Visually Estimated MRI Targeted Prostate Biopsy Could Improve the Detection of Significant Prostate Cancer in Patients with a PSA Level <10 ng/mL

Abstract

PurposeTo compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy (MRI-visual-Bx) for patients with prostate specific antigen (PSA) level less than 10 ng/mL.Materials and MethodsIn total, 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospectively in 2014. In patients with abnormal lesions on mp-MRI, we performed additional MRI-visual-Bx. We compared pathologic results, including the rate of clinically significant prostate cancer cores (cancer length greater than 5 mm and/or any Gleason grade greater than 3 in the biopsy core).ResultsThe mean PSA was 6.43 ng/mL. In total, 48 of 76 (63.2%) patients had abnormal lesions on mp-MRI, and 116 targeted biopsy cores, an average of 2.42 per patient, were taken. The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 (34.2%) and 23/48 (47.9%), respectively. In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores, the positive rates were 8.4% (77 of 912 cores) and 46.6% (54 of 116 cores), respectively (p<0.001). Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5%, respectively, in TRUS-Bx and 6.3 mm and 45.4% in MRI-visual-Bx (p<0.001). In addition, Gleason score ≥7 was noted more frequently using MRI-visual-Bx (p=0.028). The detection rate of clinically significant prostate cancer was 27/77 (35.1%) and 40/54 (74.1%) for TRUS-Bx and MRI-visual-Bx, respectively (p<0.001).ConclusionMRI-visual-Bx showed better performance in the detection of clinically significant prostate cancer, compared to TRUS-Bx among patients with a PSA level less than 10 ng/mL.

Prostate cancer screening in Europe and Asia

“…In addition, the positive prostate biopsy rate per biopsy core was 46.6% and 8.4% for MRI- and TRUS-targeted biopsy respectively. This finding translates into a potentially considerable reduction of unnecessary biopsies, biopsy cores, as well as patients' harm and costs [75] .…”

Effectiveness and Accuracy of MRI‐Ultrasound Fusion Targeted Biopsy Based on PI‐RADS v2.1 Category in Transition/Peripheral Zone of the Prostate

“…For example, the study by Exterkate et al showed csPCa detection rates of 47% in MRI‐TBx vs. 32% in TRUS‐SBx 6 . Similarly, the csPCa detection rates were 32.3% vs. 29.9% between MRI‐TBx and TRUS‐SBx in the study by Rouviere et al, and 37.8% vs. 30.9% in the study by Ahdoot et al 7,8 It has been shown that MRI‐TBx and TRUS‐SBx did not statistically differ in PCa detection, but MRI‐TBx could detect more csPCa than TRUS‐SBx because nsPCa presented negative in mp‐MRI 19–21 . This could be also confirmed by this study, which showed that MRI‐TBx had a higher csPCa detection rate than TRUS‐SBx both in TZ and in PZ, but there was no statistical difference detected in PCa diagnosis between them.…”

Comparison of Multiparametric and Biparametric MRI in First Round Cognitive Targeted Prostate Biopsy in Patients with PSA Levels under 10 ng/mL

“…Using these MRI sequences, we showed that our approach had significant efficacy to detect clinically significant prostate cancer. 8 Although we showed the efficacy of MRI in first round prostate biopsy, the cost and extended time in-bore hindered the application of this biopsy technique. Therefore, we changed the MRI protocol in our institute for patients with economic concerns.…”

“…According to several recent studies, targeted prostate biopsy using mp-MRI is efficacious in clinically significant prostate cancer detection. 5 6 7 8 Nevertheless, this biopsy technique is not popular because of its high cost. The costs of TRUS/MRI fusion Bx and bore MRI-Bx are even greater than that of the cognitive targeted prostate biopsy technique, because the former techniques require more specialized equipment.…”