Magnetic Resonance Imaging/Ultrasound Fusion Guided Prostate Biopsy Improves Cancer Detection Following Transrectal Ultrasound Biopsy and Correlates With Multiparametric Magnetic Resonance Imaging

Abstract

Purpose A novel platform was developed that fuses pre-biopsy magnetic resonance imaging with real-time transrectal ultrasound imaging to identify and biopsy lesions suspicious for prostate cancer. The cancer detection rates for the first 101 patients are reported. Materials and Methods This prospective, single institution study was approved by the institutional review board. Patients underwent 3.0 T multiparametric magnetic resonance imaging with endorectal coil, which included T2-weighted, spectroscopic, dynamic contrast enhanced and diffusion weighted magnetic resonance imaging sequences. Lesions suspicious for cancer were graded according to the number of sequences suspicious for cancer as low (2 or less), moderate (3) and high (4) suspicion. Patients underwent standard 12-core transrectal ultrasound biopsy and magnetic resonance imaging/ultrasound fusion guided biopsy with electromagnetic tracking of magnetic resonance imaging lesions. Chi-square and within cluster resampling analyses were used to correlate suspicion on magnetic resonance imaging and the incidence of cancer detected on biopsy. Results Mean patient age was 63 years old. Median prostate specific antigen at biopsy was 5.8 ng/ml and 90.1% of patients had a negative digital rectal examination. Of patients with low, moderate and high suspicion on magnetic resonance imaging 27.9%, 66.7% and 89.5% were diagnosed with cancer, respectively (p <0.0001). Magnetic resonance imaging/ultrasound fusion guided biopsy detected more cancer per core than standard 12-core transrectal ultrasound biopsy for all levels of suspicion on magnetic resonance imaging. Conclusions Prostate cancer localized on magnetic resonance imaging may be targeted using this novel magnetic resonance imaging/ultrasound fusion guided biopsy platform. Further research is needed to determine the role of this platform in cancer detection, active surveillance and focal therapy, and to determine which patients may benefit.

Multiparametric magnetic resonance imaging outperforms the Prostate Cancer Prevention Trial risk calculator in predicting clinically significant prostate cancer

“…8,18 In the current study, we observed an overall CDR of 64.6% which is comparable to the 54% to 63% range reported in the literature. 11,19,20 We observed an AUC of 0.769 (95% CI, 0.703-0.834) for lesion suspicion level on MP-MRI in predicting high-grade CaP, which is 10 percentage points better than the PCPTHG AUC of 0.676 (95% CI, 0.592-0.751; P 5 .091). In addition to its development in a cohort with a low-risk profile, a limitation of the PCPTHG is that it does not take into account individuals with Gleason 6 CaP who may have high-volume disease, thus qualifying to be classified as clinically significant CaP necessitating treatment.…”

Active Surveillance-Factors Affecting the Treatment Decision: 3M: “Marker”, “Mapping”, “MRI”

“…MR görüntüleri ile USG'den elde edilen görüntülerin birleştirilmesi sonucunda hem hedeflenen bölgeden hem de sistematik prostat biyopsisi yapılabilme olanağını sağlar. Bunlara ek olarak gerekirse aktif izlem hastalarında olduğu gibi daha önceden alınan biyopsi odaklarının kaydedilmesini sağlamaktadır (38). FDA onayı almış beş farklı firmanın MR-USG füzyon görüntüleme sağlayan cihazı mevcuttur.…”

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.…”