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

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.

[1]  Michael McCormack,et al.  Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. , 2006 .

[2]  J. Fütterer,et al.  Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. , 2013, European urology.

[3]  G. Andriole,et al.  Value of Targeted Prostate Biopsy Using Magnetic Resonance–Ultrasound Fusion in Men with Prior Negative Biopsy and Elevated Prostate-Specific Antigen: Sonn GA, Chang E, Natarajan S, et al (Univ of California, Los Angeles) Eur Urol 65:809-815, 2014 § , 2014 .

[4]  Thomas Hambrock,et al.  Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. , 2012, European urology.

[5]  Baris Turkbey,et al.  Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? , 2013, Radiology.

[6]  P. Choyke,et al.  D'Amico risk stratification correlates with degree of suspicion of prostate cancer on multiparametric magnetic resonance imaging. , 2010, The Journal of urology.

[7]  Baris Turkbey,et al.  Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. , 2011, The Journal of urology.

[8]  Baris Turkbey,et al.  Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. , 2012, The Journal of urology.

[9]  C. Sundaram,et al.  Biopsy Gleason score: how does it correlate with the final pathological diagnosis in prostate cancer? , 1997, British journal of urology.

[10]  Pingkun Yan,et al.  Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. , 2011, The Journal of urology.

[11]  Mark Emberton,et al.  Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. , 2013, European urology.

[12]  Shyam Natarajan,et al.  Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. , 2014, European urology.

[13]  P. Choyke,et al.  Prostate cancer: value of multiparametric MR imaging at 3 T for detection--histopathologic correlation. , 2010, Radiology.

[14]  Rodolfo Montironi,et al.  Contemporary Role of Systematic Prostate Biopsies: Indications, Techniques, and Implications for Patient Care , 2013 .

[15]  W. Fair,et al.  Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. , 1997, The Journal of urology.

[16]  Shyam Natarajan,et al.  MRI–ultrasound fusion for guidance of targeted prostate biopsy , 2013, Current opinion in urology.

[17]  J. Epstein,et al.  Accuracy of biopsy Gleason scores from a large uropathology laboratory: use of a diagnostic protocol to minimize observer variability. , 1998, Urology.