Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy.

Academic Article

Abstract

  • BACKGROUND: Gleason scores from standard, 12-core prostate biopsies are upgraded historically in 25-33% of patients. Multiparametric prostate magnetic resonance imaging (MP-MRI) with ultrasound (US)-targeted fusion biopsy may better sample the true gland pathology. OBJECTIVE: The rate of Gleason score upgrading from an MRI/US-fusion-guided prostate-biopsy platform is compared with a standard 12-core biopsy regimen alone. DESIGN, SETTING, AND PARTICIPANTS: There were 582 subjects enrolled from August 2007 through August 2012 in a prospective trial comparing systematic, extended 12-core transrectal ultrasound biopsies to targeted MRI/US-fusion-guided prostate biopsies performed during the same biopsy session. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The highest Gleason score from each biopsy method was compared. INTERVENTIONS: An MRI/US-fusion-guided platform with electromagnetic tracking was used for the performance of the fusion-guided biopsies. RESULTS AND LIMITATIONS: A diagnosis of prostate cancer (PCa) was made in 315 (54%) of the patients. Addition of targeted biopsy led to Gleason upgrading in 81 (32%) cases. Targeted biopsy detected 67% more Gleason ≥4+3 tumors than 12-core biopsy alone and missed 36% of Gleason ≤3+4 tumors, thus mitigating the detection of lower-grade disease. Conversely, 12-core biopsy led to upgrading in 67 (26%) cases over targeted biopsy alone but only detected 8% more Gleason ≥4+3 tumors. On multivariate analysis, MP-MRI suspicion was associated with Gleason score upgrading in the targeted lesions (p<0.001). The main limitation of this study was that definitive pathology from radical prostatectomy was not available. CONCLUSIONS: MRI/US-fusion-guided biopsy upgrades and detects PCa of higher Gleason score in 32% of patients compared with traditional 12-core biopsy alone. Targeted biopsy technique preferentially detects higher-grade PCa while missing lower-grade tumors.
  • Published In

  • European Urology  Journal
  • Keywords

  • Image-guided biopsy, Magnetic resonance imaging, Prostate cancer, Prostatic neoplasms/diagnosis, Prostatic neoplasms/pathology, Prostatic neoplasms/ultrasonography, Targeted biopsy, Aged, Biopsy, Large-Core Needle, Humans, Image Interpretation, Computer-Assisted, Image-Guided Biopsy, Magnetic Resonance Imaging, Interventional, Male, Middle Aged, Multimodal Imaging, Neoplasm Grading, Predictive Value of Tests, Prognosis, Prospective Studies, Prostatic Neoplasms, Ultrasonography, Interventional
  • Digital Object Identifier (doi)

    Author List

  • Siddiqui MM; Rais-Bahrami S; Truong H; Stamatakis L; Vourganti S; Nix J; Hoang AN; Walton-Diaz A; Shuch B; Weintraub M
  • Start Page

  • 713
  • End Page

  • 719
  • Volume

  • 64
  • Issue

  • 5