Multiparametric magnetic resonance imaging (MRI) and subsequent MRI/ultrasonography fusion‐guided biopsy increase the detection of anteriorly located prostate cancers

Abstract

Purpose Anteriorly located prostate cancer (PCa) is traditionally under-diagnosed using transrectal ultrasound (TRUS)-guided biopsy, although it represents a significant proportion of all PCa. We describe the detection rate of these tumors with the addition of MR/US fusion-guided biopsy (FGB) to standard TRUS-guided biopsy. Materials and Methods All patients regardless of their prior biopsy history who were referred for clinical suspicion of PCa (i.e elevated PSA and abnormal DRE) underwent 3T multiparametric-MRI (MP-MRI) screening; and those with suspicious lesions in the anterior region of the prostate were identified. Patients then received a FGB of all suspicious lesions in addition to systematic 12-core extended sextant TRUS-guided biopsy. We conducted a lesion based analysis comparing cancer detection rates of anterior targets using FGB versus systematic cores taken from the same anatomic sextant within the prostate. Lengths of cancer in the most involved core were also compared between the two biopsy techniques employed. Patients with only anterior targets were analyzed separately. Results Of 499 patients undergoing FGB, 162 patients had a total of 241 anterior lesions. Mean age, PSA, and prostate volume in this group was 62 years, 12.7ng/dl, and 57mL, respectively. In total, PCa was diagnosed in 121 (50.2%) of anterior lesions identified on MP-MRI. Sixty-two (25.7%) of these anterior lesions were documented positive for cancer on systematic 12-core TRUS-guided biopsy cores, while 97 (40.2%) were positive on the targeted FGB cores (p=0.001). In lesions that were positive on both FGB and TRUS biopsy, the most involved core was 112% longer on FGB (3.7mm vs. 1.6mm, p≤0.01). Forty-two patients had only anterior lesions on MP-MRI; twenty-four of them (57.1%) were found to have cancer on the FGB + TRUS biopsy platform. Six patients were positive on FGB only. Thirteen were positive on both modalities. However, 7 of 13 were upgraded by to a higher Gleason score by FGB. All 5 patients positive on TRUS biopsy only were active surveillance candidates. Conclusion FGB detects significantly more anteriorly located PCa than TRUS-guided biopsy alone and may serve to be an effective tool for this subset of patients.

Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Diagnosis in Biopsy-naive Men with Suspected Prostate Cancer Based on Elevated Prostate-specific Antigen Values: Results from a Randomized Prospective Blinded Controlled Trial

“…Our results are reported according to the Standards of Reporting for MRI-targeted Biopsy Studies recommendations [16]. Our results indicate that combined extracorporeal MP-MRI and cognitive targeting had limited value for the diagnosis of primary PCa and was mainly beneficial for the diagnosis of anterior cancers, which is consistent with previous reports [17,18]. PCa was diagnosed by using TB in 68% of patients with any MRI finding.…”

Improved detection of anterior fibromuscular stroma and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion guidance

“…10,11 Compared with TRUS-guided biopsies, fusion-guided biopsies also classify anterior PC more accurately. 12 Furthermore, mpMRI yields good negative predictive values for sPC, when compared with RP specimen. 13,14 Owing to the heterogeneous nature of the TZ, which features benign hyperplastic nodules that are difficult to distinguish from cancer foci, PC detection in TZ by mpMRI is inferior to that in PZ.…”

The Role of MRI in Active Surveillance for Prostate Cancer

“…MP-MRI and MRI/ TRUS fusion-guided prostate biopsy improve the cancer detection in patients with low apical lesions, anterior lesions, enlarged prostates, and even disease outside the prostate [18][19][20][21]. It has also been especially useful in patients with an elevated PSA despite negative TRUS biopsy where MRI has proven potential [22][23][24].…”