MP30-10 REAL TIME HIGH-RESOLUTION MICRO-ULTRASOUND GUIDED BIOPSY: A NEW STRATEGY TO OVERCOME SYSTEMATIC PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (MP30)1 Sep 2021MP30-10 REAL TIME HIGH-RESOLUTION MICRO-ULTRASOUND GUIDED BIOPSY: A NEW STRATEGY TO OVERCOME SYSTEMATIC PROSTATE BIOPSY Marco Paciotti, Davide Maffei, Pier Paolo Avolio, Vittorio Fasulo, Nicola Frego, Pietro Diana, Roberto Contieri, Alessandro Uleri, Rodolfo Hurle, Alberto Saita, Massimo Lazzeri, Paolo Casale, Giorgio Guazzoni, Nicolò Buffi, and Giovanni Lughezzani Marco PaciottiMarco Paciotti More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Pier Paolo AvolioPier Paolo Avolio More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Nicola FregoNicola Frego More articles by this author , Pietro DianaPietro Diana More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Paolo CasalePaolo Casale More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Nicolò BuffiNicolò Buffi More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002027.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI improved the detection of clinically significant PCa (csPCa), yet the consistent number of csPCa missed at MRI-target biopsy prevents us from omitting systematic biopsies (SBx). Micro-Ultrasound (mUS) has emerged as a new imaging modality providing realtime stratification of prostate tissue according to the PRI-MUS protocol, that has been developed to standardize the likelihood of PCa risk. We evaluated the reliability of mUS in identifying Pca-free regions, potentially avoiding the SBx of such areas without decreasing csPCa detection. METHODS: We prospectively collected data on 518 patients imaged with the ExactVu mUS system at our center from February 2019 to December 2020. All patients were scheduled for prostate biopsy due to clinical suspicion of PCa (abnormal DRE or elevated PSA). Prostate was systematically divided in 12 regions. The PRIMUS (1-5 score) protocol was used to stratify for likelihood of PCa risk. At least one biopsy core was obtained for each area and all lesions identified and classified as PRIMUS score ≥3 were targeted. The presence of overall PCa and csPCa (defined as ISUP >1 PCa) at pathological assessment was determined. The diagnostic accuracy of mUS was determined. RESULTS: Median patient age was 66 year (IQR 60-71.8). Median tot PSA was 6,8 ng/mL (IQR 4.9-10.2), median prostate volume was 50 ml (IQR 35-70), 133 (25.7%) patients had positive DRE, while 202 (39.0%) patients were in the repeat biopsy setting. Overall-PCa and csPCa detection rates were 51.9% (n=269) and 37.8% (n=196), respectively. A PRIMUS 1 score was assigned to 1075 (17.3%) regions: 989 (92,2%) were negative, while 33 (3.1%) were positive for csPCa. Hence, PRIMUS 1 score provided a negative predictive value for csPCA of 96.9%. A PRIMUS 2 score was assigned to 2729 (43.9%) areas: 2319 (85.0%) were negative, while 243 (8.9%) were positive for csPCa. Overall, in 18 (3.5%) patients an ISUP 1 PCa were identified only on SBx performed in PRI-MUS 1-2 regions. Six (1.16%) patients were diagnosed with csPCa thanks to SBx performed on PRI-MUS 1-2 regions. Overall, we could virtually avoid the SBx of 3804 (61.2%) out of 6216 prostate sextants missing only 6 (1.16%) csPCa diagnoses while reducing the diagnoses of non-csPCa. CONCLUSIONS: According to our preliminary results, mUS could represent a valid tool to overcome the SBx of the whole prostate. Given its high accuracy in identifying cancer-free regions, it could be used to provide a real-time targeting of any suspicious area, while avoiding the SBx when mUS is negative. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e503-e503 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Paciotti More articles by this author Davide Maffei More articles by this author Pier Paolo Avolio More articles by this author Vittorio Fasulo More articles by this author Nicola Frego More articles by this author Pietro Diana More articles by this author Roberto Contieri More articles by this author Alessandro Uleri More articles by this author Rodolfo Hurle More articles by this author Alberto Saita More articles by this author Massimo Lazzeri More articles by this author Paolo Casale More articles by this author Giorgio Guazzoni More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement Loading ...