PURPOSE: To explore the impact of MRI-ultrasound (MRI-US) fusion prostate biopsy on prediction of final surgical pathology.
MATERIALS AND METHODS: 54 consecutive men undergoing radical prostatectomy at UCLA after Artemis fusion biopsy (Eigen, Grass Valley, CA) were included in this prospective IRB-approved pilot study. Using MRI-US fusion, tissue was obtained from a 12-point systematic grid (mapping biopsy, MBx) and from regions of interest detected by multi-parametric MRI (targeted biopsy, TBx). A single radiologist read all MRIs, and a single pathologist independently re-reviewed all biopsy and whole-mount pathology, blinded to prior interpretation and matched specimen. Gleason score (GS) concordance between biopsy and prostatectomy was the primary endpoint.
RESULTS: Mean age was 62 years, with median PSA 6.2 ng/ml. Final GS at prostatectomy was 6 (13%), 7 (70%), and 8-9 (17%). A tertiary pattern was detected in 17 (31%) men. 32/45 (71%) high-suspicion (image grade 4-5) MRI targets contained prostate cancer (CaP). The per-core cancer detection rate was 20% by MBx and 42% by TBx. The highest Gleason pattern at prostatectomy was detected by MBx in 54%, TBx in 54%, and the combination in 81% of cases. 17% were upgraded from fusion biopsy to final pathology; one case (2%) was downgraded. The combination of TBx and MBx was needed to obtain the best predictive accuracy.
CONCLUSIONS: In this pilot study, MR-US fusion biopsy allowed for prediction of final prostate pathology with greater accuracy than that reported previously using conventional methods (81% versus 40-65%). If confirmed, these results would have important clinical implications.
Written by:
Le JD, Stephenson S, Brugger M, Lu DY, Lieu P, Sonn GA, Natarajan S, Dorey FJ, Huang J, Margolis DJ, Reiter RE, Marks LS. Are you the author?
Department of Urology, University of California, Los Angeles, California, USA; David Geffen School of Medicine, University of California, Los Angeles, California, USA; Department of Pathology, University of California, Los Angeles, California, USA; Department of Urology, Stanford University, Stanford, California, USA; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, California, USA; Department of Radiology, University of California, Los Angeles, California, USA.
Reference: J Urol. 2014 Apr 30. pii: S0022-5347(14)03509-5.
doi: 10.1016/j.juro.2014.04.094
PubMed Abstract
PMID: 24793118
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