To evaluate the diagnostic performance and complication rate of the in-bore magnetic resonance imaging-guided transrectal targeted prostate biopsy (MRGB) in a repeat biopsy population on basis of a nearly four year learning curve (2014-2017).
A total of 142 consecutive males with a history of previous biopsies and persistent suspicion of prostate cancer (PCa) due to prostate specific antigen (PSA) elevation initially underwent MRGB in the case of prostate imaging reporting and data system (PI-RADS) 3-5 lesions. Cancer detection rate (CDR), number/length of cores, biopsy time, operator experience, complications and prediction of clinically significant (cs) PCa (Gleason score ≥7) were investigated.
PCa was found in 57% of patients. CDR in PI-RADS 3, 4 and 5 lesions was 46%, 52% and 74% respectively. CsPCa was found in 9%, 25% and 48%. In univariate analysis the PI-RADS score (p=0.0067) was a significant predictor for csPCa. In the multivariate logistic regression, Age (p=0.0007), number of previous biopsies (p= 0.0236) and PSA density (p= 0.0250) were significant predictors for csPCa. Location/size of the index lesion, number/length of cores obtained and operator experience did not affect CDR. Concerning learning curve, biopsy time and number of cores obtained improved significantly after 10 procedures. Complications requiring medical intervention were seen in 6% (infections 2%).
In a re-biopsy setting the MRGB showed sufficient diagnostic performance in detecting csPCa in PI-RADS 3-5 lesions with low complication rate. The skill of biopsy taking is quickly acquired and location of index lesion did not impact CDR.
Urology. 2018 Jan 09 [Epub ahead of print]
Alexander Friedl, Jenifer Schneeweiss, Sabina Sevcenco, Klaus Eredics, Thomas Kunit, Martin Susani, Danijel Kivaranovic, Edith Eisenhuber-Stadler, Lukas Lusuardi, Clemens Brössner, Wolfgang Schima
Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria. Electronic address: ., Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria., Department of Urology, Donauspital, Vienna, Austria., Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria., Department of Urology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria., Department of Pathology, Medical University of Vienna, Vienna, Austria., Department of Statistics and Operations Research, University of Vienna, Vienna, Austria., Department of Diagnostic and Interventional Radiology, Göttlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Vienna, Austria.