Systematic Sampling During MRI-US Fusion Prostate Biopsy Can Overcome Errors of Targeting-prospective Single Center Experience After 300 Cases in First Biopsy Setting

Overview

Journal Transl Androl Urol

Date 2021 Jan 18

PMID 33457225

Citations 6

Authors

Emanuel Cata

Iulia Andras

Matteo Ferro

Pierre Kadula

Daniel Leucuta

Gennaro Musi

Deliu-Victor Matei

Ottavio de Cobelli

Attila Tamas-Szora

Cosmin Caraiani

Andrei Lebovici

Flavia Epure

Maria Bungardean

Radu-Tudor Coman

Nicolae Crisan

Affiliations

Soon will be listed here.

Abstract

Background: Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy have become an integral part of the diagnosis of prostate cancer (PCa), as recommended by the European Association of Urology Guidelines. The aim of the current study was to evaluate the performance of MRI and MRI-transrectal ultrasound (TRUS) fusion prostate biopsy as first biopsy setting in a tertiary center.

Methods: A cohort of 300 patients was included in the current analysis. All patients presented with clinical or biochemical suspicion of PCa and harbored at least one suspect lesion on mpMRI. MRI-TRUS fusion prostate biopsy, followed by 12 core systematic prostate biopsy were performed by the same operator using a rigid registration system.

Results: The mean age of the patients was 64 years (IQR: 58-68.5 years) and the mean PSA was 6.35 ng/mL (IQR: 4.84-9.46 ng/mL). Overall cancer and csPCa diagnosis rates were 47% and 40.66%. Overall PCa/csPCa detection rates were 20.4%/11.1%, 52%/45% and 68.5%/66.7% for PI-RADS lesions 3, 4 and 5 (P<0.001/P<0.0001). Larger lesion diameter and lesion volume were associated with PCa diagnosis (P=0.006 and P=0.001, respectively). MRI-TRUS fusion biopsy missed PCa diagnosis in 37 cases (of whom 48.6% ISUP 1) in comparison with 9 patients missed by systematic biopsy (of whom 11.1% ISUP 1). In terms of csPCa, systematic biopsy missed 77.7% of the tumors located in the anterior and transitional areas. The rate of csPCa was highest when targeted biopsy was associated with systematic biopsy: 86.52% 68.79% for targeted biopsy 80.14% for systematic biopsy, P=0.0004. In 60.6% of cases, systematic biopsy was positive for PCa at the same site as the targeted lesion. Of these patients, eight harbored csPCa and were diagnosed exclusively on systematic biopsy.

Conclusions: MRI-TRUS fusion prostate biopsy improves the diagnosis of csPCa. The main advantage of an MRI-guided approach is the diagnosis of anterior and transitional area tumors. The best results in terms of csPCa diagnosis are obtained by the combination of MRI-TRUS fusion with systematic biopsy. The systematic biopsy performed during MRI-targeted biopsy could have an important role in overcoming errors of MRI-TRUS fusion systems.

Citing Articles

Role of Systematic Biopsy in the Era of Targeted Biopsy: A Review.

Malewski W, Milecki T, Tayara O, Poletajew S, Kryst P, Tokarczyk A Curr Oncol. 2024; 31(9):5171-5194.

PMID: 39330011 PMC: 11430858. DOI: 10.3390/curroncol31090383.

Expect the unexpected: investigating discordant prostate MRI and biopsy results.

Stanzione A, Lee K, Sanmugalingam N, Rajendran I, Sushentsev N, Caglic I Eur Radiol. 2024; 34(7):4810-4820.

PMID: 38503918 PMC: 11213781. DOI: 10.1007/s00330-024-10702-x.

Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors.

Zambon A, Nguyen T, Fourcade A, Segalen T, Saout K, Deruelle C Prostate Cancer Prostatic Dis. 2023; 27(3):500-506.

PMID: 38114598 DOI: 10.1038/s41391-023-00770-3.

Prostate Biopsy in the Case of PIRADS 5-Is Systematic Biopsy Mandatory?.

Malewski W, Milecki T, Szemplinski S, Tayara O, Kuncman L, Kryst P J Clin Med. 2023; 12(17).

PMID: 37685679 PMC: 10488368. DOI: 10.3390/jcm12175612.

Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy.

Wei J, Barocas D, Carlsson S, Coakley F, Eggener S, Etzioni R J Urol. 2023; 210(1):54-63.

PMID: 37096575 PMC: 11321723. DOI: 10.1097/JU.0000000000003492.

References

van der Leest M, Cornel E, Israel B, Hendriks R, Padhani A, Hoogenboom M . Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naïve Men with Elevated Prostate-specific Antigen: A Large.... Eur Urol. 2018; 75(4):570-578. DOI: 10.1016/j.eururo.2018.11.023. View

Miah S, Hosking-Jervis F, Connor M, Eldred-Evans D, Shah T, Arya M . A Multicentre Analysis of the Detection of Clinically Significant Prostate Cancer Following Transperineal Image-fusion Targeted and Nontargeted Systematic Prostate Biopsy in Men at Risk. Eur Urol Oncol. 2019; 3(3):262-269. DOI: 10.1016/j.euo.2019.03.005. View

