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

Abstract

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.

Multiparametric MRI Apparent Diffusion Coefficient (ADC) Accuracy in Diagnosing Clinically Significant Prostate Cancer

“…First, a greater number of patients should be prospectively evaluated. Second, although mpMRI is strongly recommended in men candidates to repeat biopsy, still today, standard prostate biopsy (extended or saturation procedure) should be always combined with mMRI/TRUS fusion biopsy because of mpMRI's false-negative rate (15-20% of PCa with low volume and Gleason score ≥7) (19,20). Finally, the reproducibility of ADC values should be evaluated performing multicentric studies and external validation using different mpMRI devices.…”

PSMA Ligands for PET Imaging of Prostate Cancer

“…However, the cross-sectional imaging and bone scintigraphy recommended in many guidelines have shown limitations in detecting sites of nodal or bone involvement in preoperative patients (2)(3)(4). Further, in patients with high suspicion of PC, multiparametric MRI helps to rule out clinically significant disease and to guide targeted biopsy (5), although multiparametric MRI can miss aggressive PC lesions (6). In BCR, accurate restaging is crucial because local versus systemic disease substantially influences further treatment management.…”

Association between a 17-gene genomic prostate score and multiparametric prostate MRI in men with low- and intermediate-risk prostate cancer (PCa).

“…As a result, we were not able to compare gene expression profiles on a per-lesion basis. In addition, because of a growing appreciation for improved diagnostic yield associated with MR-ultrasound fusion, it is conceivable that some degree of undersampling may be present relative to a targeted method [18] [23]. As the GPS assay has been previously shown to predict prostate cancer aggressiveness in the face of biopsy under-sampling and heterogeneity in Gleason grade, our approach may hold validity in assessing the broader tumor profile of the gland, though further study is warranted using image-guidance or whole-mount correlation [5].…”