetics.
He is a compensated investigator for Johnson & Johnson, Medivation, and
Wilex. Eric H. Kim and Michael H. Johnson have nothing to disclose.
Loeb S, et al. Eur Urol 2014;65:1046–55.
Moore CM, et al. Eur Urol 2013;63:125–40.
Pokorny MR, et al. Eur Urol 2014;66:22–9.
Moore CM, et al. Eur Urol 2013;64:544–52.
Eric H. Kim, Michael H. Johnson, Gerald L. Andriole
Division of Urologic Surgery, Washington University School of Medicine,
St. Louis, MO, USA
*Corresponding author. Division of Urologic Surgery,
Washington University School of Medicine, 4960 Children’s Place,
Campus Box 8242, St. Louis, MO 63110, USA.
E-mail address:
(G.L. Andriole).
EUROPEAN UROLOGY 66 (2014) 593–598