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Improved Detection of Clinically Significant Prostate Cancer With Software-assisted Systematic Biopsy Using MR/US Fusion in Patients With Negative Prostate MRI

      ABSTRACT

      Objective

      To compare detection rates of clinically significant prostate cancer (Gleason 7 or above) between standard transrectal ultrasound guided biopsy (TRUSGB) and software-assisted systematic biopsy (SASB) using magnetic resonance/ultrasound fusion in the setting of negative multiparametric magnetic resonance imaging (mpMRI) in biopsy-naïve patients.

      Methods

      We reviewed our prospectively maintained database of consecutive men that underwent prostate biopsy following mpMRI from September 2015 to December 2016. Patients with no prior biopsy (ie, biopsy naïve) whose mpMRI demonstrated no targetable lesions were included. Patients underwent either TRUSGB (n = 23) or SASB (n = 29). SASB was performing using the MRI/US fusion systematic template. Prebiopsy data were collected, and the detection rate of clinically significant prostate cancer was compared between biopsy approaches.

      Results

      Baseline patient characteristics were similar between the TRUSGB and SASB groups. Clinically significant prostate cancer was found in no patients undergoing TRUSGB and in 6 patients undergoing SASB (0 vs 21%, P = .028).

      Conclusion

      Based on our institutional experience, SASB is associated with a higher detection rate of clinically significant prostate cancer when compared to TRUSGB for biopsy-naïve patients with negative prostate mpMRI. Software co-registration of the MRI and ultrasound image may optimize the distribution of biopsy cores allowing for improved prostate cancer detection compared to conventional TRUSGB.
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      References

