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TRUS-FUSION TARGETED PROSTATE BIOPSY?
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
MP16-16 GLEASON SCORING OF PROSTATE BIOPSIES IN ACTIVE SURVEILLANCE PATIENTS OBTAINED BY STANDARD TRUS AND MRI: AN UPDATE James Bienvenu*, Peter Haddock, Joseph Cusano, Joseph Wagner, Hartford, CT INTRODUCTION AND OBJECTIVES: MRI-TRUS biopsy systems allow MRI to be linked to the practicality of ultrasound and may be useful in the selection and follow up of active surveillance (AS) patients. Our previously reported experience contradicted most series in which MRI-TRUS significantly increases the detection rate of clinically-significant cancers. In this follow up study, we examined whether process changes and increased experience resulted in increased MRI-TRUS detection of significant cancer. METHODS: Two cohorts were identified (i) a training group of 75 AS patients (Jan-Dec 2014), and (ii) a study group of 65 AS patients (Dec 2014-Sept 2015). MRI-TRUS process changes (software upgrade, improvements in image alignment, and prevention of RF interference) were implemented. An MRI-TRUS (3T or 1.5T with endorectal coil) confirmatory biopsy was performed within 1 year in AS patients. Regions of interest (ROI) were identified. 12 systematic standard TRUS biopsies and 3 cores from each ROI using MRI-TRUS fusion (UroNav) were performed. Gleason score 7 or a single core volume of >50% was considered clinically significant. Each patient served as their own control. Rates of clinically significant cancer detected by standard biopsies, ROI biopsies, and both methodologies were determined. RESULTS: In the training and study groups, 36.0% (27/75) and 33.8% (22/65) of patients, respectively had clinically significant cancer. In the training group, 11.1% (3/27) were identified by MRI-TRUS fusion alone, 51.9% (14/27) by standard TRUS alone, and 37.0% (10/27) by both biopsy methods. In the study group, 13.6% (3/22) were identified by MRI-TRUS fusion alone, 50.0% (11/22) by standard TRUS alone, and 36.4% (8/22) were by both biopsy methods. CONCLUSIONS: Despite process improvements and increased experience, MRI-TRUS fusion only increased the rate of detecting clinically significant cancer to 13.6%. Importantly, performing MRI-TRUS fusion alone and eliminating standard systematic biopsies would have missed 51% of clinically significant cancers. Our continued experience with MRI-TRUS fusion continues to contradict most published series in which MRI-TRUS fusion significantly increases the detection rate of clinically significant cancers.
THE JOURNAL OF UROLOGYâ
accurate diagnosis of significant cancer (SC) and avoidance of overdiagnosis of insignificant cancer (IC). Here, we assessed diagnostic performance of mpMRI/TRUS-fusion targeted biopsy (TgB) in comparison with that of systematic multisite biopsy (SyB) and asked if SyB can be safely omitted in diagnosing SC. METHODS: From April 2013 to August 2015, 202 men with elevated PSA (<20 ng/ml) or abnormal DRE finding were enrolled in this study. All pts underwent mpMRI prior to biopsy. mpMRI findings were evaluated according to Prostate Imaging-Reporting and Data System (PI-RADS) and scores 3 were considered positive. All patients underwent transperineal 14-core SyB and those with mpMRI-positive lesions further underwent 4-core TgB per lesion using real-time virtual sonography (Arietta70, Hitachi-Aloka Medical). SC was defined as Gleason score 4+3 or maximum cancer length 5 mm. We evaluated the diagnostic performance of SyB TgB in detecting all cancer and SC. RESULTS: The median (range) age and PSA levels were 69 years (45-82) and 7.8 ng/ml (1.6-19.6). Of the 202 men, 166 (82%) were positive for MRI. Detection rates of all cancer, SC and IC were 58% (117/202), 44% (89/202) and 14% (28/202), respectively, and 16% (32/ 202) were categorized to NCCN high-risk disease. TgB showed significantly higher SC detection rate and lower IC detection rate than SyB (47% vs 36%, p ¼ 0.03; and 7% vs 35%, p ¼ 0.004; respectively). TgB alone detected 88% of SC (78/89) and more importantly 97% of high-risk disease (31/32). CONCLUSIONS: Most of clinically significant diseases were diagnosed by MRI/TRUS-fusion targeted biopsy alone. Our data suggest that multisite systematic biopsy can be safely omitted in the era of MRI/TRUS-fusion targeted biopsy depending on the patient’s general condition.
