MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE Daniel Nemirovsky, Zoe Blake, Jacob Enders, Alexander Kenigsberg, Neil Mendrihatta, Michael Rothberg, Michael Daneshvar, Lindsey Hazen, Charisse Garcia, Sheng Xu, Baris Turkbey, Bradford Wood, Peter Pinto, and Sandeep Gurram Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Jacob EndersJacob Enders More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Lindsey HazenLindsey Hazen More articles by this author , Charisse GarciaCharisse Garcia More articles by this author , Sheng XuSheng Xu More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , Peter PintoPeter Pinto More articles by this author , and Sandeep GurramSandeep Gurram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monitoring MRI-invisible prostate cancer remains a challenge for patients on active surveillance (AS) due to an inability to reliably re-biopsy tumors without an associated lesion on MRI. In this study, we sought to describe our experience using a prostate image-fusion platform in tracking MRI-invisible lesions in patients on AS, as well as to determine differences in cancer detection and upgrading rates between systematic, MRI-targeted, and tracked biopsies. METHODS: A prospectively maintained AS database was queried for patients with ≥1 tracked prostate biopsy session. Needle trajectories of all biopsy cores were saved using the UroNav™ (Philips) platform. Patients underwent MRI/US guided biopsies of systematic and MRI-targeted lesions via transperineal or transrectal approaches. Tracked biopsy was defined as a repeat MRI/US fusion-guided biopsy which re-targeted regions corresponding to previously positive systematic cores not associated with MRI visible lesions. Gleason grade was compared between initial and subsequent biopsy sessions for all three biopsy modalities: systematic, MRI-targeted, and tracked. RESULTS: Between 2009-2022, 271 patients on AS with ≥1 tracked biopsy sessions were identified. 101/271 (37.3%) had two tracked biopsy sessions and 31/271 (11.4%) had three. The median time from initial to subsequent biopsy session was 19 months (IQR: 13-29). Among 271 patients, there were 83 upgrading events captured by the three modalities on first repeat biopsy (Table 1). On first repeat biopsy, 31/83 (37.3%) upgrading events were identified by tracking, with 11/83 (13.3%) identified only on tracking biopsy. Of the 110 total upgrading events between the three repeat tracked biopsy sessions, 41/110 (37.3%) were captured on tracking, with 16/110 (14.5%) discovered solely by tracking. The median number of biopsy cores for systematic, MRI-targeted, and tracked approaches were 12, 4 (IQR: 2-4), and 2 (IQR: 2-4), respectively. CONCLUSIONS: In this series, a significant portion of upgrading events for patients on AS were uniquely identified on tracked biopsy and would have otherwise been missed on repeat systematic and MRI-targeted biopsy. Notably, given the low number of additional biopsy cores required for tracking, this approach may be an appropriate and low-risk supplement to standard AS protocols. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e527 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Jacob Enders More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Michael Rothberg More articles by this author Michael Daneshvar More articles by this author Lindsey Hazen More articles by this author Charisse Garcia More articles by this author Sheng Xu More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Sandeep Gurram More articles by this author Expand All Advertisement PDF downloadLoading ...