Critical evaluation of MRI-targeted TRUS-guided transperineal fusion biopsy for detection of prostate cancer.

Abstract

e16063 Background: Precise staging of prostate cancer (PC) is essential for individualized treatment decisions. However, the majority of transrectal biopsies are negative for prostate cancer or show imprecise results. Additionally, the rate of upgrading in Gleason scores between biopsy and prostatectomy specimen is around 30-40%. MRI/TRUS fusion has shown encouraging results for detecting clinically significant prostate cancer. Methods: 412 consecutive patients with suspicion of PC were prospectively included in our database. The median age of patients was 65 years (range 42-84). Mean PSA level was 9.56 ng/ml (± 7.9ng/ml, SD). 55% of men had previous TRUS-guided biopsies, 45% underwent primary biopsy. Imaging data and biopsy results were analyzed and a self-designed questionnaire was send to all men regarding further clinical history and adverse effects of the biopsy. Results: In 236 of 412 (57.3%) biopsy samples showed PC. 71.6% of biopsy proven PC were clinically significant (D’Amico criteria). On multiparametric (mp)-MRI, 120 men were reported as highly suspicious for PC and in these tumor detection rate was 83.3% (100/120). In patients without cancer-suspicious MRI-lesions, 31,8% (42/132) men were diagnosed with significant disease (Table 1). Regarding adverse effects, 152 patients (49%) reported hematuria after biopsy. 9 patients (2%) needed temporary catheterization after biopsy due to prostate swelling. In three patients (0.7%) febrile urinary tract infection occurred after biopsy. Major limitation is the limited follow-up of 12-months of biopsy-negative patients. Conclusions: MRI-targeted TRUS-guided transperineal fusion biopsy provides high detection rates of clinically significant tumors. mp-MRI still has its limitations, and therefore systematic biopsies should currently not be omitted. The morbidity of the transperineal saturation approach is reasonable and mainly self-limiting. [Table: see text]

Current status of magnetic resonance imaging (MRI) and ultrasonography fusion software platforms for guidance of prostate biopsies

“…Overall, results such as these are consistent with those of the other platforms mentioned in the present review (UroNav, Artemis, Koelis and BiopSee) and indicate targeted biopsy has greater utility not only in detecting PCa, but in avoiding the diagnosis of nonsignificant disease.…”

“…With earlier and more accurate diagnosis of PCa, not only does this have the potential to improve patient quality of life but could also potentially affect mortality outcomes for men with intermediate‐ to high‐risk disease at the time of initial diagnosis. As present studies indicate, while there is certainly measurable utility in the use of targeted cores, systematic biopsy methods cannot be dismissed because they continue to diagnose a small but measurable number of significant lesions that are missed on targeted biopsy . Whether this is attributable to limitations of MRI to detect lesions below a certain size threshold, non‐imageable cancer foci, or misplaced targeted cores because of poor co‐registration of MRI with the TRUS used for guidance is unclear at this point, but MRI technology improvements may potentially shed light on these questions, as MRI strives to shed light on PCa detection and characterization.…”

“…Since then, multiple MRI/US software platforms have been developed. The existing platforms with published clinical data to date are summarized in Table . The general workflow of all platforms first requires a pre‐biopsy diagnostic MRI to identify and annotate lesions suspicious for cancer based on imaging characteristics, with interpretation by a prostate‐trained radiologist.…”

“…Results of 582 patients have shown an increasing correlation between mpMRI suspicion and Gleason score with detection for Gleason score ≥8 PCa showing a 98% sensitivity at the low to moderate threshold and a 91% negative predictive value at the moderate to high threshold . Overall PCa detection rates are nearly equivalent for targeted vs systematic (80 vs 81%; Table ), but the addition of targeted cores to systematic cores markedly increased the detection rates of intermediate‐ to high‐risk disease, with 32% of patients upgraded after targeted biopsy (TB). Furthermore, targeted cores detected clinically significant disease (biopsy Gleason score ≥4 + 3) in 18% of patients with negative systematic biopsies, while systematic cores detected 8% of Gleason ≥4 + 3 cases missed by targeted biopsy .…”

“…Patient recruitment for BiopSee began in June 2010 and by March 2012 it had enrolled 347 patients . Overall PCa detection was 58% of patients with targeted biopsy cores accounting for 51% of cases, of which 41% had clinically significant disease.…”