Value of Targeted Prostate Biopsy Using Magnetic Resonance–Ultrasound Fusion in Men with Prior Negative Biopsy and Elevated Prostate-specific Antigen

Abstract

Background Conventional biopsy fails to detect the presence of some prostate cancers (PCas). Men with a prior negative biopsy but persistently elevated prostate-specific antigen (PSA) pose a diagnostic dilemma, as some harbor elusive cancer. Objective To determine whether use of magnetic resonance–ultrasound (MR-US) fusion biopsy results in improved detection of PCa compared to repeat conventional biopsy. Design, setting, and participants In a consecutive-case series, 105 subjects with prior negative biopsy and elevated PSA values underwent multiparametric magnetic resonance imaging (MRI) and fusion biopsy in an outpatient setting. Intervention Suspicious areas on multiparametric MRI were delineated and graded by a radiologist; MR–US fusion biopsy was performed by a urologist using the Artemis device; targeted and systematic biopsies were obtained regardless of MRI result. Outcome measurements and statistical analysis Detection rates of all PCa and clinically significant PCa (Gleason ≥3 + 4 or Gleason 6 with maximal cancer core length ≥4 mm) were determined. The yield of targeted biopsy was compared to systematic biopsy. The ability of an MRI grading system to predict clinically significant cancer was investigated. Stepwise multivariate logistic regression analysis was performed to determine predictors of significant cancer on biopsy. Results and limitations Fusion biopsy revealed PCa in 36 of 105 men (34%; 95% confidence interval [CI], 25–45). Seventy-two percent of men with PCa had clinically significant disease; 21 of 23 men (91%) with PCa on targeted biopsy had significant cancer compared to 15 of 28 (54%) with systematic biopsy. Degree of suspicion on MRI was the most powerful predictor of significant cancer on multivariate analysis. Twelve of 14 (86%) subjects with a highly suspicious MRI target were diagnosed with clinically significant cancer. Conclusions MR-US fusion biopsy provides improved detection of PCa in men with prior negative biopsies and elevated PSA values. Most cancers found were clinically significant.

Evidence-based guideline recommendations on multiparametric magnetic resonance imaging in the diagnosis of prostate cancer: A Cancer Care Ontario clinical practice guideline

“…1 The current standard method to diagnose clinically significant prostate cancer (CSPC) is transrectal ultrasound (TRUS)-guided systematic biopsy (10-12 cores), 2 which may over-diagnose non-CSPC or miss CSPC in patients in the first or repeated biopsy settings. 3,4 The template transperineal mapping biopsy or saturation biopsy technique should be more sensitive, but are more invasive than TRUS-guided systematic biopsy. 5 Recently, there have been several publications investigating whether multiparametric magnetic resonance imaging (mpMRI) techniques improve the diagnostic accuracy of CSPC.…”

Active Surveillance-Factors Affecting the Treatment Decision: 3M: “Marker”, “Mapping”, “MRI”

“…Bir çalışmada MR-USG füzyon görüntüleme eşliğinde yapılan prostat biyopsisinin sistematik prostat biyopsisine göre prostat kanserini 3 kat daha fazla oranla tespit ettiğini belirtmişlerdir (35). Ayrıca füzyon biyopsilerin daha önceki biyopsileri negatif ve PSA artışı tespit edilen hastalarda prostat kanseri tespitini arttırdığı belirtilmiştir (39).…”

Current prostate biopsy procedures for in the detection of cancer

“…Так, при повторной биопсии с применением описанной методики удается подтвердить наличие опухоли у 34% пациентов, из которых у 72% РПЖ является клинически значимым [36]. При этом отмечено, что визуализация патологических очагов в железе, по данным МРТ, является предиктором для выявления злокачественных из-менений.…”