MP53-09 TRANSITIONAL ZONE AND ANTERIOR ZONE PROSTATE CANCER– DETECTION USING MULTIPARAMETRIC MR-IMAGING AND FUSION-GUIDED TRANSPERINEAL BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-09 TRANSITIONAL ZONE AND ANTERIOR ZONE PROSTATE CANCER– DETECTION USING MULTIPARAMETRIC MR-IMAGING AND FUSION-GUIDED TRANSPERINEAL BIOPSY Jan Philipp Radtke, Silvan Boxler, Yesilda Belavarca, Timur Hasan Kuru, Matthias Röthke, Heinz-Peter Schlemmer, Markus Hohenfellner, and Boris Hadaschik Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Yesilda BelavarcaYesilda Belavarca More articles by this author , Timur Hasan KuruTimur Hasan Kuru More articles by this author , Matthias RöthkeMatthias Röthke More articles by this author , Heinz-Peter SchlemmerHeinz-Peter Schlemmer More articles by this author , Markus HohenfellnerMarkus Hohenfellner More articles by this author , and Boris HadaschikBoris Hadaschik More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1640AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives To evaluate the incidence of anterior zone (AZ) and transitional zone (TZ) prostate cancer (PCA) in MRI-navigated, TRUS-fusion-guided perineal biopsies and to determine the detection accuracy of multiparametric (mp) 3T MRI and PI-RADS scoring. Methods In 200 consecutive patients undergoing stereotactic biopsy from june 2010 to december 2011, 62 patients had biopsy proven AZ and TZ PCA and were retrospectively analyzed. Every patient underwent mp 3T MRI before biopsy, which was scored according to PI-RADS. In addition to targeted cores, systematic transperineal biopsies were taken as gold standard (median 24 cores). Cancerous lesions were stratified to that prostate zone, where the main volume of the index lesion was localized. Statistical analysis was performed using Fisher's test. Results 20 out of 62 patients had PCA ventral to the urethra in the AZ (median PSA-level 12.01 ng/ml), and 42 out of 62 were positive predominantly in the TZ (median PSA-level 11.78 ng/ml). Overall, incidence was 10% in the AZ and 21% in the TZ. Gleason-score (GS) of AZ PCA was 6, 7a, and 7b in 30%, 50%, and 20%, respectively. In TZ PCA, GS was 6, 7a, 7b, 8, and 9 in 31%, 43%, 19%, 2%, and 5%, respectively. Coincidental small cancer lesions in the peripheral zone (PZ) were GS 6 in 39%, 7a in 48%, 7b in 10 % and 9 in 3 %. Accuracy, sensitivity, specificity, PPV and NPV of PI-RADS Likert scores ≥3 for AZ cancers was 79%, 60%, 88%, 71% and 82%. For TZ cancers, it was 63%, 59%, 75%, 87% and 73%, and for coincidental cancers in the PZ it was 74%, 67%, 77%, 75% and 73%, respectively. Distribution of Gleason grades 4 and 5 showed no significant difference between TZ and PZ (p = 0.231), but were significantly lower in AZ (p < 0.05). The correlation of high Gleason grades (4,5) to high PI-RADS scores (3-5) was significant for AZ (p = 0.006), TZ (p = 0.003) and PZ (p = 0.009). Conclusions 31% of PCA index lesions were detected outside the PZ. As expected, PCA was more frequent in the TZ than in the AZ. In our cohort, accuracy of mp MRI was highest in the AZ. GS distribution was not statistically significant different between PZ and TZ, but high gleason patterns were more frequent in both as compared to the AZ. A cancer suspicious PI-RADS score correlated significantly with the appearance of gleason patterns 4 and 5 in all prostate zones. The combination of mp MRI and fusion-guided transperineal biopsy shows promising results in PCAs of the TZ and AZ. However, targeted biopsy alone cannot be recommended since the NPV of MRI as compared to systematic transperineal saturation biopsy is still not optimal. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e592 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jan Philipp Radtke More articles by this author Silvan Boxler More articles by this author Yesilda Belavarca More articles by this author Timur Hasan Kuru More articles by this author Matthias Röthke More articles by this author Heinz-Peter Schlemmer More articles by this author Markus Hohenfellner More articles by this author Boris Hadaschik More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...