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Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting

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-tra...

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Autores principales: Cata, Emanuel, Andras, Iulia, Ferro, Matteo, Kadula, Pierre, Leucuta, Daniel, Musi, Gennaro, Matei, Deliu-Victor, De Cobelli, Ottavio, Tamas-Szora, Attila, Caraiani, Cosmin, Lebovici, Andrei, Epure, Flavia, Bungardean, Maria, Coman, Radu-Tudor, Crisan, Nicolae
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807351/
https://www.ncbi.nlm.nih.gov/pubmed/33457225
http://dx.doi.org/10.21037/tau-20-1001
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author Cata, Emanuel
Andras, Iulia
Ferro, Matteo
Kadula, Pierre
Leucuta, Daniel
Musi, Gennaro
Matei, Deliu-Victor
De Cobelli, Ottavio
Tamas-Szora, Attila
Caraiani, Cosmin
Lebovici, Andrei
Epure, Flavia
Bungardean, Maria
Coman, Radu-Tudor
Crisan, Nicolae
author_facet Cata, Emanuel
Andras, Iulia
Ferro, Matteo
Kadula, Pierre
Leucuta, Daniel
Musi, Gennaro
Matei, Deliu-Victor
De Cobelli, Ottavio
Tamas-Szora, Attila
Caraiani, Cosmin
Lebovici, Andrei
Epure, Flavia
Bungardean, Maria
Coman, Radu-Tudor
Crisan, Nicolae
author_sort Cata, Emanuel
collection PubMed
description 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% vs. 68.79% for targeted biopsy vs. 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.
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spelling pubmed-78073512021-01-15 Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting Cata, Emanuel Andras, Iulia Ferro, Matteo Kadula, Pierre Leucuta, Daniel Musi, Gennaro Matei, Deliu-Victor De Cobelli, Ottavio Tamas-Szora, Attila Caraiani, Cosmin Lebovici, Andrei Epure, Flavia Bungardean, Maria Coman, Radu-Tudor Crisan, Nicolae Transl Androl Urol Original Article 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% vs. 68.79% for targeted biopsy vs. 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. AME Publishing Company 2020-12 /pmc/articles/PMC7807351/ /pubmed/33457225 http://dx.doi.org/10.21037/tau-20-1001 Text en 2020 Translational Andrology and Urology. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Cata, Emanuel
Andras, Iulia
Ferro, Matteo
Kadula, Pierre
Leucuta, Daniel
Musi, Gennaro
Matei, Deliu-Victor
De Cobelli, Ottavio
Tamas-Szora, Attila
Caraiani, Cosmin
Lebovici, Andrei
Epure, Flavia
Bungardean, Maria
Coman, Radu-Tudor
Crisan, Nicolae
Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting
title Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting
title_full Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting
title_fullStr Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting
title_full_unstemmed Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting
title_short Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting
title_sort systematic sampling during mri-us fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807351/
https://www.ncbi.nlm.nih.gov/pubmed/33457225
http://dx.doi.org/10.21037/tau-20-1001
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