Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation

Abstract

Introduction: This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsy patients with prior atypical small acinar proliferation (ASAP). Materials: 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the prebiopsy MP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches. Results: Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months. Conclusions: MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx.

Atypical small acinar proliferation at index prostate biopsy: rethinking the re-biopsy paradigm

“…Reasonably, such patients may be best managed in accordance with current active surveillance guidelines to minimize the overutilization of prostate biopsies 9 . Moreover, one can consider further investigation with newer imaging modalities such as multi-parametric magnetic resonance imaging 18,19 or employ a less morbid transperineal template-guided approach on repeat biopsy 20 .…”

Significance of MRI/Transrectal Ultrasound Fusion Three-Dimensional Model-Guided, Targeted Biopsy Based on Transrectal Ultrasound-Guided Systematic Biopsy in Prostate Cancer Detection: A Systematic Review and Meta-Analysis

“…Of 2,137 men who were assigned to undergo MR-MRI in 4 studies, 1,794 men (84%) returned with positive imaging finding [14,16,17,19]. This suggests that most PCa-suspected patients could go for MRI/TRUS fusion-targeted biopsy.…”

“…However, compared to the traditional TRUS-guided 12-core prostate biopsy, many studies showed that the 3D-Tb might have better sensitivity without statistical differences [14][15][16][17][18]. Furthermore, some researches showed that 3D-Tb tended to find more high-Gleasonscore (≥7) cases [16][17][18], but some other studies did not obtain significant results [14,15,[19][20][21][22]. To our knowledge, rarely do studies test the efficiency of 3D-Tb combined with Sb as primary endpoint.…”

“…Numbers of the 4 principal items were extracted for meta-analysis: sample size, overall PCa (3D-Tb and/or Sb positive), respective PCa in 3D-Tb and Sb, and respective high/low-Gleason-score PCa in 3D-Tb and Sb. Considering the different definitions of clinical-significant or high-risk disease, such as Gleason score ≥4 + 3 [11,17,22], Gleason score ≥7 or Gleason score = 6 and maximum cancer core length >5 mm [15], or others [20,21,25], we unified them as Gleason score ≥7 [14,16,18] for more equitable analysis (Table 1). On the other hand, tumors with Gleason pattern 4 (3 + 4/4 + 3) have significantly worse prognosis than those with lower Gleason score [26,27].…”

3D printing in urology: Is it really promising?

“…[5] MR-TRUS fusion biopsies were found to be superior over Creating the final object by stereolithography, material extrusion, lamination, jetting, etc standard transrectal biopsies. [6] If the softwares will get cheaper, 3D printed prostatic biopsies can take place of MR-guided ones.…”