PCRI’s resident moderator, Mark Moyad, MD, MPH, and radiologist Daniel Margolis, MD, discuss the current state of the 12-core prostate biopsy and whether it still has a place in the diagnosis of prostate cancer or whether it should be totally replaced by the MRI targeted biopsy.

Daniel Margolis, MD, is an Associate Professor of Radiology at the Weill Cornell Medical College and an Associate Attending Radiologist at New York-Presbyterian Hospital. He received a B.A. from UC Berkeley in 1992 and his medical degree at the Keck School of Medicine of USC in 1998. He went on to serve his community by completing an internship at the Los Angeles Department of Veterans Affairs. He then finished his residency at the UCLA Medical Center in 2003 and completed a prestigious fellowship at Stanford University sponsored by the National Cancer Institute. Dr. Margolis specializes in abdominal imaging and has co-authored nearly 100 publications, many of which focus on prostate imaging.

0:08 Dr. Moyad asks Dr. Margolis why with all of the improvements in imaging a doctor would order a biopsy without first doing an MRI. Dr. Margolis responds by describing a rigorous international study published recently in the New England Journal of Medicine by University College London. It compared two groups of men: One that used an MRI to determine whether a biopsy was necessary and where to perform it, and another group that did not use the MRI. The study found that the group who used MRI found more significant cancers in their biopsies, less insignificant cancers, and had fewer biopsies overall than the group that did not have MRI. The data was so strong that the study ended early. It is unclear if the FDA will use this study to determine protocol in the United States because they are wary of studies that do not include American patients, however, this study may be an exception because it included so many different countries.

2:25 Dr. Moyad asks Dr. Margolis if the MRI targeted biopsy will completely replace the random 12 core biopsy in the coming years given the strength of the evidence. Dr. Margolis says that this has not happened yet (apart from bureaucratic inefficiencies) because there is a small percentage of men whose cancer will be missed by an MRI. Normally cancer that is missed by an MRI is insignificant, and there is now an attempt to find signs to help predict which men would have significant cancer that does not show up on MRI, but that is still a work in progress. In England, the protocol is already moving towards the exclusive use of MRI targeted biopsies and their strategy for filling this gap is to ensure follow up MRIs. Even if the cancer is still not detectable on the follow-up MRIs, a radiologist will be able to see suspicious changes from the first MRI and can then order a targeted biopsy.

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