2123 HARD TO DETECT PROSTATE CANCER DIAGNOSED BY TARGETED BIOPSY USING COMBINED T2 WEIGHTED AND DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112123 HARD TO DETECT PROSTATE CANCER DIAGNOSED BY TARGETED BIOPSY USING COMBINED T2 WEIGHTED AND DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING Seung Hwan Lee, Chan Dong Yeom, Kyung Kgi Park, Mun Su Chung, Byung Ha Chung, and Koon Ho Rha Seung Hwan LeeSeung Hwan Lee Seoul, Korea, Republic of More articles by this author , Chan Dong YeomChan Dong Yeom Seoul, Korea, Republic of More articles by this author , Kyung Kgi ParkKyung Kgi Park Seoul, Korea, Republic of More articles by this author , Mun Su ChungMun Su Chung Seoul, Korea, Republic of More articles by this author , Byung Ha ChungByung Ha Chung Seoul, Korea, Republic of More articles by this author , and Koon Ho RhaKoon Ho Rha Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2320AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is a urologist¡ -s common dilemma when a prostate biopsy is negative and there is still a clinical suspicion of prostate cancer (PCA). We aimed to evaluate the efficacy of targeted prostatic biopsy using magnetic resonance imaging (MRI) and characterize clinicopathological features of tumors detected with targeted prostatic biopsy in men with prior negative prostatic biopsy. METHODS 87 patients with a persistently increasing trend of serum prostate specific antigen (PSA), at least 1 previous set of negative 12 cores prostatic biopsies and normal digital rectal examination were prospectively included. All patients were examined with combined T2 weighted and diffusion weighted MRI before the targeted biopsy. RESULTS Of the 87 patients, 46 (52.9%) had a PCA in at least one core. There was a significant difference in the suspicious regions such as the anterior or apex lesions from which the biopsy was taken. For prostatic cores, 149/518 (28.8%) samples from the targeted lesions and 32/903 (3.6%) from the standard biopsies had PCA (p=0.012). The detection rate of the targeted biopsy in the anterior or apex area of the prostate was 74.3% (34 of the 46 patients); however, only 14 patients (7.0%) were detected on the anterior or apex area in the standard biopsy group. CONCLUSIONS Foci of PCA in patients with a previous negative prostatic biopsy were located in the hard-to-detect apex or anterior location. In these patients, targeted prostatic biopsy following prostate MRI should be considered for the identification of cancer foci and the detection of PCA. Table 1. The baseline characteristics of patients with and without confirmed PCA by targeted prostate biopsy No cancer detection (n=41) Cancer detection (n=46) Median age, years (range) 68(50–84) 66(48–76) Median (mean) Prebiopsy total PSA (ng/ml)+ 7.90(11.24) 9.48(12.78) PSA density 0.19(0.49) 0.28(0.57) Prostate volume(cc) 40.8(33.9) 35.4(33.1) No previous biopsy (range) 2(1–3) 2(1–4) No. cores/biopsy (range) 12 (10–12) 11 (10–12) No. targeted cores/biopsy (range) 9 (6–14) 8 (6–14) Months from previous biopsy (range) 13.2(6–19) 11.8(7–21) MRI finding (%) Norma 3(7.7) 2(4.3) Suspicious anterior 13(30.8) 19(41.3) Suspicious apex⁎ 11(26.9) 19(41.3) Other 14(34.6) 6(13.0) Suspicious tumor size (cm) 1.68 1.47 +p<0.05 by Mann-Whitney U test ⁎ p<0.05 by Fisher's exact test Table 2. Comparison of prostate cancer location among MRI, prostate biopsy, and radical prostatectomy specimens (N=43) Bx findings (positive/total cores) Bx findings (positive/total cores) Bx findings (positive/total cores) Pathologic findings Pathologic findings Pathologic findings Pts Anterior Apex Other Anterior Apex Other Positive sites (MRI) 43 15 19 9 19 18 6 Normal 1 0 0 1(3/16) 0 0 1 Anterior 17 12(50/264) 3(9/56) 2(3/37) 15 1 1 Apex 19 2(3/38) 15(73/287) 2(4/41) 3 16 0 Other 6 1(3/21) 1(2/20) 4(15/71) 1 1 4 Gleason Scores =5 0 1 3 0 0 1 0 6 0 6 8 3 5 6 3 <>=7 0 8 8 6 14 11 3 Stage T1c 0 0 1 1 0 0 0 T2 0 13 15 8 15 13 5 T3 0 2 3 0 3 4 1 T4 0 0 0 0 1 1 0 © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e849-e850 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seung Hwan Lee Seoul, Korea, Republic of More articles by this author Chan Dong Yeom Seoul, Korea, Republic of More articles by this author Kyung Kgi Park Seoul, Korea, Republic of More articles by this author Mun Su Chung Seoul, Korea, Republic of More articles by this author Byung Ha Chung Seoul, Korea, Republic of More articles by this author Koon Ho Rha Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...