        • Shaw GL
        • Thomas BC
        • Dawson SN
        • et al.
        Identification of pathologically insignificant prostate cancer is not accurate in unscreened men.
        Br J Cancer. 2014; 110: 2405-2411
        • Barzell WE
        • Melamed MR
        • Cathcart P
        • Moore CM
        • Ahmed HU
        • Emberton M
        Identifying candidates for active surveillance: an evaluation of the repeat biopsy strategy for men with favorable risk prostate cancer.
        J Urol. 2012; 188: 762-767
        • Djavan B
        • Ravery V
        • Zlotta A
        • et al.
        Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop?.
        J Urol. 2001; 166: 1679-1683
        • McNeal JE
        • Redwine EA
        • Freiha FS
        • Stamey TA
        Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread.
        Am J Surg Pathol. 1988; 12: 897-906
        • Isariyawongse BK
        • Sun L
        • Banez LL
        • et al.
        Significant discrepancies between diagnostic and pathologic Gleason sums in prostate cancer: the predictive role of age and prostate-specific antigen.
        Urology. 2008; 72: 882-886
        • Pinthus JH
        • Witkos M
        • Fleshner NE
        • et al.
        Prostate cancers scored as Gleason 6 on prostate biopsy are frequently Gleason 7 tumors at radical prostatectomy: implication on outcome.
        J Urol. 2006; 176: 979-984
        • Greer MD
        • Brown AM
        • Shih JH
        • et al.
        Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: a multireader study.
        J Magn Reson Imaging. 2017; 45: 579
        • Garcia-Reyes K
        • Passoni NM
        • Palmeri ML
        • et al.
        Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis.
        Abdom Imaging. 2015; 40: 134
        • Kirkham APS
        • Emberton M
        • Allen C
        How good is MRI at detecting and characterizing cancer within the prostate?.
        Eur Urol. 2006; 50: 1163-1175
        • Puech P
        • Potiron E
        • Lemaitre L
        • et al.
        Dynamic contrast-enhanced-magnetic resonance imaging evaluation of intraprostatic prostate cancer: correlation with radical prostatectomy specimens.
        Urology. 2009; 74: 1094-1099
        • Turkbey B
        • Mani H
        • Shah V
        Multiparametric 3 T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds.
        J Urol. 2011; 186: 1818
        • Haffner J
        • Lemaitre L
        • Puech P
        • et al.
        Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection.
        BJU Int. 2011; 108: E171-E178
        • Moore CM
        • Robertson NL
        • Arsanious N
        • et al.
        Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review.
        Eur Urol. 2013; 63: 125-149
        • Sonn GA
        • Chang E
        • Natarajan S
        • et al.
        Value of targeted prostate biopsy using magnetic resonance–ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen.
        Eur Urol. 2014; 65: 809-815
        • Vourganti S
        • Rastinehad A
        • Yerram NK
        • et al.
        Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies.
        J Urol. 2012; 188: 2152-2157
        • Lu AJ
        • Syed JS
        • Nguyen KA
        • et al.
        Negative multiparametric magnetic resonance imaging of the prostate predicts absence of clinically significant prostate cancer on 12-core template prostate biopsy.
        Urology. 2017; 105: 118-122
        • Wysock JS
        • Mendhiratta N
        • Zattoni F
        • et al.
        Predictive value of negative 3T multiparametric magnetic resonance imaging of the prostate on 12-core biopsy results.
        BJU Int. 2016; 118: 515-520
        • Wang RS
        • Kim EH
        • Vetter JM
        • et al.
        Determination of the role of negative magnetic resonance imaging of the prostate in clinical practice: is biopsy still necessary?.
        Urology. 2017; 102: 190-197
        • Weinreb JC
        • Barentsz JO
        • Choyke PL
        • et al.
        PI-RADS Prostate Imaging—Reporting and Data System: 2015, Version 2.
        Eur Urol. 2016; 69: 16-40
        • Ankerst DP
        • Hoefler J
        • Bock S
        • et al.
        Prostate Cancer Prevention Trial Risk Calculator 2.0 for the prediction of low- versus high-grade prostate cancer.
        Urology. 2014; 83: 1362-1368
        • Kim EH
        • Vemana G
        • Johnson MH
        • et al.
        Magnetic resonance imaging-targeted vs. conventional transrectal ultrasound-guided prostate biopsy: single-institution, matched cohort comparison.
        Urol Oncol. 2015; 33: 109, e1-6
        • Kuru TH
        • Saeb-Parsy K
        • Cantiani A
        • et al.
        Evolution of repeat prostate biopsy strategies incorporating transperineal and MRI-TRUS fusion techniques.
        World J Urol. 2014; 32: 945-950
        • Lawrence EM
        • Tang SY
        • Barrett T
        • et al.
        Prostate cancer: Performance characteristics of combined T2W and DW-MRI scoring in the setting of template transperineal re-biopsy using MR-TRUS fusion.
        Eur Radiol. 2014; 24: 1497-1505
        • Bjurlin MA
        • Meng X
        • Le nobin J
        • et al.
        Optimization of prostate biopsy: the role of magnetic resonance imaging targeted biopsy in detection, localization and risk assessment.
        J Urol. 2014; 192: 648-658
        • Watanabe Y
        • Terai A
        • Araki T
        • et al.
        Detection and localization of prostate cancer with the targeted biopsy strategy based on ADC map: a prospective large-scale cohort study.
        J Magn Reson Imaging. 2012; 35: 1414-1421
        • Numao N
        • Yoshida S
        • Komai Y
        • et al.
        Usefulness of pre-biopsy multiparametric magnetic resonance imaging and clinical variables to reduce initial prostate biopsy in men with suspected clinically localized prostate cancer.
        J Urol. 2013; 190: 502-508
        • Megwalu II
        • Ferguson GG
        • Wei JT
        • et al.
        Evaluation of a novel precision template-guided biopsy system for detecting prostate cancer.
        BJU Int. 2008; 102: 546-550
        • Sidelsky S
        • Setia S
        • Vourganti S
        Spatial tracking of targeted prostate biopsy locations: moving towards effective focal partial prostate gland ablation with improved treatment planning.
        Curr Urol Rep. 2017; 18: 93
        • Riney JC
        • Sarwani NE
        • Siddique S
        • et al.
        Prostate magnetic resonance imaging: the truth lies in the eye of the beholder.
        Urol Oncol. 2018; (Advance online publication)https://doi.org/10.1016/j.urolonc.2017.12.013