PURPOSE: Patients with enlarged prostates and suspicion of prostate cancer (PCa) pose a diagnostic dilemma.
PCa detection rate of systematic 12-core TRUS-guided biopsy ranges between 30-40%. For prostates >40cc this decreases to = 30%. MR-US fusion biopsy has demonstrated superior PCa detection rates. Herein, we define the detection rate of MR-US fusion biopsy in men with enlarged prostate glands.
MATERIALS AND METHODS: Patients who underwent multiparametric prostate MRI (MP-MRI) followed by MR-US fusion biopsy at our institution were analyzed. Whole prostate (WP) volumes were calculated using reconstructions of the MRI. Detection rates were analyzed with respect to age, PSA, and WP volumes. Multivariable logistic regression was used to assess these as independent predictors of PCa detection.
RESULTS: A total of 649 patients (mean age 61.8± 7.9 years) with a median PSA of 6.65ng/ml (IQR 4.35 - 11.0ng/ml) were analyzed. Mean WP volume was 58.7± 34.3 cc. Overall detection rate of the MR-US fusion platform was 55%. For prostates < 40cc the detection rate was 71.1% compared to 57.5%, 46.9%, 46.9% 33.3%, 36.4% and 30.4% for glands between 40-54.9cc, 55-69.9cc, 70-84.9cc, 85-99.9cc, 100-114.9cc and =115cc respectively (p< 0.0001). Multivariable logistic regression showed significant inverse association of MRI volume with PCa detection controlling for age and PSA.
CONCLUSIONS: TRUS-guided and fusion biopsy cancer detection rates decrease with increasing prostate volume. However, MR-US fusion biopsy has higher PCa detection rate when compared to TRUS-guided biopsy reported in the literature. MR-US fusion biopsy represents a promising solution for patients with suspicion of PCa and enlarged prostates.
Written by:
Walton-Diaz A, Hoang AN, Turkbey B, Hong CW, Truong H, Sterling T, Rais-Bahrami S, Siddiqui MM, Stamatakis L, Vourganti S, Nix J, Logan J, Harris C, Weintraub M, Chua C, Merino MJ, Choyke P, Wood BJ, Pinto PA. Are you the author?
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Reference: J Urol. 2013 Jun 17. pii: S0022-5347(13)04619-3.
doi: 10.1016/j.juro.2013.05.118
PubMed Abstract
PMID: 23792130
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