Source of Funding: None
MP16-17 CAN SYSTEMATIC BIOPSY BE SAFELY OMITTED IN THE ERA OF MRI/TRUS-FUSION TARGETED PROSTATE BIOPSY? Yasukazu Nakanishi*, Hiroshi Fukushima, Minato Yokoyama, Madoka Kataoka, Ken-ichi Tobisu, Fumitaka Koga, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Multi-parametric MRI (mpMRI) prior to prostate biopsy has been increasingly utilized for
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Source of Funding: none
MP16-16 GLEASON SCORING OF PROSTATE BIOPSIES IN ACTIVE SURVEILLANCE PATIENTS OBTAINED BY STANDARD TRUS AND MRI: AN UPDATE James Bienvenu*, Peter Haddock, Joseph Cusano, Joseph Wagner, Hartford, CT INTRODUCTION AND OBJECTIVES: MRI-TRUS biopsy systems allow MRI to be linked to the practicality of ultrasound and may be useful in the selection and follow up of active surveillance (AS) patients. Our previously reported experience contradicted most series in which MRI-TRUS significantly increases the detection rate of clinically-significant cancers. In this follow up study, we examined whether process changes and increased experience resulted in increased MRI-TRUS detection of significant cancer. METHODS: Two cohorts were identified (i) a training group of 75 AS patients (Jan-Dec 2014), and (ii) a study group of 65 AS patients (Dec 2014-Sept 2015). MRI-TRUS process changes (software upgrade, improvements in image alignment, and prevention of RF interference) were implemented. An MRI-TRUS (3T or 1.5T with endorectal coil) confirmatory biopsy was performed within 1 year in AS patients. Regions of interest (ROI) were identified. 12 systematic standard TRUS biopsies and 3 cores from each ROI using MRI-TRUS fusion (UroNav) were performed. Gleason score 7 or a single core volume of >50% was considered clinically significant. Each patient served as their own control. Rates of clinically significant cancer detected by standard biopsies, ROI biopsies, and both methodologies were determined. RESULTS: In the training and study groups, 36.0% (27/75) and 33.8% (22/65) of patients, respectively had clinically significant cancer. In the training group, 11.1% (3/27) were identified by MRI-TRUS fusion alone, 51.9% (14/27) by standard TRUS alone, and 37.0% (10/27) by both biopsy methods. In the study group, 13.6% (3/22) were identified by MRI-TRUS fusion alone, 50.0% (11/22) by standard TRUS alone, and 36.4% (8/22) were by both biopsy methods. CONCLUSIONS: Despite process improvements and increased experience, MRI-TRUS fusion only increased the rate of detecting clinically significant cancer to 13.6%. Importantly, performing MRI-TRUS fusion alone and eliminating standard systematic biopsies would have missed 51% of clinically significant cancers. Our continued experience with MRI-TRUS fusion continues to contradict most published series in which MRI-TRUS fusion significantly increases the detection rate of clinically significant cancers.
THE JOURNAL OF UROLOGYâ
accurate diagnosis of significant cancer (SC) and avoidance of overdiagnosis of insignificant cancer (IC). Here, we assessed diagnostic performance of mpMRI/TRUS-fusion targeted biopsy (TgB) in comparison with that of systematic multisite biopsy (SyB) and asked if SyB can be safely omitted in diagnosing SC. METHODS: From April 2013 to August 2015, 202 men with elevated PSA (<20 ng/ml) or abnormal DRE finding were enrolled in this study. All pts underwent mpMRI prior to biopsy. mpMRI findings were evaluated according to Prostate Imaging-Reporting and Data System (PI-RADS) and scores 3 were considered positive. All patients underwent transperineal 14-core SyB and those with mpMRI-positive lesions further underwent 4-core TgB per lesion using real-time virtual sonography (Arietta70, Hitachi-Aloka Medical). SC was defined as Gleason score 4+3 or maximum cancer length 5 mm. We evaluated the diagnostic performance of SyB TgB in detecting all cancer and SC. RESULTS: The median (range) age and PSA levels were 69 years (45-82) and 7.8 ng/ml (1.6-19.6). Of the 202 men, 166 (82%) were positive for MRI. Detection rates of all cancer, SC and IC were 58% (117/202), 44% (89/202) and 14% (28/202), respectively, and 16% (32/ 202) were categorized to NCCN high-risk disease. TgB showed significantly higher SC detection rate and lower IC detection rate than SyB (47% vs 36%, p ¼ 0.03; and 7% vs 35%, p ¼ 0.004; respectively). TgB alone detected 88% of SC (78/89) and more importantly 97% of high-risk disease (31/32). CONCLUSIONS: Most of clinically significant diseases were diagnosed by MRI/TRUS-fusion targeted biopsy alone. Our data suggest that multisite systematic biopsy can be safely omitted in the era of MRI/TRUS-fusion targeted biopsy depending on the patient’s general condition.
Source of Funding: None
MP16-17 CAN SYSTEMATIC BIOPSY BE SAFELY OMITTED IN THE ERA OF MRI/TRUS-FUSION TARGETED PROSTATE BIOPSY? Yasukazu Nakanishi*, Hiroshi Fukushima, Minato Yokoyama, Madoka Kataoka, Ken-ichi Tobisu, Fumitaka Koga, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Multi-parametric MRI (mpMRI) prior to prostate biopsy has been increasingly utilized for
e167
Source of Funding: none