MP48-20 WEIGHTED GLEASON SCORES DO NOT OUTPERFORM STANDARD CLINICAL GLEASON SCORES IN PREDICTING PATHOLOGIC GLEASON SCORE, MARGIN STATUS AND RECURRENCE IN PATIENTS WITH DISCORDANT PROSTATE BIOPSIES

Abstract

purpose was to evaluate the performance of cognitive target MRI-TRUS fusion biopsies of MRI detected PI-RADS (Prostate Imaging Reporting and Data System) 4 and 5 lesions. The correlation between the apparent diffusion coefficient (ADC) and Gleason outcome was also studied. METHODS: 52 consecutive patients in the period from 12/ 2013-06/2014 with increased PSA and PI-RADS 4 or 5 lesions on MRI (3T Siemens-skyra, protocol and reporting according to ESUR guidelines) were included. All patients underwent target biopsies using TRUS (B&K, Falcon 2101) which were performed by the same urologist and radiologist with MRI images and structured report available. In patients with a negative biopsy, MRI-guided biopsy was advised. A bi-variate pearson correlation was performed for ADC and Gleason outcome in positive cases. RESULTS: A total of 52 patients were included (16 PIRADS 4 and 36 PIRADS 5 lesions). Mean PSA and PSA-density value was respectively 9,88 (SD 6,1) and 0.20 (SD 0.11). Mean lesion size was 13.95 mm (SD 6.26 mm). 9 PIRADS 4 lesions (56%) and 26 PIRADS 5 lesions (72%) were found positive for prostate cancer. The correlation between the ADC value and histology outcome is showed in figure 1. Overall 67% of the biopsies were positive for prostate cancer using cognitive target MRI-TRUS fusion biopsies. The additional MRI-guidedbiopsies that were performed from the negative cases proved in 50% to be malignant (0/2 for PI-RADS 4 and 3/4 for PI-RADS 5 lesions). A significant correlation between ADC and Gleason value was found (-0.363 P<0.01) CONCLUSIONS: Cognitive target MRI-TRUS fusion biopsies are an effective first step in the evaluation of PIRADS 4 and 5 MRI detected lesions. Additional MRI-Guided-Biopsies of negative results for at least PIRADS 5 lesions are mandatory.