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Eur Urol. 2014 Apr;65(4):809-15. doi: 10.1016/j.eururo.2013.03.025. Epub 2013 Mar 17.

Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen.

Author information

1
Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: geoffsonn@gmail.com.
2
Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
3
Department of Biomedical Engineering, University of California, Los Angeles, Los Angeles, CA, USA; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, CA, USA.
4
Department of Radiology, University of California, Los Angeles, Los Angeles, CA, USA.
5
Department of Pathology, University of California, Los Angeles, Los Angeles, CA, USA.
6
Department of Orthopedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.

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.

KEYWORDS:

Magnetic resonance imaging; Prostate biopsy; Prostate cancer; Ultrasound

PMID:
23523537
PMCID:
PMC3858524
DOI:
10.1016/j.eururo.2013.03.025
[Indexed for MEDLINE]
Free PMC Article

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