title: [Prostatic biopsy: From organ biopsy to lesion biopsy. The role of MRI and MRI based biopsy systems].
abstract: OBJECTIVE
  Ultrasound guided prostatic biopsy is still the reference method for the diagnosis of prostate cancer. Nevertheless, multiparametric magnetic resonance imaging (mpMRI) has become the best imaging method to identify clinically significant tumors. Form this new situation derives the search of the best method to enable the biopsy of the lesions identified by mpMRI and are not visible on ultrasound. The objective of this work is to review the current role of MRI and the various modalities of MRI based biopsies.
  
  
  METHODS
  Non-structured literature review about the current status of prostatic mpMRI and the various methods of biopsy of the lesions identified with it: in bore, cognitive and different commercial fusion software biopsy methods available for directed biopsies.
  
  
  RESULTS
  Although results in the literature are very heterogeneous, all three bore biopsy, cognitive biopsy in experienced hands and the various fusion/biopsy software platforms enable a precise biopsy of mpMRI/identified lesions, increasing the yield of each sample obtained. Fusion systems do not imply a clear advantage in global detection over systematic biopsy, except in the subgroup of patients with previous negative biopsy. Nevertheless, they do demonstrate a higher detection rate for clinically significant tumors that increases in patients with a first negative biopsy. Its role in the new therapeutic approaches for prostate cancer is yet to be defined, but it will be growing and essential in a near future.
  
  
  CONCLUSIONS
  Multiparametric MRI is already an essential test in diagnostic algorithms for prostate cancer and the systems that enable to biopsy the lesion identified are day by day a more integrated tool in the urological daily practice, and urological procedures that will enable a more precise diagnosis leading to a personalized treatment for each patient.
authors.affiliation: Servicio de Urología. Hospital Ramón y Cajal Pozuelo de Alarcón. Madrid. España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rodríguez-Patrón
authors.affiliation: Servicios de Urología y Radiología. Hospital Ramón y Cajal. Universidad de Alcalá. Madrid. España.
authors.forename: Cristina
authors.initials: C
authors.lastname: González Gordaliza
authors.affiliation: Servicio de Urología. Hospital Ramón y Cajal Pozuelo de Alarcón. Madrid. España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Sanz-Mayayo
authors.affiliation: Servicio de Urología. Hospital Ramón y Cajal Pozuelo de Alarcón. Madrid. España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Burgos Revilla
mesh_terms: D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*