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MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer

  • ONCOLOGY IMAGING
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A Correction to this article was published on 09 January 2018

This article has been updated

Abstract

Purpose

The aim of this study was to validate the role of MR/Ultrasound Fusion-Guided Targeted Biopsy as a first diagnostic modality in subjects with clinical suspicion of prostate cancer (PCa).

Materials and methods

108 men (age range 46–78 years) with clinical suspicion for PCa (PSA > 4 ng/mL) underwent multiparametric MRI of the prostate (mpMRI) and, when suspicious lesion were found (according to the PIRADSv2 scoring system), targeted biopsy was performed. All patients without significant alteration patterns at mpMRI have been referred for follow-up at 1 year.

Results

91/108 patients showed on the mpMRI highly suspicious lesions (PIRADS 4 and 5); the remaining 17/108 patients revealed no significant alteration consistent with PCa (PIRADS 3). Among the first group of patients, 58/91 proved to be positive for PCa on the pathology report: 24 patients had a Gleason Score (GS) 6 (3 + 3); 18 patients GS 7 of which 7 (3 + 4) and 11 (4 + 3); 14 patients GS 8 (4 + 4); two patients GS 9 (5 + 4); 33 proved to be negative. Overall cancer detection rate (CDR) was 63%. However, the CDR rises significantly, up to 77%, after the 53 initial consecutive biopsies that were performed (p < 0,05) and thus identified as part of the learning curve. Patients of the second group (17/108) have been followed with serial PSA assessments, clinical reevaluation, and follow-up mpMRI.

Conclusion

Performing exclusively targeted MR/Ultrasound Fusion-Guided biopsies for the diagnosis of PCa in patients with suspicious PSA levels (> 4 ng/mL) increases the detection rate of clinically significant cancer, changing both the therapeutic options and the prognosis.

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Change history

  • 09 January 2018

    In the original publication of the article, the first and last names of the second author were interchanged.

References

  1. Jahn JL, Giovannucci EL, Stampfer MJ (2015) The high prevalence of undiagnosed prostate cancer at autopsy: implications for epidemiology and treatment of prostate cancer in the prostate-specific antigen-era: high prostate cancer prevalence: research implications in the PSA-ERA. Int J Cancer 137(12):2795–2802

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Heidenreich A et al (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59(1):61–71

    Article  PubMed  Google Scholar 

  3. Wu J et al (2015) Is magnetic resonance/ultrasound fusion prostate biopsy better than systematic prostate biopsy? an updated meta- and trial sequential analysis. Oncotarget 6(41):43571–43580

    PubMed  PubMed Central  Google Scholar 

  4. Collins GN, Lloyd SN, Hehir M, McKelvie GB (1993) Multiple transrectal ultrasound-guided prostatic biopsies–true morbidity and patient acceptance. Br J Urol 71(4):460–463

    Article  CAS  PubMed  Google Scholar 

  5. Siddiqui MM et al (2015) Comparison of MR/Ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 313(4):390

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Moore CM et al (2013) Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 63(1):125–140

    Article  PubMed  Google Scholar 

  7. Wolf AMD et al (2010) American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 60(2):70–98

    Article  PubMed  Google Scholar 

  8. Busetto GM et al (2013) Prostate cancer gene 3 and multiparametric magnetic resonance can reduce unnecessary biopsies: decision curve analysis to evaluate predictive models. Urology 82(6):1355–1362

    Article  PubMed  Google Scholar 

  9. Schimmöller L et al (2014) Predictive power of the ESUR scoring system for prostate cancer diagnosis verified with targeted MR-guided in-bore biopsy. Eur J Radiol 83(12):2103–2108

    Article  PubMed  Google Scholar 

  10. Itatani R et al (2014) Negative predictive value of multiparametric MRI for prostate cancer detection: outcome of 5-year follow-up in men with negative findings on initial MRI studies. Eur J Radiol 83(10):1740–1745

    Article  CAS  PubMed  Google Scholar 

  11. Thompson J, Lawrentschuk N, Frydenberg M, Thompson L, Stricker P, USANZ (2013) The role of magnetic resonance imaging in the diagnosis and management of prostate cancer: The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int 112:6–20

    Article  PubMed  Google Scholar 

  12. Bratan F et al (2013) Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol 23(7):2019–2029

    Article  PubMed  Google Scholar 

  13. Tan CH, Paul Hobbs B, Wei W, Kundra V (2015) Dynamic contrast-enhanced MRI for the detection of prostate cancer: meta-analysis. Am J Roentgenol 204(4):W439–W448

    Article  Google Scholar 

  14. Sciarra A et al (2011) Advances in magnetic resonance imaging: how they are changing the management of prostate cancer. Eur Urol 59(6):962–977

    Article  PubMed  Google Scholar 

  15. Oderda M et al (2016) Prostate cancer detection rate with koelis fusion biopsies versus cognitive biopsies: a comparative study. Urol Int 97(2):230–237

    Article  PubMed  Google Scholar 

  16. Panebianco V et al (2012) Conventional imaging and multiparametric magnetic resonance (MRI, MRS, DWI, MRP) in the diagnosis of prostate cancer. Q. J. Nucl. Med. Mol. Imaging 56(4):331–342

    CAS  PubMed  Google Scholar 

  17. Ukimura O et al (2013) Contemporary role of systematic prostate biopsies: indications, techniques, and implications for patient care. Eur Urol 63(2):214–230

    Article  PubMed  Google Scholar 

  18. Radtke JP et al (2016) Multiparametric magnetic resonance imaging (MRI) and MRI–transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen. Eur Urol 70(5):846–853

