Mp30-11 upgrading of Gleason Score From Prostate Biopsy to Radical Prostatectomy: Magnetic Resonance Imaging-Ultra Sound Fusion Guided Biopsy Versus Systematic Biopsy of Prostate

Abstract

Suspicious lesions were reported on both TRUS (hypoechoic lesion (HEL)) and MRI (!PI-RADS v2 score 3) in 69% of patients. More lesions per patient were found on MRI compared to TRUS (1.49 vs. 1.03, p<0.01). PI-RADS 3, 4, and 5 MRI lesions were seen as HEL on TRUS in 51%, 69%, and 85% of patients, respectively. PCa and clinically significant PCa were detected in 84% and 5% of PI-RADS 3 lesions, 80% and 49% of PI-RADS 4 lesions, and 93% and 79% of PI-RADS 5 lesions, respectively. SBx detected the highest overall Gleason score or was equivalent to MBx/TBx in 135 patients (67%). The highest overall Gleason score was detected in 17 patients (8%) by TBx, and in 13 patients (6%) by MBx. In 36 patients (18%) no PCa was found by any biopsy method.CONCLUSIONS: In the setting of high expertise and experience with TRUS and TBx, MRI and MBx do identify some additional high-grade cases, but this is not common, and the incremental value of MBx over SBx and TBx is relatively modest. SBx should not be omitted routinely from biopsy protocols, and urologists should not abandon TRUS as an important diagnostic imaging modality.