MP67-04 MULTIPARAMETRIC MRI CAN IMPROVE THE DETECTION RATE OF PROSTATE CANCER AND UPGRADE THE GLEASON SCORE AT REPEATED BIOPSY

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You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2014MP67-04 MULTIPARAMETRIC MRI CAN IMPROVE THE DETECTION RATE OF PROSTATE CANCER AND UPGRADE THE GLEASON SCORE AT REPEATED BIOPSY Lars Boesen, Nis Nørgaard, Elizaveta Chabanova, Vibeke Løgager, Ingegerd Balslev, Kari Mikines, and Henrik Thomsen Lars BoesenLars Boesen More articles by this author , Nis NørgaardNis Nørgaard More articles by this author , Elizaveta ChabanovaElizaveta Chabanova More articles by this author , Vibeke LøgagerVibeke Løgager More articles by this author , Ingegerd BalslevIngegerd Balslev More articles by this author , Kari MikinesKari Mikines More articles by this author , and Henrik ThomsenHenrik Thomsen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2071AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (PCa) is traditionally diagnosed by histological examination of 10-12 transrectal ultrasound guided biopsies (TRUS-bx) from standard zones in the prostate. TRUS-bx has limited sensitivity and specificity in PCa detection and repeated biopsy (re-biopsy)-strategies are therefore often necessary in patients with persistent suspicion of PCa after negative TRUS-bx due to the high false-negative rates. In addition, there is also a risk that the most pathological aggressive part of the tumour can be missed at TRUS-bx leading to an incorrect Gleason score and diagnosis. Scientific work support the growing use of multiparametric MRI (mp-MRI) as the most sensitive and specific imaging tool for detection of PCa where mp-MRI suspicious lesions can be targeted by biopsies towards the most aggressive part. METHODS Patients scheduled for repeated biopsies due to persistent suspicion of PCa after standard TRUS-bx with negative findings were prospectively enrolled. Mp-MRI (T2W-, DWI- and DCE-imaging) was performed prior to re-biopsy. All identified lesions were scored by the ESUR guidelines, classified overall on a five-point scale according to the probability of clinically significant malignancy to be present and divided into 3 groups – low, moderate and high suspicion of PCa. All patients underwent systematic TRUS-bx (10 cores) and visual mp-MRI-targeted biopsies (mp-MRI-bx) under TRUS-guidance of any mp-MRI-suspicious lesion not hit on systematic TRUS-bx. RESULTS 83 patients with median 2(1-5) prior negative TRUS-Bx and median PSA 11(2-97) underwent mp-MRI before re-biopsy. PCa was found in 39/83 (47%) patients. Mp-MRI identified at least one PCa positive lesion in all 39 patients with median 2 (0-5) identified lesions per patient. Biopsies positive for PCa correlated to suspicion of malignancy and Gleason score are shown in Table 1. 5 patients (13%) had cancer detected only on mp-MRI-bx (p=0.025) and another 7 patients (21%) had an overall Gleason score upgrade (p=0.037) based on the mp-MRI-bx. 37/39 cancer patients were classified as clinically significant according to the Epstein criteria (2004). CONCLUSIONS Multiparametric MRI can improve the detection rate of clinically significant prostate cancer at repeated biopsy and allows for a more accurate Gleason grading. Table 1: Biopsy results correlated to mp-MRI suspicion of malignancy and the relation to Gleason score MRI suspicion Positive biopsy Negative biopsy Lesions(n) Gleason score 6(3+3) Gleason score 7(3+4) Gleason score 7(4+3) Gleason score 8-10 High 43(77%) 13(23%) 56 10 14 7 12 Moderate 8(15%) 44(85%) 52 4 4 Low 1(2%) 47(98%) 48 1 Total 52 104 156 15 18 7 12 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e749-e750 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lars Boesen More articles by this author Nis Nørgaard More articles by this author Elizaveta Chabanova More articles by this author Vibeke Løgager More articles by this author Ingegerd Balslev More articles by this author Kari Mikines More articles by this author Henrik Thomsen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...