PURPOSE: MRI-guided biopsies are increasingly used for prostate cancer (PCa) diagnosis.
However, there is a lack of well controlled prospective trials to support this treatment method. The aim of this study was to prospectively compare the MRI-guided in-bore biopsy with the standard systematic TRUS-guided biopsy in biopsy naïve men with elevated PSA.
MATERIALS AND METHODS: Prospective inclusion of 132 biopsy-naïve men (ClinicalTrials.gov, NCT01553838) with elevated PSA (>4 ng/ml). After functional multiparametric MRI at 3-TESLA, patients were referred for a MRI-guided in-bore biopsy of prostate lesions (maximum three) followed by a standard systematic TRUS-guided biopsy (12 cores). Analysis of detection rates for PCa and significant PCa was performed (>5 mm total cancer length or any Gleason pattern >3).
RESULTS: 128 patients (age 66.1±8.1 years; median PSA 6.7 ng/ml, lower quartile 5.1 ng/ml, upper quartile 9.0 ng/ml) met all study requirements. Both biopsy methods produced the same detection rate of 53.1% (for significant PCa: TRUS-biopsy 79.4%; MRI-guided biopsy 85.3%). 7.8% of clinically significant PCa were missed by the MRI-guided in-bore biopsy and 9.4% by the TRUS-biopsy. MRI-guided in-bore biopsy required significantly less cores (p< 0.01) and showed higher percentage of cancer involvement per biopsy core (p< 0.01). The combination of both methods showed a detection rate of 60.9% (significant PCa: 82.1%).
CONCLUSIONS: MRI-guided in-bore biopsies and systematic TRUS-guided biopsies achieved equally high detection rates in biopsy-naïve patients with elevated PSA levels. MRI-guided in-bore biopsies required significantly less cores and showed a significantly higher percentage of cancer involvement per biopsy core.
Written by:
Quentin M, Blondin D, Arsov C, Schimmöller L, Hiester A, Godehardt E, Albers P, Antoch G, Rabenalt R. Are you the author?
Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225, Dusseldorf, Germany; Department of Urology, University Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225, Dusseldorf, Germany; Department of Cardiovascular Surgery, division statistics, University Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225, Dusseldorf, Germany.
Reference: J Urol. 2014 May 24. pii: S0022-5347(14)03683-0.
doi: 10.1016/j.juro.2014.05.090
PubMed Abstract
PMID: 24866597
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