Transrectal ultrasound examination of prostate cancer guided by fusion imaging of multiparametric MRI and TRUS: avoiding unnecessary mpMRI-guided targeted biopsy / 亚洲男科学杂志(英文版)

The purpose of this study was to explore transrectal ultrasound (TRUS) findings of prostate cancer (PCa) guided by multiparametric magnetic resonance imaging (mpMRI) and to improve the Prostate Imaging Reporting and Data System (PI-RADS) system for avoiding unnecessary mpMRI-guided targeted biopsy (TB). From January 2018 to October 2019, fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients. The study included 188 suspicious lesions on mpMRI in 156 patients, all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy (SB). Univariate analyses were performed to investigate the relationship between TRUS features and PCa. Then, logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa. The detection rates of PCa based on TB alone, SB alone, and combined SB and TB were 55.9% (105 of 188), 52.6% (82 of 156), and 62.8% (98 of 156), respectively. The significant predictors of PCa on TRUS were hypoechogenicity (odds ratio [OR]: 9.595, P = 0.002), taller-than-wide shape (OR: 3.539, P = 0.022), asymmetric vascular structures (OR: 3.728, P = 0.031), close proximity to capsule (OR: 3.473, P = 0.040), and irregular margins (OR: 3.843, P = 0.041). We propose subgrouping PI-RADS score 3 into categories 3a, 3b, 3c, and 3d based on different numbers of TRUS predictors, as the creation of PI-RADS 3a (no suspicious ultrasound features) could avoid 16.7% of mpMRI-guided TBs. Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.

Comparison of MRI-ultrasound fusion–guided and transrectal ultrasound–guided prostate biopsy for the detection of prostate cancer in biopsy-naive men

OBJECTIVE@#Transrectal ultrasound-guided prostate biopsy (TRUSPBx) is the recommended method for the histopathologic confirmation of prostate cancer. However, the overall cancer detection rate is low; hence, patients are potentially exposed to multiple biopsies and their attendant morbidity. Multiparametric MRI of the prostate followed by MRI-Ultrasound fusion-guided prostate biopsy (FBx) is an emerging diagnostic pathway that has been established and recommended in men with a persistently elevated PSA despite a previous negative biopsy. However, evidence regarding its value in the biopsy-naïve setting is scarce. The objective is to compare the diagnostic accuracy of MRI fusion-guided prostate biopsy against TRUSPBx in biopsy-naïve men. @*METHODS@#This is a retrospective cohort study involving biopsy-naïve men with a PSA of 3 to 20 ng/ml. Primary outcomes of the study include overall cancer detection rate (CDR) and detection of clinically-significant prostate cancer (csPCa). Subgroup analyses were performed based on PSA level and prostate volume. Independent t-test, Mann Whitney U test and Chi square test were used in the statistical analysis.@*RESULTS@#A total of 185 biopsy-naïve men with a PSA level of 3 – 20 ng/mL were included in the study. Median pre-biopsy PSA level was 7.07 ng/mL (5.06 – 11.0) and 9.02 ng/mL (5.8 – 13.8) in the FBx arm and TRUS-guided biopsy arm, respectively. Ninety-nine (n=99; 53%) underwent MP-MRI of the prostate followed by MRI fusion-guided prostate biopsy and eighty-six (n=86; 46%) underwent the standard TRUS-guided prostate biopsy. Compared to TRUSPBx, FBx significantly detected more prostate cancer (CDR: 68% vs 30%, p<0.0001) and csPCa (46% vs 22%, p=0.001). The diagnostic yield of FBx was distinctly superior in the subgroup of men with a PSA of 4 – 10 ng/mL (CDR: 64% vs 7%, p<0.0001; csPCa: 43% vs 2%, p<0.0001) and a prostate volume of <40grams (CDR: 82% vs 36%, p<0.0001; csPCa: 53% vs 21%, p=0.006).@*CONCLUSION@#Compared to the current standard, the diagnostic yield of MRI fusion-guided prostate biopsy is significantly better in biopsy-naïve men. FBx detected more men with prostate cancer, with a higher proportion of men having clinically-significant disease. This advantage is strongly evident in men with a PSA level of 4 – 10 ng/mL and an average prostate volume of 40 grams. Hence, Multiparametric MRI of the prostate followed by MRI fusion-guided prostate biopsy is an effective first-line diagnostic modality for prostate cancer in men presenting with elevated PSA levels.

