PURPOSE: Anteriorly located prostate cancer (PCa) is traditionally under-diagnosed using transrectal ultrasound (TRUS)-guided biopsy, although it represents a significant proportion of all PCa.
We describe the detection rate of these tumors with the addition of MR/US fusion-guided biopsy (FGB) to standard TRUS-guided biopsy.
MATERIALS AND METHODS: All patients regardless of their prior biopsy history who were referred for clinical suspicion of PCa (i.e elevated PSA and abnormal DRE) underwent 3T multiparametric-MRI (MP-MRI) screening; and those with suspicious lesions in the anterior region of the prostate were identified. Patients then received a FGB of all suspicious lesions in addition to systematic 12-core extended sextant TRUS-guided biopsy. We conducted a lesion based analysis comparing cancer detection rates of anterior targets using FGB versus systematic cores taken from the same anatomic sextant within the prostate. Lengths of cancer in the most involved core were also compared between the two biopsy techniques employed. Patients with only anterior targets were analyzed separately.
RESULTS: Of 499 patients undergoing FGB, 162 patients had a total of 241 anterior lesions. Mean age, PSA, and prostate volume in this group was 62 years, 12.7ng/dl, and 57mL, respectively. In total, PCa was diagnosed in 121 (50.2%) of anterior lesions identified on MP-MRI. Sixty-two (25.7%) of these anterior lesions were documented positive for cancer on systematic 12-core TRUS-guided biopsy cores, while 97 (40.2%) were positive on the targeted FGB cores (p=0.001). In lesions that were positive on both FGB and TRUS biopsy, the most involved core was 112% longer on FGB (3.7mm vs. 1.6mm, p≤ 0.01). Forty-two patients had only anterior lesions on MP-MRI; twenty-four of them (57.1%) were found to have cancer on the FGB + TRUS biopsy platform. Six patients were positive on FGB only. Thirteen were positive on both modalities. However, 7 of 13 were upgraded by to a higher Gleason score by FGB. All 5 patients positive on TRUS biopsy only were active surveillance candidates.
CONCLUSION: FGB detects significantly more anteriorly located PCa than TRUS-guided biopsy alone and may serve to be an effective tool for this subset of patients.
Written by:
Volkin D, Turkbey B, Hoang AN, Rais-Bahrami S, Yerram N, Walton-Diaz A, Nix JW, Wood BJ, Choyke PL, Pinto PA. Are you the author?
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health.
Reference: BJU Int. 2014 Feb 12. Epub ahead of print.
doi: 10.1111/bju.12670
PubMed Abstract
PMID: 24712649
UroToday.com Prostate Cancer Section
