title: Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies.
abstract: OBJECTIVE
  The clinical utility of image-targeted biopsies can only be judged by a comparison of the current standard of systematic 10-12 core biopsy schemes. The aim of this review was to gather the current evidence in favor of or against targeted biopsies in the detection of prostate cancer based on well-designed, controlled studies, in order to draw clinical relevant conclusions.
  
  
  METHODS
  A systematic literature review was performed addressing studies that compared the prostate cancer detection rates of targeted and systematic biopsy schemes using the imaging techniques of elastography, contrast-enhanced ultrasound, histoscanning and multiparametric MRI. Only well-designed, controlled studies were included and the results summarized.
  
  
  RESULTS
  All imaging techniques are associated with varying results regarding better or poorer detection rates relative to systematic biopsies. No technique provides a clear trend in favor of or against image-targeted biopsies. In almost all studies, the combination of targeted and systematic biopsies provided sometimes a substantial, increase in the detection rate relative to systematic biopsies alone. MRI-targeted biopsies show no advantage in the initial biopsy setting, whereas in the repeat biopsy setting improvements in the detection rates are often observed relative to systemic biopsies.
  
  
  CONCLUSIONS
  Based on well-designed, controlled studies no clear advantage of targeted biopsies over the current standard of systematic biopsies can be observed. Therefore, targeted biopsies cannot replace systematic biopsies in the diagnosis of prostate cancer. In all indications, the combination of systematic and targeted biopsy schemes provides the highest detection rate.
authors.affiliation: Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite, BP 156, 13273, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: van Hove
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Savoie
authors.forename: Charlotte
authors.initials: C
authors.lastname: Maurin
authors.forename: Serge
authors.initials: S
authors.lastname: Brunelle
authors.forename: Gwenaëlle
authors.initials: G
authors.lastname: Gravis
authors.forename: Naji
authors.initials: N
authors.lastname: Salem
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
mesh_terms: D001706:Biopsy / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D054459:Elasticity Imaging Techniques; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography