MP42-02 POTENTIAL OF ADDITIONAL MAGNETIC RESONANCE IMAGING (MRI)-TARGETED PROSTATE BIOPSY TO AVOID UNDERESTIMATION OF SYSTEMATIC 14-CORE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2014MP42-02 POTENTIAL OF ADDITIONAL MAGNETIC RESONANCE IMAGING (MRI)-TARGETED PROSTATE BIOPSY TO AVOID UNDERESTIMATION OF SYSTEMATIC 14-CORE BIOPSY Noboru Numao, Yoh Matsuoka, Masaya Ito, Soichiro Yoshida, Yudai Ishikawa, Yusuke Uchida, Masahiro Toide, Saori Higuchi, Takayuki Nakayama, Masaharu Inoue, Hideki Takeshita, Toshiki Kijima, Yasukazu Nakanishi, Junichiro Ishioka, Kazutaka Saito, Yasuhisa Fujii, and Kazunori Kihara Noboru NumaoNoboru Numao More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Masaya ItoMasaya Ito More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Yudai IshikawaYudai Ishikawa More articles by this author , Yusuke UchidaYusuke Uchida More articles by this author , Masahiro ToideMasahiro Toide More articles by this author , Saori HiguchiSaori Higuchi More articles by this author , Takayuki NakayamaTakayuki Nakayama More articles by this author , Masaharu InoueMasaharu Inoue More articles by this author , Hideki TakeshitaHideki Takeshita More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Yasukazu NakanishiYasukazu Nakanishi More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1179AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Even extended biopsy that includes anterior samplings, which meets biopsy criteria for selecting candidates for active surveillance, is reported to be associated with significant underestimation. Since 2011, we have performed MRI-targeted biopsy (MRBx) in addition to transrectal ultrasound (TRUS)-guided systematic 14-core biopsy with anterior samplings (S14Bx). We aimed to use the data to evaluate the potential of additional MRBx to avoid underestimation of S14Bx. Methods Between September 2011 and July 2013, we prospectively evaluated 216 consecutive men with cancerous lesions on prebiopsy 1.5T MRI and clinical stage T1-2 based on digital rectal examination. MRI protocol included T2-weighted, diffusion-weighted, and/or dynamic contrast-enhanced imaging. Biopsy protocol was a combination of MRBx and S14Bx. MRBx was performed using the free-hand technique or the MRI-TRUS fusion system. Four-core samplings for each suspected lesion on MRI were performed. Detected cancer was categorized into very low, low, intermediate, and high risk (NCCN criteria) based on information obtained by S14Bx only and by S14Bx plus MRBx. Very low risk criteria was modified to fit this study and was defined as prostate-specific antigen (PSA) < 10 ng/ml, clinical stage T1c, biopsy Gleason score of 3+3 or less, and maximum cancer length < 5 mm. We evaluated characteristics of cancers that were missed by S14Bx but detected by MRBx. We also analyzed risk category change by additional MRBx in cancers detected by both S14Bx and MRBx. Results The median PSA was 8.3 ng/ml. The number of suspected lesions on MRI was one/two/three in 192/23/1 cases, respectively. The mean number of sampling cores in MRBX was 4.5. The cancer detection rate of S14Bx plus MRBx was 72% (155/216). Based on the S14Bx plus MRBx information, the number of cancers in the very low-/low-/intermediate-/high-risk category was 11/10/77/57, respectively. S14Bx detected 143 cancers and missed 12 cancers. S14Bx-missed cancers included 2/2/6/2 in the very low-/low-/intermediate-/high-risk categories, respectively. Of the 143 S14Bx-detected cancers, the risk categories in 22 cancers changed to higher risk. Conclusions Additional MRBx avoided underestimation of S14Bx in 15% (32/216) of the overall cohort, including 10 additional cancer detections except for very low-risk cancer and 22 risk category changes to higher risk. These results suggest that additional MRBx has high potential to avoid underestimation of systematic biopsy. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e468 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Noboru Numao More articles by this author Yoh Matsuoka More articles by this author Masaya Ito More articles by this author Soichiro Yoshida More articles by this author Yudai Ishikawa More articles by this author Yusuke Uchida More articles by this author Masahiro Toide More articles by this author Saori Higuchi More articles by this author Takayuki Nakayama More articles by this author Masaharu Inoue More articles by this author Hideki Takeshita More articles by this author Toshiki Kijima More articles by this author Yasukazu Nakanishi More articles by this author Junichiro Ishioka More articles by this author Kazutaka Saito More articles by this author Yasuhisa Fujii More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...