Maxeiner A, Kittner B, Blobel C, Wiemer L, Hofbauer S, Fischer T . Primary magnetic resonance imaging/ultrasonography fusion-guided biopsy of the prostate. BJU Int. 2018; 122(2):211-218. DOI: 10.1111/bju.14212. View

Schlemmer H, Bittencourt L, DAnastasi M, Domingues R, Khong P, Lockhat Z . Global Challenges for Cancer Imaging. J Glob Oncol. 2018; 4:1-10. PMC: 6180759. DOI: 10.1200/JGO.17.00036. View

Turkbey B, Rosenkrantz A, Haider M, Padhani A, Villeirs G, Macura K . Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019; 76(3):340-351. DOI: 10.1016/j.eururo.2019.02.033. View

Stabile A, Delloglio P, Gandaglia G, Fossati N, Brembilla G, Cristel G . Not All Multiparametric Magnetic Resonance Imaging-targeted Biopsies Are Equal: The Impact of the Type of Approach and Operator Expertise on the Detection of Clinically Significant Prostate Cancer. Eur Urol Oncol. 2019; 1(2):120-128. DOI: 10.1016/j.euo.2018.02.002. View

Hansen N, Barrett T, Lloyd T, Warren A, Samel C, Bratt O . Optimising the number of cores for magnetic resonance imaging-guided targeted and systematic transperineal prostate biopsy. BJU Int. 2019; 125(2):260-269. PMC: 8641376. DOI: 10.1111/bju.14865. View

Schouten M, Hoeks C, Bomers J, Hulsbergen-van de Kaa C, Witjes J, Thompson L . Location of Prostate Cancers Determined by Multiparametric and MRI-Guided Biopsy in Patients With Elevated Prostate-Specific Antigen Level and at Least One Negative Transrectal Ultrasound-Guided Biopsy. AJR Am J Roentgenol. 2015; 205(1):57-63. DOI: 10.2214/AJR.14.12960. View

Miah S, Servian P, Patel A, Lovegrove C, Skelton L, Shah T . A prospective analysis of robotic targeted MRI-US fusion prostate biopsy using the centroid targeting approach. J Robot Surg. 2019; 14(1):69-74. PMC: 7000504. DOI: 10.1007/s11701-019-00929-y. View

10.

Andras I, Crisan D, Cata E, Tamas-Szora A, Caraiani C, Coman R . MRI-TRUS fusion guided prostate biopsy - initial experience and assessment of the role of contralateral lobe systematic biopsy. Med Ultrason. 2019; 21(1):37-44. DOI: 10.11152/mu-1705. View

11.

Moore C, Kasivisvanathan V, Eggener S, Emberton M, Futterer J, Gill I . Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol. 2013; 64(4):544-52. DOI: 10.1016/j.eururo.2013.03.030. View

12.

Brembilla G, Delloglio P, Stabile A, Damascelli A, Brunetti L, Ravelli S . Interreader variability in prostate MRI reporting using Prostate Imaging Reporting and Data System version 2.1. Eur Radiol. 2020; 30(6):3383-3392. DOI: 10.1007/s00330-019-06654-2. View

13.

Volkin D, Turkbey B, Hoang A, Rais-Bahrami S, Yerram N, Walton-Diaz A . Multiparametric magnetic resonance imaging (MRI) and subsequent MRI/ultrasonography fusion-guided biopsy increase the detection of anteriorly located prostate cancers. BJU Int. 2014; 114(6b):E43-E49. PMC: 5613950. DOI: 10.1111/bju.12670. View

14.

Venderink W, Govers T, de Rooij M, Futterer J, Sedelaar J . Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion. AJR Am J Roentgenol. 2017; 208(5):1058-1063. DOI: 10.2214/AJR.16.17322. View

15.

Ahmed H, El-Shater Bosaily A, Brown L, Gabe R, Kaplan R, Parmar M . Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017; 389(10071):815-822. DOI: 10.1016/S0140-6736(16)32401-1. View

16.

Mortezavi A, Marzendorfer O, Donati O, Rizzi G, Rupp N, Wettstein M . Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging and Fusion Guided Targeted Biopsy Evaluated by Transperineal Template Saturation Prostate Biopsy for the Detection and Characterization of Prostate Cancer. J Urol. 2018; 200(2):309-318. DOI: 10.1016/j.juro.2018.02.067. View

17.

Drost F, Osses D, Nieboer D, Steyerberg E, Bangma C, Roobol M . Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev. 2019; 4:CD012663. PMC: 6483565. DOI: 10.1002/14651858.CD012663.pub2. View

18.

Engels R, Israel B, Padhani A, Barentsz J . Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 1: Acquisition. Eur Urol. 2019; 77(4):457-468. DOI: 10.1016/j.eururo.2019.09.021. View

19.

Meng X, Rosenkrantz A, Huang R, Deng F, Wysock J, Bjurlin M . The Institutional Learning Curve of Magnetic Resonance Imaging-Ultrasound Fusion Targeted Prostate Biopsy: Temporal Improvements in Cancer Detection in 4 Years. J Urol. 2018; 200(5):1022-1029. DOI: 10.1016/j.juro.2018.06.012. View

20.

Rouviere O, Puech P, Renard-Penna R, Claudon M, Roy C, Mege-Lechevallier F . Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol. 2018; 20(1):100-109. DOI: 10.1016/S1470-2045(18)30569-2. View