Prostate cancer detection using an extended prostate biopsy schema in combination with additional targeted cores from suspicious images in conventional and functional endorectal magnetic resonance imaging of the prostate

Abstract

The purpose of this study is to report our method in detecting prostate cancer (PCa) using an 18-core transrectal ultrasound (TRUS) prostate biopsy (PB) schema, in combination with additional targeted cores from suspicious images in conventional (e-cMRI) and functional (e-fMRI) endorectal magnetic resonance imaging (e-MRI) of the prostate. From 2004 to 2008, 260 consecutive patients with a clinical suspicion of PCa underwent PB and were prospectively studied. e-cMRI and e-fMRI was performed in all patients before PB. The patients were divided into two groups (A and B) according to the results of their radiological findings (group A ¼ suspicious findings, group B ¼ non-suspicious findings). After the images were processed, an 18-core TRUS-guided PB was performed. When a patient exhibited a suspicious site on e-cMRI and e-fMRI images, three additional targeted PBs were obtained from that site. In group A, 17.5% of PCa was detected by the 18-core PB and 56.5% of PCa was detected by the targeted cores. The overall PCa detection rate (18 þ targeted cores) was 73.9%. The overall specificity was 73.9%. In group B, overall false-positive detection rate reached 19.2%, with the overall sensitivity being 80.8%. The method described above is not only practical but also a promising modality in PCa detection. As seen, PCa was optimally detected when combining the 18-core and targeted-core PB schema together. Non-suspicious images do not rule out the probability of PCa, thus justifying a PB in these patients as well.

Evaluation of a Structured Report of Functional Prostate Magnetic Resonance Imaging in Patients with Suspicion for Prostate Cancer or under Active Surveillance

“…Using a division into 18 regions, the present standardized approach enables a relatively high tumor detection rate of 72% on repeat biopsy. Similar PCa detection rates of 73.9% by transperineal repeat biopsy have been reported [13]. However, transperineal biopsy commonly requires general or spinal anesthesia.…”

Cognitive-Targeted versus Magnetic Resonance Imaging-Guided Prostate Biopsy in Prostate Cancer Detection

“…Several publications analyzed the value of cognitively performed targeted biopsy [16,17,20,21]. Our overall detection rate for CTB without concomitant TRUS-GB is 50% and with concomitant TRUS-GB is 56%.…”

“…Kasivisvanathan et al [20] detected in 57% of the cases PCa. Labanaris et al [21] evaluated 260 patients who had a prior negative biopsy. They show a PCa detection rate of 56%.…”

“…CTB is a fast and relatively simple technique: an existing TRUS facility, knowledge of the target location on MRI and familiarity with prostate anatomy on ultrasonography are sufficient. Recent studies show promising results for cognitive targeting of CSL [16,17,18,19,20,21]. …”

Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit?

“…Despite the widespread utility and acceptance of image-guided biopsy protocols after negative TRUS-guided biopsies (14)(15)(16), data is relatively scarce about the actual role of mp-MRI-guided prostate biopsies in biopsy-naive patients. In our study, we tried to investigate if MRI-guidance via cognitive fusion or in-bore real-time targeting could increase the overall and clinically significant cancer detection rate in the initial biopsies of those men without DRE findings suggestive of locally advanced disease (≥cT3).…”