    Article  PubMed  Google Scholar 

  19. Haffner J et al (2011) Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection: role of MRI before initial biopsy. BJU Int. 108(8b):E171–E178

    Article  PubMed  Google Scholar 

  20. Pinto PA et al (2011) magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and Correlates with multiparametric magnetic resonance imaging. J Urol 186(4):1281–1285

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mozer P et al (2015) First round of targeted biopsies using magnetic resonance imaging/ultrasonography fusion compared with conventional transrectal ultrasonography-guided biopsies for the diagnosis of localised prostate cancer: mRI/TRUS-fusion targeted vs standard TRUS-guided biopsy. BJU Int. 115(1):50–57

    Article  CAS  PubMed  Google Scholar 

  22. Chun FK-H et al (2006) Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol 49(5):820–826

    Article  PubMed  Google Scholar 

  23. Weinreb JC et al (2016) PI-RADS prostate imaging—reporting and data system: 2015, version 2. Eur Urol 69(1):16–40

    Article  PubMed  Google Scholar 

  24. Barentsz JO et al (2016) Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol 69(1):41–49

    Article  PubMed  Google Scholar 

  25. Jemal A et al (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30

    Article  PubMed  Google Scholar 

  26. Marien A, De Castro Abreu A, Gill I, Villers A, Ukimura O (2017) Quel est l’intérêt de l’échographie 3D et fusion d’image IRM pour la détection du cancer de la prostate ? Prog. En Urol. 27(10):521–528

    Article  CAS  Google Scholar 

  27. Panebianco V et al (2013) Prostate cancer recurrence after radical prostatectomy: the role of 3-T diffusion imaging in multi-parametric magnetic resonance imaging. Eur Radiol 23(6):1745–1752

    Article  PubMed  Google Scholar 

  28. Panebianco V et al (2014) Metabolic atrophy and 3-T 1H-magnetic resonance spectroscopy correlation after radiation therapy for prostate cancer: advantages of MRSI after radiation therapy for PCa. BJU Int. 114(6):852–859

    Article  CAS  PubMed  Google Scholar 

  29. Filson CP et al (2016) Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies: CaP detection With MR-US fusion Biopsy. Cancer 122(6):884–892

    Article  PubMed  PubMed Central  Google Scholar 

  30. Salami SS et al (2015) In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12-core biopsy still necessary in addition to a targeted biopsy?: performance of mpMRI in predicting prostate cancer on repeat biopsy. BJU Int. 115(4):562–570

    Article  PubMed  Google Scholar 

  31. Dickinson L et al (2011) Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a european consensus meeting. Eur Urol 59(4):477–494

    Article  PubMed  Google Scholar 

  32. Maxeiner A et al (2014) Die Echtzeit-MRT/US-Fusionsbiopsie in Patienten mit und ohne Vorbiopsie mit Verdacht auf ein Prostatakarzinom. Aktuelle Urol. 46(1):34–38

    Article  PubMed  Google Scholar 

  33. Porpiglia F et al (2017) Multiparametric-magnetic resonance/ultrasound fusion prostate biopsy: number and spatial distribution of cores for a better index tumor detection and characterization. J Urol 198(1):58–64

    Article  PubMed  Google Scholar 

  34. Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MGM (2015) Magnetic Resonance Imaging? targeted Biopsy May enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 68(3):438–450

    Article  PubMed  Google Scholar 

  35. Kuru TH et al (2013) Critical evaluation of magnetic resonance imaging targeted, transrectal ultrasound guided transperineal fusion biopsy for detection of prostate cancer. J Urol 190(4):1380–1386

    Article  PubMed  Google Scholar 

  36. Lacetera V et al (2016) MRI/US fusion prostate biopsy: our initial experience. Arch Ital Urol E Androl 88(4):296

    Article  Google Scholar 

  37. Tan N et al (2017) In-Bore 3-T MR-guided transrectal targeted prostate biopsy: prostate imaging reporting and data system version 2–based diagnostic performance for detection of prostate cancer. Radiology 283(1):130–139

    Article  PubMed  Google Scholar 

  38. Panebianco V, Barchetti F, Manenti G, Aversa T, Catalano C, Simonetti G (2015) MR imaging-guided prostate biopsy: technical features and preliminary results. Radiol Med (Torino) 120(6):571–578

    Article  Google Scholar 

  39. Arsov C et al (2015) Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided In-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol 68(4):713–720

    Article  PubMed  Google Scholar 

  40. Pokorny MR et al (2014) Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound? guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. Eur Urol 66(1):22–29

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Prostate Unit—Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy

    Maurizio Del Monte, Vincenzo Salvo, Marcello Domenico Grompone, Martina Pecoraro, Riccardo Campa, Francesco Vullo, Carlo Catalano & Valeria Panebianco

  2. Department of Urology, Sapienza University, Rome, Italy

    Costantino Leonardo & Alessandro Sciarra

  3. Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy

    Arnaldo Stanzione

Authors
  1. Maurizio Del Monte
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  2. Costantino Leonardo
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  3. Vincenzo Salvo
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  4. Marcello Domenico Grompone
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Corresponding author

Correspondence to Valeria Panebianco.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The original version of this article was revised: the first and last names of the second author were interchanged. Now, it has been corrected.

A correction to this article is available online at https://doi.org/10.1007/s11547-017-0852-5.

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Del Monte, M., Leonardo, C., Salvo, V. et al. MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer. Radiol med 123, 227–234 (2018). https://doi.org/10.1007/s11547-017-0825-8

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  • DOI: https://doi.org/10.1007/s11547-017-0825-8

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