Concordance of multiparameteric MRI and MRI ultrasound fusion-guided prostate biopsy

@#Multiparametric MRI (mpMRI) of the prostate is recently becoming more and more utilized in the detection of prostate cancer. Studies have shown that a higher PIRADS score correlated to a higher chance of obtaining a clinically significant prostate cancer but few studies have correlated PIRADS score to a specific Gleason score.@*OBJECTIVE@#This study aimed to determine the concordance of PIRADS score to the Gleason score result of MRI ultrasound fusion-guided prostate biopsy.@*METHODS@#All patients who had at least a PIRADS 2 lesion on mpMRI and underwent MRI ultrasound fusion-guided biopsy of the prostate from August 2018 up to November 2019 at St. Luke’s Medical Center, Global City were included in the study. An ambispective collection of data was done until the ideal sample size of greater than 100 positive lesions was obtained, in order to derive concordance rate.@*RESULTS@#One hundred and sixty-two patients were included in the study with a total of 212 lesions analyzed. Forty three percent were benign while 57% were found to be malignant. PIRADS 2 lesions had zero high grade cancers, and the percentage steadily increased with 37.8% of PIRADS lesions considered high grade. Concordance was computed to be 0.38 showing a fair, direct concordance between PIRADS and Gleason score with significant result (p<0.05).@*CONCLUSION@#A result of PIRADS 4 or 5 lesion on mpMRI will have a higher urgency of doing a prostate biopsy and subsequent management to prevent unfavorable outcomes as opposed to PIRADS 3 lesions.

Initial Experience of Transperineal Biopsy After Multiparametric Magnetic Resonance Imaging in Korea; Comparison With Transrectal Biopsy

PURPOSE: The aim of this study is to confirm the detection rate of transperineal biopsy after multiparametric magnetic resonance imaging (mpMRI) and compared it to that of transrectal biopsy. We also examined the role of mpMRI and the rate of complications for each method. MATERIALS AND METHODS: In a retrospective study, we analyzed 147 patients who underwent mpMRI before prostate biopsy because of elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings at Korea University Hospital, Seoul, Korea from March 2017 to April 2018. Regions on the mpMRI that were suggestive of prostate cancer were categorized according to the Prostate Imaging–Reporting and Data System (PI-RADS v2). For transperineal biopsy, a 20-core saturation biopsy was performed by MRI-TRUS cognitive or fusion techniques and a 12-core biopsy was performed in transrectal biopsy. RESULTS: Sixty-three and 84 patients were enrolled in transperineal group and transrectal group, respectively. The overall detection rate of prostate cancer in transperineal group was 27% higher than that in transrectal group. Classification according to PI-RADS score revealed a significant increase in detection rate in all patients, as the PI-RADS score increased. Frequency of complications using the Clavien-Dindo classifications revealed no significant differences in the total complications rate, but two patients in transrectal group received intensive care unit care due to urosepsis. CONCLUSIONS: Our results confirmed that transperineal biopsy is superior to transrectal biopsy for the detection of prostate cancer. From the complication point of view, this study confirmed that there were fewer severe complications in transperineal biopsy.

Accuracy of the multiparametric magnetic resonance imaging (MRI) and multiparametric MRI ultrasound cognitive fusion biopsy in the detection of prostate cancer among patients at a tertiary hospital

OBJECTIVE@#Image-guided targeted biopsy techniques have been proposed to address problems ofsystematic transrectal ultrasound guided prostate biopsies that lead to the suboptimal cancer detectionrate as well as inaccurate grading of the disease. This study aims to provide local data on the diagnosticaccuracy of multiparametric MRI (MP-MRI) and MP-MRI ultrasound cognitive fusion biopsy inidentifying areas of clinically significant malignancy of the prostate.@*MATERIALS AND METHODS@#This is a validity study involving patients who underwent MP-MRI and MP-MRI ultrasound cognitive fusion biopsy, who eventually underwent robot-assisted laparoscopic radicalprostatectomy (RALRP). Outcome measures included sensitivity, specificity, positive and negativepredictive values of MP-MRI and MP-MRI ultrasound cognitive fusion biopsy. Reference standardused was the final histopathologic report obtained after RALRP.@*RESULTS@#MP-MRI has a sensitivity of 35.5%, specificity of 95.2%, positive predictive value of 97.1%,and negative predictive value of 25%. MP-MRI ultrasound fusion biopsy had similar results, withsensitivity of 34.4%, specificity of 81.0%, positive predictive value of 88.9%, and negative predictivevalue of 21.8%.@*CONCLUSION@#The high specificity and positive predictive value of MP-MRI (95.2% and 97.1%respectively) indicates the necessity for a prostate biopsy and supports the utility of a targeted MP-MRI guided ultrasound cognitive fusion biopsy. However, the low sensitivity and negative predictivevalue (25% and 35% respectively) of 35.5% indicates that MP-MRI guidance does not limit thenumber of biopsy samples only to visible MP-MRI lesions, since negative areas on MP-MRI stillcontains tumors in 75% of cases.