Multiparametric magnetic resonance imaging–targeted biopsy for the detection of prostate cancer in patients with prior negative biopsy results

Abdi, Hamidreza; Zargar, Homayoun; Goldenberg, S. Larry; Walshe, Triona; Pourmalek, Farshad; Eddy, Christopher; Chang, Silvia D.; Gleave, Martin; Harris, Alison; So, Alan; Machan, Lindsay; Black, Peter C.

doi:10.1016/j.urolonc.2015.01.004

Cited by 36 publications

(20 citation statements)

References 20 publications

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“…Instead we have been dependent on systematic biopsies carried out in relatively blind fashion, PSA kinetics and digital rectal exam (1,2,5,14,15). Multiparametric MRI, however, has dramatically shifted this paradigm, and is allowing us now to assess tumor burden more accurately, and target lesions for biopsy that were previously not appreciated by available clinical tools (1,15,16) With the increased use of MRI in prostate cancer detection and in men on active surveillance, serial imaging of the prostate is becoming a more common clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…For a long time prostate cancer (PCa) has been the only cancer in the body diagnosed by blind biopsy without visualization of a suspicious lesion (1,2,3). This paradigm, however, is rapidly changing with the advent of multiparametric magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

“…This paradigm, however, is rapidly changing with the advent of multiparametric magnetic resonance imaging (MRI). Technologic advances, including stronger magnets, diffusion-weighted imaging and dynamic contrast enhancement, have greatly improved the clinical utility of MRI for the diagnosis of prostate cancer (2,4). It is now used frequently in the context of active surveillance, as well as in patients with persistent suspicion of prostate cancer despite a prior negative biopsy (1,5).…”

Section: Introductionmentioning

confidence: 99%

“…The attractiveness of MRI is the potential to reduce the need for prostate needle biopsy, which is invasive and is associated with significant complications (7)(8)(9)(10). However, the imperfect negative predictive value of MRI for significant prostate cancer prevents us from leaving out biopsy in men with a normal MRI (2,3).…”

Section: Introductionmentioning

confidence: 99%

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Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Ghavimi

Abdi

Waterhouse

et al. 2018

CUAJ

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Introduction: The natural history of prostatic lesions identified on multiparametric magnetic resonance imaging (mpMRI) is largely unknown. We aimed to describe changes observed over time on serial MRI. Methods: All patients with ≥2 MRI studies between 2008 and 2015 at our institution were identified. MRI progression was defined as an increase in Prostate Imaging Reporting and Data System (PI-RADS; version 2) or size of existing lesions, or the appearance of a new lesion PIRADS ≥4. Patients on active surveillance (AS) were analyzed for correlation of MRI progression to biopsy reclassification. Results: A total of 83 patients (54 on AS and 29 for diagnostic purposes) underwent serial MRI, with a mean interval of 1.9 years between scans. At baseline, 115 lesions (66 index, 49 non-index) were identified. Index lesions were more likely than non-index lesions to increase in size ≥2 mm (36.2 vs. 7.3 %; p=0.002). Overall progression was more likely to be seen among the index cohort (34.8 vs. 7.6%; p<0.001). New lesions with PIRADS ≥4 were seen on second imaging in 13 (16.5%) men, and became the index lesion in 29 cases (34.9%). Eighteen men on AS showed evidence of MRI progression (five with new lesions, 13 with progression of a previous lesion). Biopsy reclassification was present in three men (16.7%) with and seven men without MRI progression (19.4%). Conclusions: Overall changes in size and PIRADS scores of index lesions on MRI were small. New lesions were common, but usually did not alter management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Ghavimi

Abdi

Waterhouse

et al. 2018

CUAJ

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“…45 Subgroup analysis revealed that mpMRTB detects more significant prostate cancer than TRUS-guided biopsy in men with prior negative biopsy results; however, mpMRTB and TRUS-guided biopsy detect significant prostate cancer equally in biopsy native patients. [49][50][51] Proceeding a biopsy based on the presence of a suspicious region on prebiopsy, mpMRI can increase efficiency: fewer men undergo biopsy and fewer cores are biopsied per gland while maintaining the same significant cancer detection rate. 52 Obtaining biopsies representative of true Gleason grade improved the pretreatment risk stratification.…”

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confidence: 99%

Spotlight on multiparametric magnetic resonance imaging in prostate cancer management: current perspectives

Hassanzadeh¹,

Tempany²

2016

RMI

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Clinical behavior of prostate cancer, the most common noncutaneous cancer in men, ranges from a nonsignificant indolent tumor to an aggressive cancer. Prostate cancer is subject to overdiagnosis and overtreatment, making screening, diagnosis, and treatment planning a controversial issue. Recently, even noninvasive simple screening methods such as prostatespecific antigen level and digital rectal examination are no longer recommended for screening as it has resulted in no reduction in mortality. Diagnosis and further treatment planning, however, are still based on a random transrectal ultrasound-guided biopsy, an invasive method with controversial efficacy that has been deemed as unnecessarily revealing nonsignificant tumors. Magnetic resonance (MR)-based techniques are emerging that provide noninvasive tools that are promising in the detection of clinically significant lesions and accurate staging. Moreover, MR imaging improves the performance of image-guided procedures, both in diagnosis and therapy. We focus here on recent advances in multiparametric MR imaging in prostate cancer diagnosis and provide a brief overview of other emerging techniques.

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Prostate cancer detection with magnetic resonance‐ultrasound fusion biopsy: The role of systematic and targeted biopsies

Filson

Natarajan

Margolis

et al. 2016

Cancer

377

231

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BACKGROUND To evaluate performance of magnetic resonance (MR)-ultrasound guided fusion biopsy in diagnosing clinically significant prostate cancer (csCaP). METHODS 1042 men underwent multi-parametric MRI (mpMRI) and fusion biopsy consecutively in a prospective trial (2009 – 2014). An expert reader graded mpMRI regions of interest (ROI) 1–5 using published protocols. The fusion biopsy device was used to obtain targeted cores from ROIs (when present) followed by a fusion-image guided 12-core systematic biopsy in all men, even if no suspicious ROI. Primary endpoint was detection of clinically significant CaP (i.e., Gleason score ≥ 7). RESULTS Among 825 men with ≥ 1 suspicious ROI of grade 3 or higher, 289 (35%) had csCaP. Powerful predictors of csCaP were ROI grade (grade 5 vs 3, OR 6.5, p<0.01) and prostate-specific antigen density (each increase of 0.05 ng/mL/cc, OR 1.4, p<0.01). Combining systematic and targeted biopsies detected more csCaP (n=289) than targeting (n=229) or systematic biopsy alone (n=199). Among patients with no suspicious ROI, 35 (16%) had csCaP on systematic biopsy. CONCLUSION In this prospective trial, MR-ultrasound fusion biopsy allowed detection of csCaP with a direct relationship with ROI grade and PSA density. The combination of targeted and systematic biopsy detected more csCaP than either modality alone; systematic biopsies revealed csCaP in 16% of men with no suspicious MRI target. Advantages of this new biopsy method are apparent, but issues of cost, training, and reliability await resolution prior to widespread adoption.

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Multiparametric magnetic resonance imaging–targeted biopsy for the detection of prostate cancer in patients with prior negative biopsy results

Cited by 36 publications

References 20 publications

Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Spotlight on multiparametric magnetic resonance imaging in prostate cancer management: current perspectives

Prostate cancer detection with magnetic resonance‐ultrasound fusion biopsy: The role of systematic and targeted biopsies

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