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Eur Urol. 2016 Mar;69(3):512-7. doi: 10.1016/j.eururo.2015.06.005. Epub 2015 Jun 22.

Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion-targeted Prostate Biopsy Outcomes.

Author information

1
Department of Urology, NYU Langone Medical Center, New York, NY, USA.
2
Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
3
School of Medicine, NYU Langone Medical Center, New York, NY, USA.
4
Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Urology, New York Hospital Queens, Flushing, NY, USA.
5
Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Urology, St. Barnabas Hospital, Bronx, NY, USA.
6
Department of Pathology, NYU Langone Medical Center, New York, NY, USA.
7
Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, NYU Langone Medical Center, New York, NY, USA. Electronic address: samir.taneja@nyumc.org.

Abstract

BACKGROUND:

Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB).

OBJECTIVE:

To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included.

INTERVENTIONS:

All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB.

OUTCOMES:

Detection rates for all PCa and high-grade PCa (Gleason score [GS] ≥7) were compared using the McNemar test.

RESULTS AND LIMITATIONS:

MRF-TB detected fewer GS 6 PCas (75 vs 121; p<0.001) and more GS ≥7 PCas (158 vs 117; p<0.001) than SB. Higher mSS was associated with higher detection of GS ≥7 PCa (p<0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS ≥7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS ≥7 PCas in men with no prior biopsy (88 vs 72; p=0.012), in men with a prior negative biopsy (28 vs 16; p=0.010), and in men with a prior cancer diagnosis (42 vs 29; p=0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p<0.001) and men with prior cancer (30 vs 46; p=0.034). Limitations include the retrospective design and the potential for selection bias given a referral population.

CONCLUSIONS:

MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted.

PATIENT SUMMARY:

We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.

KEYWORDS:

Magnetic resonance imaging-ultrasound fusion; Magnetic resonance imaging–targeted prostate biopsy; Prostate biopsy; Prostate cancer; Prostate magnetic resonance imaging

PMID:
26112001
PMCID:
PMC5104338
DOI:
10.1016/j.eururo.2015.06.005
[Indexed for MEDLINE]
Free PMC Article

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