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Multiparametric magnetic resonance imaging in fusion with transrectal ultrasound for targeted prostate biopsy by BioJet™ System. Technical details and results
VJY05
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Multiparametric magnetic resonance imaging in fusion with transrectal ultrasound for targeted prostate biopsy by BioJet™ System. Technical details and results Russo A.1, Kinzikeeva E.1, Maga T.1, Losa A.1, Lista G.1, Pini G.1, Cardone G.2, Briganti A.3, Salonia A.3, Montorsi F.3, Suardi N.1, Gaboardi F.1 1
IRCCS Ospedale San Raffaele Turro, Dept. of Urology, Milano, Italy, 2Irccs Ospedale San Raffaele Turro, Dept. of Radiology, Milano, Italy, 3Irccs Ospedale San Raffaele, Dept. of Urology, Milano, Italy INTRODUCTION & OBJECTIVES: To report our experience in the diagnosis of prostate cancer (PCa) by combination of multiparametric magnetic resonance imaging (mpMRI) fusion images and real-time transrectal ultrasound (TRUS) in patients with suspicious PCa. MATERIAL & METHODS: In this prospective study, 45 patients with suspicious mpMRI (PIRADS 3-5) were submitted to prostate targeted biopsy (TB) combining real-time TRUS with MRI fusion technique BioJet™. between June 2015 and March 2016. Furthermore, in 34 patients additional standard prostate biopsy mapping (SB) was concomitantly performed. The technique of fusion biopsy is showed in the enclosed video. We evaluated the overall rate of positive biopsies and of clinically significant PCa in the overall cohort, in the target areas and in the biopsies outside of the target. Moreover, the correlations with PIRADS at pre-operative mpMRI were analyzed. RESULTS: Median patients’ age was 66,4 years(range: 51 – 86). Median PSA was 7,91±3,63 ng/ml (range: 1.2 – 18.3) and median prostate volume was 47,6 ml (range: 20 – 144). Nine patients (20%) had positive digital rectal examination (DRE). Finally, 21(46,67%) patients had previously undergone a prostate biopsy: 6 (13,3%) positive positive for low-grade PCa (Gleason score 3+3) and 15 (33.3%) negative. Overall, PCa was detected in 35/45 patients (77,7%) with clinically significant PCa, as defined by Gleason score≥7, in 29/45 (64,4%). Of 50 target lesions, 34 (68%) and 30 (60%) were positive for cancer and for significant cancer, respectively. When analysing TB only, PCa was detected in 33/45 patients (73,3%). Gleason score was 7 in 48,8% (22/45 patients), 8 – in 8,8% (4/45) and 9-10 – in 6,6% (3/45). When analysing only patients submitted to both TB and SB (n=34), 16 (47,06%) patients had positive biopsy outside of the target with Gleason score 6, 7 and 8-10 in 5,8% (2/34 patients), 29,4% (10/34), 11,7% (4/34). However, no clinically significant PCa was diagnosed at SB and missed by TB. In patients with previous positive biopsy for low grade PCa, targeted biopsy was positive for PCa in 83,3% (5/6 patients) and all these patients had clinically significant PCa. Finally, detection rate of PCa and significant PCa were 45% (9/20 patients) and 40% (8/20) in PIRADS 3 lesions, 85% (17/20) and 70% (14/20) in PIRADS 4 lesions and 100% and 100% (8/8) in PIRADS 5 lesions, respectively. CONCLUSIONS: Targeted MRI/TRUS prostate biopsy for MRI multi-parametric suspicious lesion with fusion technique (BioJet™) is associated with high detection of PCa and especially of clinically significant PCa.
Eur Urol Suppl 2016; 15(7):217
Award winning video
Multiparametric magnetic resonance imaging in fusion with transrectal ultrasound for targeted prostate biopsy by BioJet™ System. Technical details and results Russo A.1, Kinzikeeva E.1, Maga T.1, Losa A.1, Lista G.1, Pini G.1, Cardone G.2, Briganti A.3, Salonia A.3, Montorsi F.3, Suardi N.1, Gaboardi F.1 1
IRCCS Ospedale San Raffaele Turro, Dept. of Urology, Milano, Italy, 2Irccs Ospedale San Raffaele Turro, Dept. of Radiology, Milano, Italy, 3Irccs Ospedale San Raffaele, Dept. of Urology, Milano, Italy INTRODUCTION & OBJECTIVES: To report our experience in the diagnosis of prostate cancer (PCa) by combination of multiparametric magnetic resonance imaging (mpMRI) fusion images and real-time transrectal ultrasound (TRUS) in patients with suspicious PCa. MATERIAL & METHODS: In this prospective study, 45 patients with suspicious mpMRI (PIRADS 3-5) were submitted to prostate targeted biopsy (TB) combining real-time TRUS with MRI fusion technique BioJet™. between June 2015 and March 2016. Furthermore, in 34 patients additional standard prostate biopsy mapping (SB) was concomitantly performed. The technique of fusion biopsy is showed in the enclosed video. We evaluated the overall rate of positive biopsies and of clinically significant PCa in the overall cohort, in the target areas and in the biopsies outside of the target. Moreover, the correlations with PIRADS at pre-operative mpMRI were analyzed. RESULTS: Median patients’ age was 66,4 years(range: 51 – 86). Median PSA was 7,91±3,63 ng/ml (range: 1.2 – 18.3) and median prostate volume was 47,6 ml (range: 20 – 144). Nine patients (20%) had positive digital rectal examination (DRE). Finally, 21(46,67%) patients had previously undergone a prostate biopsy: 6 (13,3%) positive positive for low-grade PCa (Gleason score 3+3) and 15 (33.3%) negative. Overall, PCa was detected in 35/45 patients (77,7%) with clinically significant PCa, as defined by Gleason score≥7, in 29/45 (64,4%). Of 50 target lesions, 34 (68%) and 30 (60%) were positive for cancer and for significant cancer, respectively. When analysing TB only, PCa was detected in 33/45 patients (73,3%). Gleason score was 7 in 48,8% (22/45 patients), 8 – in 8,8% (4/45) and 9-10 – in 6,6% (3/45). When analysing only patients submitted to both TB and SB (n=34), 16 (47,06%) patients had positive biopsy outside of the target with Gleason score 6, 7 and 8-10 in 5,8% (2/34 patients), 29,4% (10/34), 11,7% (4/34). However, no clinically significant PCa was diagnosed at SB and missed by TB. In patients with previous positive biopsy for low grade PCa, targeted biopsy was positive for PCa in 83,3% (5/6 patients) and all these patients had clinically significant PCa. Finally, detection rate of PCa and significant PCa were 45% (9/20 patients) and 40% (8/20) in PIRADS 3 lesions, 85% (17/20) and 70% (14/20) in PIRADS 4 lesions and 100% and 100% (8/8) in PIRADS 5 lesions, respectively. CONCLUSIONS: Targeted MRI/TRUS prostate biopsy for MRI multi-parametric suspicious lesion with fusion technique (BioJet™) is associated with high detection of PCa and especially of clinically significant PCa.
Eur Urol Suppl 2016; 15(7):217