However, there are several challenges that must be addressed before MRS is acceptable as an alternative to prostate biopsy. An obvious hurdle is the exclusion of reimbursement by Medicare/Medicaid and private third-party payers. Equally crucial is the lack of standardization in the protocol, and the technology requires improvements that would eliminate inconclusive or ambiguous diagnostic spectra. Finally, today there is no true substitute for the kinds of genetic or molecular examination that can be accomplished with the actual cells extracted by needle biopsy. For physicians and patients interested in focal ablation procedures, laboratory analysis of cell lines yields greater knowledge and therefore a higher degree of confidence regarding appropriate treatment choices.
Freiherr concludes, "...MRS use is far from becoming standard. Even staunch advocates agree that it must be used in conjunction with other modalities and techniques. MRS is increasingly referred to as a 'virtual biopsy'; however, MRS is not a candidate to replace the biopsy needle, at least not in the near term."
ihttp://www.medscape.com/viewarticle/750176_print
iiScheenen T, Fütterer J, et al. Discriminating cancer from noncancer tissue in the prostate by 3-dimensional proton magnetic resonance spectroscopic imaging: a prospective multicenter validation study. Invest Radiol. 2011;46:25-33.
