762 Detection of anterior and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion-guidance

Title

762

Detection of anterior and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion-guidance Eur Urol Suppl 2015;14/2;e762          

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Radtke J.P.1 , Boxler S. 2 , Kuru T.3 , Wolf M. 4 , Alt C.5 , Popeneciu V. 3 , Steinemann S. 3 , Huettenbrink C.3 , Bergstraesser-Gasch C.3 , Klein T.3 , Kesch C.3 , Roethke M. 4 , Roth W.6 , Schlemmer H-P. 7 , Hohenfellner M. 8 , Hadaschik B. 8 1 UniversitätsKlinikum

Heidelberg, Heidelberg University Hospital, Heidelberg, Germany, 2 University Hospital Berne, Dept. of Urology,

Berne, Switzerland, 3 University Hospital Heidelberg, Dept. of Urology, Heidelberg, Germany, 4 German Cancer Research Center, Dept. of Radiology, Heidelberg, Germany, 5 University Hospital Heidelberg, Dept. of Diagnostic and Interventional Radiology, Heidelberg, Germany, 6 University

Hospital Heidelberg, Institute of Pathology, Heidelberg, Germany, 7 German Cancer Research Center, Institute of Radiology,

Heidelberg, Germany, 8 University Hospital Heidelberg, Institute of Urology, Heidelberg, Germany INTRODUCTION & OBJECTIVES: To analyze the potential of prostate MRI to detect significant prostate cancer (sPCa) and to assess the accuracy of different multiparametric MRI (mpMRI) sequences. MATERIAL & METHODS: 859 consecutive patients underwent pre-biopsy mpMRI, transperineal saturation biopsy (SB) and MRI-targeted biopsy (TB) in case of suspicious MRI with software registration between June 2010 and June 2014. mpMRI were performed at 3T without endorectal coil. From July 2012 on, image analyses were performed according to the ESUR guidelines. Older mpMRI were retrospectively assessed using PIRADS. All patients underwent SB as reference test and TB with rigid software-registration in case of MRI-suspicious lesions (PIRADS≥2). Index cancer lesions (defined as the highest volume lesion) were distributed into anterior prostate, including the anterior fibromuscular stroma and the transition zone anterior to the urethra, the posterior transition zone (pTZ) and the peripheral zone. Student’s-t-tests, McNemar’s-tests, predictive values and univariate logistic regression were used to evaluate detection rates of MRI and biopsy. Detection rates and accuracy were assessed for four different definitions of sPCa, including Gleason Score (GS), PSA-level and tumour volume (TV). RESULTS: 136 out of 859 patients had biopsy proven anterior PCa (APCa)(n=52) or pTZ PCa (n=84). Overall prevalence was 15.8% (6.1% for APCa, 9.7% for pTZ PCa). High-risk PCa (GS 8-10 PSA>20ng/ml) occurred more often in the pTZ in both, biopsy and radical prostatectomy (RP) specimen. TV in RP specimen was significantly higher for APCa (p=0.008), but sPCa was less frequent (p=0.05). For APCa, mpMRI, biparametric MRI (bpMRI), and T2w alone were not statistically significant different in sPCa detection, using all four definitions. In the pTZ, T2w and DWI alone were significantly worse in sPCa detection. Sensitivity of PIRADS Score≥2 was ≥95.8% for all four sPCa definitions, using both, mpMRI or bpMRI. PIRADS Score was a significant predictor of sPCa for APCa, pTZ and the overall cohort, using linear regression (p<0.001, p=0.001, respectively). CONCLUSIONS: PCa was more frequent in pTZ. High-risk lesions occurred more often in the pTZ, but TV was significantly increased in APCa. Both mpMRI and the more cost-efficient bpMRI detected sPCa accurately in anterior prostate and pTZ, while T2w and DWI alone were statistically inferior to bpMRI and mpMRI in pTZ. PIRADS scoring offered a high sensitivity for PIRADS≥2 and ≥3. PIRADS was a superior predictor for sPCa, compared to clinical variables.

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