MP40-05 EFFECTS OF INTRODUCING PRE-BIOPSY MPMRI INTO CONTEMPORARY UK PROSTATE CANCER DETECTION.

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2018MP40-05 EFFECTS OF INTRODUCING PRE-BIOPSY MPMRI INTO CONTEMPORARY UK PROSTATE CANCER DETECTION. Catherine Hobbs, Katie Eyre, Robert McCormick, Fergus Gleeson, Ruth MacPherson, Clare Verrill, Freddie Hamdy, Simon Brewster, and Richard Bryant Catherine HobbsCatherine Hobbs More articles by this author , Katie EyreKatie Eyre More articles by this author , Robert McCormickRobert McCormick More articles by this author , Fergus GleesonFergus Gleeson More articles by this author , Ruth MacPhersonRuth MacPherson More articles by this author , Clare VerrillClare Verrill More articles by this author , Freddie HamdyFreddie Hamdy More articles by this author , Simon BrewsterSimon Brewster More articles by this author , and Richard BryantRichard Bryant More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1272AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pre-biopsy multiparametric magnetic resonance imaging (PB-mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS) has become an adjunct to prostate cancer (PCa) diagnosis, and was incorporated into our PCa diagnostic pathway in July 2016. Interrogating our PCa series, we hypothesized that PB-mpMRI increases the diagnostic yield of transrectal prostate biopsy (TRPB), and may allow us to discontinue recommending systematic TRPB to men with a ″negative″ MRI. METHODS 997 patients underwent TRPB without PB-mpMRI in 18 months to June 2016 (cohort A), and 792 patients underwent TRPB following PB-mpMRI during the 12 months from July 2016 (cohort B), all patients being previously biopsy-naive. Patients with PB-mpMRI lesions (PI-RADS 3-5) underwent cognitive targeted plus systematic TRPB, whilst patients without targetable lesions underwent systematic TRPB. We investigated the impact of introducing PB-mpMRI on the diagnostic yield of TRPB. RESULTS Cohort B comprised younger (median 68 v 69 years, p=0.001) men with a lower PSA (median 7.6 v 7.9 ng/mL, p=0.032) and prostate volume (median 56.7 v 62 cc, p=0.006) compared with cohort A. No difference was seen in family history, finasteride use, or PSA-density (p>0.05 for each). We observed increased detection of multi-focal prostatic intraepithelial neoplasia ± atypical small acinar proliferation (p=0.018) and increased maximum PCa core length (≥5mm versus <5mm, p=0.041) in Cohort B, but no difference in overall PCa detection (57.6 v 56.7%), Gleason Grade (GG), or number of positive cores (p>0.05 for each), compared with cohort A. We also observed a significant shift towards PCa radical intervention (surgery and/or radiotherapy) for Cohort B (p<0.001). A significant correlation was observed between the PI-RADS score and overall biopsy result (R=0.612, p<0.001) and GG (R=0.569, p<0.001). 49.9% of PB-mpMRIs revealed PI-RADS 4/5 lesions (% Sensitivity, Specificity, PPV and NPV for GG Group 2-5 PCa 79.6, 78.5, 78.1 and 80.1 respectively for PI-RADs 4/5 lesions). The % sensitivity, specificity, PPV and NPV of combined PI-RADs 1/2 lesions for GG Group 2-5 PCa was 88.1, 59.8, 67.8 and 84 respectively. CONCLUSIONS 1) Introducing PB-mpMRI into our contemporary PCa detection pathway increased the diagnostic yield of TRPB by increasing the maximum cancer length per biopsy core. This may explain the observed shift towards more radical treatment interventions for PCa.2) A ″negative″ MRI scan (PI-RADS 1/2) missed GG group 2 or higher PCa detected by systematic TRPB in 16% of cases (i.e. approximately 1 in 6 cases), highlighting the need to recommend both investigations for men referred with suspected PCa. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e521 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Catherine Hobbs More articles by this author Katie Eyre More articles by this author Robert McCormick More articles by this author Fergus Gleeson More articles by this author Ruth MacPherson More articles by this author Clare Verrill More articles by this author Freddie Hamdy More articles by this author Simon Brewster More articles by this author Richard Bryant More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...