Targeted Biopsy in the Detection of Prostate Cancer Using an Office Based Magnetic Resonance Ultrasound Fusion Device

Abstract

Purpose Targeted biopsy of lesions identified on MRI may enhance detection of clinically relevant prostate cancers (CaP). We evaluate CaP detection rates in 171 consecutive men using MR-US fusion prostate biopsy. Materials and Methods Subjects underwent targeted biopsy either for active surveillance (N=106) or persistently elevated PSA but negative prior conventional biopsy (N=65). Before biopsy, each man had a multiparametric MRI at 3.0-Tesla. Lesions on MRI were outlined in 3D and assigned increasing cancer suspicion levels (image grade 1–5) by a uroradiologist. The Artemis biopsy tracking system was used to fuse the stored MRI with real-time ultrasound (US), generating a 3D prostate model on-the-fly. Working from the 3D model, transrectal biopsy of target lesions and 12 systematic biopsies were performed under local anesthesia in the clinic. Results 171 subjects (median age 65) underwent targeted biopsy. At biopsy, median PSA = 4.9 ng/ml and prostate volume = 48 cc. A targeted biopsy was three times more likely to identify cancer than a systematic biopsy (21% vs. 7%). CaP was found in 53% of men, 38% of whom had Gleason ≥7. 38% of men with Gleason ≥7 cancers were detected only on targeted biopsies. Targeted biopsy findings correlated with level of suspicion on MRI. 15 of 16 men (94%) with an image grade 5 target (highest suspicion) had CaP, including 7 with Gleason ≥7. Conclusions Prostate lesions identified on MRI can be accurately targeted using MR-US fusion biopsy by a urologist in clinic. Biopsy findings correlate with level of suspicion on MRI.

Multiparametric MRI of the prostate: diagnostic performance and interreader agreement of two scoring systems

“…Multiparametric MRI plays an incremental role in the detection, characterization and management of prostate cancer, including assistance in guiding biopsies, 1 treatment planning and patient selection for active surveillance, 2,3 guidance of focal therapies 4,5 and assessment of post-treatment effects. [6][7][8] However, the interpretation of multiparametric MRI remains difficult and with substantial interreader variability.…”

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

“…Bu özelliğinden dolayı MR kılavuzluğunda prostat biyopsisi tanımlanmıştır. En büyük avantajı biyopsideki toplam kor sayısını azalmış olmasına rağmen, artan maliyet ve işlem süresi nedeniyle pratik uygulamaya girememiştir (35). MR kılavuzluğunda üç çeşit prostat biyopsisi yapılabilmektedir.…”

“…Sistematik prostat biyopsi yapılmadığı için önemsiz prostat kanseri daha az sıklıkla tespit edildiği bildirilmiştir (36). Ayrıca birçok önemli kanser hedeflenen prostat dokusunun dışında geliştiğinden MR ile hedef biyopsi yapıldığında bazı kanserlerin atlanmış olabileceği endişesine yol açabileceği ifade edilmektedir (35). Kognitif füzyon ise daha önceden çekilmiş 2 boyutlu MR görüntüsüne bakılarak ultrasound yardımı ile prostattan biyopsi alınmasıdır.…”

“…FDA onayı almış beş farklı firmanın MR-USG füzyon görüntüleme sağlayan cihazı mevcuttur. Bir çalışmada MR-USG füzyon görüntüleme eşliğinde yapılan prostat biyopsisinin sistematik prostat biyopsisine göre prostat kanserini 3 kat daha fazla oranla tespit ettiğini belirtmişlerdir (35). Ayrıca füzyon biyopsilerin daha önceki biyopsileri negatif ve PSA artışı tespit edilen hastalarda prostat kanseri tespitini arttırdığı belirtilmiştir (39).…”

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.…”