MP20-20 BETTER PREDICTION OF TUMOR AGGRESSIVENESS IN MRI/ULTRASOUND-FUSION-BIOPSY COMPARED TO SYSTEMATIC PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2018MP20-20 BETTER PREDICTION OF TUMOR AGGRESSIVENESS IN MRI/ULTRASOUND-FUSION-BIOPSY COMPARED TO SYSTEMATIC PROSTATE BIOPSY Angelika Borkowetz, Ivan Platzek, Marieta Toma, Theresa Renner, Michael Froehner, Stefan Zastrow, and Manfred Wirth Angelika BorkowetzAngelika Borkowetz More articles by this author , Ivan PlatzekIvan Platzek More articles by this author , Marieta TomaMarieta Toma More articles by this author , Theresa RennerTheresa Renner More articles by this author , Michael FroehnerMichael Froehner More articles by this author , Stefan ZastrowStefan Zastrow More articles by this author , and Manfred WirthManfred Wirth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.690AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate tumor assessment is essential in counselling patients with prostate cancer (PCa) for further treatment. Therefore, we compared transperineal MRI/ultrasound-fusion biopsy (fusPbx) with systematic transrectal prostate biopsy (sysPbx) for prediction of final histopathology. Furthermore, we assessed the prediction of extracapsular extension (ECE) and infiltration of seminal vesicles (SvI) in multiparametric MRI (mpMRI) compared to prostatectomy specimen (PrS). METHODS 320 patients undergoing radical prostatectomy were investigated. In all patients, PCa was proven by transperineal fusPbx combined with transrectal sysPbx (comPbx). Lesions detected in mpMRI were evaluated according to PI-RADS. PCa-detection rate in all biopsy modalities were evaluated. Tumour grading of the biopsy specimen (fusPbx, sysPbx and comPbx) and the PrS were compared. Finally, the concordance of ECE and SvI in mpMRI and PrS was investigated. Significant PCa was defined as Gleason score (GS) ≥ 7(3+4). RESULTS PCa detection rate was 88% (n=280) in fusPbx and 73% (n=235) in sysPbx (p<0.005). Significant PCa was detected in 72% (n=231) in fusPbx and in 60% (n=193) in sysPx (p=0.001). In PrS, 5% (n=15) of patients presented a GS=6 and 95% (n=305) of patients presented a GS ≥7 PCa. FusPbx alone would have missed 40 tumors (GS=6: 10% (n=4), GS≥7: 90% (n=36)), sysPbx alone would have missed 85 tumors (GS=6: 6% (n=5), GS≥7: 94% (n=80). Concordance on GS between biopsy and PrS was 50% (n=159), 40% (n=127) and 56% (n=180) in fusPbx, sysPbx and comPbx, respectively. Upgrading on GS between biopsy and PrS occurred in 38% (n=122), 48% (n=152) and 27% (n=85) in fusPbx, sysPbx and comPbx, respectively. Gamma correlation for detection of any cancer was 0.7 for comPbx, 0.6 for fusPbx alone and 0.4 for sysPbx alone. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for ECE and SvI in mpMRI were 26%, 91%, 54%, 73%, 71% and 22%, 99%, 57%, 96%, 95%; respectively. CONCLUSIONS FusPbx is associated with a higher detection rate while sysPbx would miss a higher proportion of PCa with a GS≥7. FusPbx shows a higher concordance and a lower GS upgrading than sysPbx. But the combination of both presents the best concordance of GS in PrS. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e261 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Angelika Borkowetz More articles by this author Ivan Platzek More articles by this author Marieta Toma More articles by this author Theresa Renner More articles by this author Michael Froehner More articles by this author Stefan Zastrow More articles by this author Manfred Wirth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...