18 F-DCFPyL positron emissiontomography/magnetic resonanceimaging-guided ultrasound fusion biopsy is an identical pathway in prostate cancer diagnosis.

Shaoxi Niu,Mu Lin,Xiao Chang,Xiaohui Ding,Jinhang Li,Baixuan Xu,Baojun Wang,Haiyi Wang,Hongkai Yu,Xin Ma,Xiaodong Feng,Yong Xu,Xu Zhang,Jiajin Liu,Yachao Liu,Liyan Ao,Huijie Gong

doi:10.1002/pros.24446

Abstract

Prostate biopsy is still unavoidable in patients with a rising prostate-specific antigeneven thoughmultiparametric magnetic resonance imaging (MRI)is widely used. 18 F-DCFPyL positron emission tomography (PET)/MRIwas proved to be promising both in sensitivity and specificity. But its guiding fusion biopsy and the advantages in the diagnosis of prostate disease is seldom reported. This study aimed to verify the feasibility and advantage of 18 F-DCFPyLPET/MRI-guided fusion targeted biopsy (TB) over whole-mount histopathology (WMH) for prostate cancer diagnosis. A prospective study of 94 biopsy-naïve patients were conducted using 18 F-DCFPyL PET/MRI scans and scored on a scale of 1-4. Systematic biopsy was performed for all patients. Patients with suspicious lesions also underwent PET/MRI/transrectal ultrasound-guided fusion biopsy. Patients with pathologically confirmed cancer underwent surgery and WMHsections. Systematic biopsy was compared with TBfor the detection of index tumors (ITs). Significant cancer was defined as Grade group (GG) 2 or higher no matter the length of the cancer core. 18 F-DCFPyL PET/MRIdetected 30/94 (32%) patients with a score of 4, all of whom were verified to have prostate cancer. While it detected 10patients with a score of 1 (10.6%), they were shown to have no cancer. The sensitivity and specificity of 18 F-DCFPyLPET/MRIwere 94.4% and 75%, respectively, if images with a score of 3 are defined as positive. Systematic biopsy detected 18% (203/1128) samples as prostate cancer; conversely, TBdetected 113 samples out of 259 scores (43.6%). A statistically significant difference was seen between the PCa detection rates by TB and SB (p < 0.001). All targeted lesions were pathologically proven to be the ITon WMH. In biopsy-naïve patients, the ultrasound fusion biopsy targeted by 18 F-DCFPyLPET/MRIis an identical pathway for the detection of prostate cancer.

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