D'Amico Risk Stratification Correlates With Degree of Suspicion of Prostate Cancer on Multiparametric Magnetic Resonance Imaging

Abstract

Objective We sought to determine if there is a correlation between D'Amico risk stratification and degree of suspicion of prostate cancer on multi-parametric MRI, based on targeted biopsies obtained with our electromagnetically (EM) tracked MRI/ultrasound (US) fusion platform. Methods 101 patients underwent 3 Tesla multi-parametric MR imaging of the prostate which consisted of T2, DCE, DWI, and spectroscopy images in patients with a suspicion for, or diagnosis of prostate cancer. All prostate MRI lesions were then identified and graded by the number of modalities positive: low (≤2), moderate (3) and high (4) suspicion. Patients and lesions were stratified by D'Amico risk stratification. The biopsy protocol included a standard 12 core biopsy followed by real-time MRI/US fusion-targeted biopsies of the suspicious MR lesions. Results 90.1% of men were clinical T1c with a mean age of 62.7 ± 8.3 years and the median PSA was 5.8 ng/ml. 54.5% of the patients were positive for cancer on the protocol biopsy. A Chi-squared analysis resulted in a statistically significant correlation between the MR suspicion and D'Amico risk stratification for patients (p<0.0001). Within-cluster re-sampling technique determined that there was a statistically significant correlation between MR suspicion and D'Amico risk stratification for MR ‘targeted’ core biopsies and MR lesions (p<0.01) Conclusion Our data supports that with multi-parametric MR prostate imaging, one may be able to quantitatively assess the degree of risk associated with MR visible lesions within the prostate.

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“…Giderek artan bilimsel veriler, MR-TRUS füzyon biyopsisi ile klinik anlamlı kanser tanısının arttığını, bunun yanı sıra klinik anlamsız kanser tanısının da azaldığını göstermektedir (13,16). Bu da uygulanan prostat biyopsisinin hedefine ulaşması olarak kabul edilebilir.…”

Focal Cryotherapy in the Treatment of Localized Prostate Cancer

“…Turkbey et al 11 reported that multiparametric MRI has a positive predictive value of 98% to 100% and 68% sensitivity for detecting prostate cancer tumors > 5 mm in diameter. A study by Rastinehad et al 12 reported 94% sensitivity for lesions in the peripheral zone of the prostate, with 99% specificity using multiparametric MRI. MRI/ultrasound fusion-guided biopsy is a more recent imaging modality that is under investigation.…”

Fusion Target Biopsy of the Prostate Using Real-Time Ultrasound and MR Images. A Multicenter RCT on Target Biopsy Techniques in the Diagnosis of Prostate Cancer

“…Despite these results MRGB remains controversial due to impracticalities, as its low availability, required expertise and time consuming nature. An upcoming technique is MRI-TRUS fusion (MTF) targeted biopsy [28][29][30][31][32][33][34][35][36][37][38]. MTF devices utilise the high diagnostic yield of the mpMRI for prostate cancer in combination with the practicality and affordability of TRUS biopsy systems by fusing the pre-interventional MR images with real-time ultrasound images.…”

“…The mpMRI information is used 'cognitively' by the physician to target tumour suspicious areas of the prostate using TRUS without applying image fusion [39,40]. All these techniques demonstrate an increased TDR of significant prostate cancer compared to systematic TRUS biopsy [17,[25][26][27][28][29][30][31][32][33][34][35][36][39][40][41][42]. There is no consensus which technique for targeted biopsy should be preferred.…”