Repeat transrectal ultrasound biopsies with additional targeted cores according to results of functional prostate MRI detects high-risk prostate cancer in patients with previous negative biopsy and increased PSA - a pilot study.
ABSTRACT Patients with previous negative transrectal ultrasound-guided biopsy (TRUS-GB) and persistently increased prostate-specific antigen (PSA) value represent a great diagnostic problem. Magnetic resonance imaging (MRI)-guided biopsy demonstrates high prostate cancer detection rates in these patients if functional MRI is suspicious for prostate cancer. However, MRI-guided biopsy is not commonly available and features considerable technical requirements. This was a pilot study to investigate if a standard repeat TRUS-GB, with additional targeted cores to suspicious lesions on functional MRI, can achieve similar detection rates as compared to MRI-guided biopsy.
3 Tesla functional MRI was performed in 58 patients with ≥1 previous negative biopsy, persistently increased PSA ≥4 ng/ml and unsuspicious digital rectal examination. Suspicious lesions were marked on a localization map to enable their finding on TRUS. Random TRUS-GB with additional targeted cores according to the functional MRI findings were performed in patients with ≥1 suspicious lesion.
In 37.9% (22/58), functional MRI demonstrated suspicious findings. Out of these 22 patients, 16 underwent TRUS-GB with additional targeted cores. Prostate cancer was diagnosed in 68.8% (11/16). Eight out of these 11 patients subsequently underwent radical prostatectomy and all tumors fulfilled criteria for high-risk prostate cancer. With a median follow-up of 49.1 weeks neither significant PSA increase nor prostate cancer was detected in patients with normal functional MRI findings.
Our approach enables excellent detection rates of clinically significant prostate cancer in patients with ≥1 previous negative biopsy and persistently increased PSA levels. Due to the current disadvantages of MRI-guided biopsy, our approach therefore represents an excellent alternative to MRI-guided biopsy.
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ABSTRACT: Purpose:To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targeted biopsy (TB) with that of extended systematic biopsy (SB) in prostate cancer (PCa) detection.Materials and Methods:This institutional review board-approved multicenter prospective study (May 2009 to January 2011) included 95 patients with informed consent who were suspected of having PCa, with a suspicious abnormality (target) at prebiopsy MR. Patients underwent 12-core SB and four-core TB with transrectal ultrasonographic (US) guidance, with two cores aimed visually (cognitive TB [TB-COG]) and two cores aimed using transrectal US-MR fusion software (fusion-guided TB [TB-FUS]). SB and TB positivity for cancer and sampling quality (mean longest core cancer length, Gleason score) were compared. Clinically significant PCa was any 3 mm or greater core cancer length or any greater than 3 Gleason pattern for SB or any cancer length for TB. Statistical analysis included t test, paired χ(2) test, and κ statistic. Primary end point (core cancer length) was calculated (paired t test).Results:Among 95 patients (median age, 65 years; mean prostate-specific antigen level, 10.05 ng/mL [10.05 μg/L]), positivity rate for PCa was 59% (n = 56) for SB and 69% (n = 66) for TB (P = .033); rate for clinically significant PCa was 52% (n = 49) for SB and 67% (n = 64) for TB (P = .0011). Cancer was diagnosed through TB in 16 patients (17%) with negative SB results. Mean longest core cancer lengths were 4.6 mm for SB and 7.3 mm for TB (P < .0001). In 12 of 51 (24%) MR imaging targets with positive SB and TB results, TB led to Gleason score upgrading. In 79 MR imaging targets, positivity for cancer was 47% (n = 37) with TB-COG and 53% (n = 42) with TB-FUS (P = .16). Neither technique was superior for Gleason score assessment.Conclusion:Prebiopsy MR imaging combined with transrectal US-guided TB increases biopsy performance in detecting PCa, especially clinically significant PCa. No significant difference was observed between TB-FUS and TB-COG for TB guidance.© RSNA, 2013Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121501/-/DC1.Radiology 04/2013; · 6.34 Impact Factor
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ABSTRACT: OBJECTIVES: The recent European Society of Urogenital Radiology (ESUR) guidelines for evaluation and reporting of prostate multiparametric magnetic resonance imaging (mp-MRI) include the Prostate Imaging Reporting and Data System (PI-RADS). The aim of this study was to investigate the inter-reader agreement of this scoring system. METHODS: One hundred and sixty-four lesions in 67 consecutive patients with elevated prostate-specific antigen and previously negative trans-rectal ultrasound (TRUS)-guided biopsy were scored retrospectively by three blinded readers using PI-RADS. Mp-MRI was performed at 3 T using T2-weighted, diffusion-weighted and dynamic contrast-enhanced imagings (T2WI, DWI, DCE-MRI). Histology of all lesions was obtained by in-bore MRI-guided biopsy. Cohen's kappa statistics were calculated for all readers. RESULTS: Inter-reader agreement for all lesions was good to moderate (T2WI, κ = 0.55; DWI, κ = 0.64; DCE-MRI, κ = 0.65). For tumour lesions it was good (T2WI, κ = 0.66; DWI, κ = 0.80; DCE-MRI, κ = 0.63) and for benign lesions moderate to good (T2WI, κ = 0.46; DWI, κ = 0.52; DCE-MRI, κ = 0.67). Using an overall PI-RADS score with a threshold of ≥10, we achieved a sensitivity of 85.7 %, and negative predictive value of 90.1 % for biopsied lesions. CONCLUSION: PI-RADS score shows good to moderate inter-reader agreement and enables standardised evaluation of prostate mp-MRI, with high sensitivity and negative predictive value. KEY POINTS : • The European Society of Urogenital Radiology recently published guidelines for prostate MRI. • We have evaluated inter-reader agreement of ESUR scoring for multiparametric prostate MRI. • PI-RADS shows good to moderate inter-reader agreement and is clinically applicable. • PI-RADS achieves in our series high sensitivity and negative predictive value for biopsied lesions. • PI-RADS can be used as standardised scoring system in prostate cancer detection.European Radiology 06/2013; · 4.34 Impact Factor