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BJU Int. 2018 Jul;122(1):40-49. doi: 10.1111/bju.14049. Epub 2017 Nov 15.

Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy-naïve men with suspicion of prostate cancer.

Author information

1
CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
2
Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
3
Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
4
Australian Urology Associates and Department of Surgery, Central Clinical School, Monash University, Melbourne, Vic., Australia.
5
Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
6
Healthcare Imaging and Monash University, Melbourne, Vic., Australia.
7
Department of Pathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
8
Institute of Medical Statistics, Informatics and Epidemiology, University Hospital Cologne, Cologne, Germany.
9
Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.

Abstract

OBJECTIVES:

To analyse the detection rates of primary magnetic resonance imaging (MRI)-fusion transperineal prostate biopsy using combined targeted and systematic core distribution in three tertiary referral centres.

PATIENTS AND METHODS:

In this multicentre, prospective outcome study, 807 consecutive biopsy-naïve patients underwent MRI-guided transperineal prostate biopsy, as the first diagnostic intervention, between 10/2012 and 05/2016. MRI was reported following the Prostate Imaging-Reporting and Data System (PI-RADS) criteria. In all, 236 patients had 18-24 systematic transperineal biopsies only, and 571 patients underwent additional targeted biopsies either by MRI-fusion or cognitive targeting if PI-RADS ≥3 lesions were present. Detection rates for any and Gleason score 7-10 cancer in targeted and overall biopsy were calculated and predictive values were calculated for different PI-RADS and PSA density (PSAD) groups.

RESULTS:

Cancer was detected in 68% of the patients (546/807) and Gleason score 7-10 cancer in 49% (392/807). The negative predictive value of 236 PI-RADS 1-2 MRI in combination with PSAD of <0.1 ng/mL/mL for Gleason score 7-10 was 0.91 (95% confidence interval ± 0.07, 8% of study population). In 418 patients with PI-RADS 4-5 lesions using targeted plus systematic biopsies, the cancer detection rate of Gleason score 7-10 was significantly higher at 71% vs 59% and 61% with either approach alone (P < 0.001). For 153 PI-RADS 3 lesions, the detection rate was 31% with no significant difference to systematic biopsies with 27% (P > 0.05). Limitations include variability of multiparametric MRI (mpMRI) reading and Gleason grading.

CONCLUSION:

MRI-based transperineal biopsy performed at high-volume tertiary care centres with a significant experience of prostate mpMRI and image-guided targeted biopsies yielded high detection rates of Gleason score 7-10 cancer. Prostate biopsies may not be needed for men with low PSAD and an unsuspicious MRI. In patients with high probability lesions, combined targeted and systematic biopsies are recommended.

KEYWORDS:

#PCSM, #ProstateCancer; MRI-TRUS fusion; cognitive fusion; magnetic resonance imaging; prostate biopsy; transperineal

PMID:
29024425
DOI:
10.1111/bju.14049
[Indexed for MEDLINE]
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