MP77-18 OUTCOMES OF MRI-US FUSION TARGETED PROSTATE BIOPSY IN MEN WITH HISTORY OF PROSTATIC INTRAEPITHELIAL NEOPLASIA AND/OR ATYPICAL SMALL ACINAR PROLIFERATION: EVIDENCE FOR AN ALTERATION OF CURRENT PRACTICE.

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening VI1 Apr 2015MP77-18 OUTCOMES OF MRI-US FUSION TARGETED PROSTATE BIOPSY IN MEN WITH HISTORY OF PROSTATIC INTRAEPITHELIAL NEOPLASIA AND/OR ATYPICAL SMALL ACINAR PROLIFERATION: EVIDENCE FOR AN ALTERATION OF CURRENT PRACTICE. Neil Mendhiratta, Andrew B. Rosenkrantz, Xiaosong Meng, Michael Fenstermaker, Richard Huang, James S. Wysock, Fang-Ming Deng, Ming Zhou, William C. Huang, Herbert Lepor, and Samir S. Taneja Neil MendhirattaNeil Mendhiratta More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz More articles by this author , Xiaosong MengXiaosong Meng More articles by this author , Michael FenstermakerMichael Fenstermaker More articles by this author , Richard HuangRichard Huang More articles by this author , James S. WysockJames S. Wysock More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , Ming ZhouMing Zhou More articles by this author , William C. HuangWilliam C. Huang More articles by this author , Herbert LeporHerbert Lepor More articles by this author , and Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.558AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES On contemporary prostate biopsy, high grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) are common findings which often prompt repeat biopsy. We investigated the detection of prostate cancer (PCa) in men with a history of HGPIN, ASAP, or both (HGPIN/ASAP) who underwent combined MRI-ultrasound fusion targeted (MRF-TB) and 12-core systematic prostate biopsy (SB). METHODS From an IRB-approved database of patients undergoing MRF-TB, we queried clinical data including MRI suspicion score (mSS) and biopsy results from all men with a history of negative systematic biopsy who underwent MRF-TB and SB using the Artemis/Pro-fuseTM (Eigen, Grass Valley) system between 6/12 and 8/14 to identify those with history of HGPIN or ASAP. Maximum Gleason scores (GS) detected per patient were compared by McNemar's test. RESULTS Of 173 men with a history of previous negative biopsy, 27 (16%), 11 (6%), and 16 (9%) men had histories of HGPIN alone, ASAP alone, and HGPIN/ASAP, for a total of 54 men meeting inclusion criteria (mean age 64±7.6 years; mean PSA 7.3, SEM 1.1 ng/mL). mSS of 2-5 were found in 20 (37%), 17 (32%), 11 (20%), and 6 (11%) men, respectively. Overall 16/54 men (30%) were found to have PCa. Cancer detection rates of MRF-TB and SB were 22% and 13%, respectively (p = 0.39). MRF-TB detected more GS≥7 cancers than SB (p = 0.02, Table 1). 7/9 (78%) GS≥7 cancers and 4/4 (100%) dominant Gleason grade (dGG) ≥4 cancers were detected in men with mSS≥4 lesions, making the negative predictive value of mSS < 4 for GS≥7 and dGG ≥4 cancer 95% and 100%, respectively. In multivariate analysis of the 173 men with prior negative biopsies, mSS, but not HGPIN, ASAP, or HGPIN/ASAP, was an independent predictor of PCa (p < 0.001, p = 0.69, p = 0.09, p = 0.12, respectively). CONCLUSIONS Pre-biopsy MRI results should be considered prior to empiric repeat biopsy in men with history of HGPIN and/or ASAP. Adequate detection of clinically significant cancers with fewer biopsy cores may be achieved in men with mSS≥4 lesions using MRF-TB only, while men with mSS≤4 lesions may not benefit from repeat biopsy despite a history of HGPIN or ASAP. A history of HGPIN and/or ASAP does not confer a higher risk of PCa independently of mSS. Table 1. Cancer Detection Rates: HGPIN/ASAP (n= 54) Targeted biopsy CDR n(%) Gleason ≥ 7 Gleason 6 Negative Total Gleason ≥ 7 1 (2%) 1 (2%) 0 (0%) 2 (4%)† Systematic biopsy CDR n(%) Gleason 6 0 (0%) 1 (2%) 4 (7%) 5 (9%) Negative 7 (13%) 2 (4%) 38 (70%) 47 (87%) Total 8 (15%)† 4 (7%) 42 (78%) 54 (100%) † p < 0.05, McNemar's Test, SB vs MRF-TB for Gleason ≥ 7 PCa © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1000 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neil Mendhiratta More articles by this author Andrew B. Rosenkrantz More articles by this author Xiaosong Meng More articles by this author Michael Fenstermaker More articles by this author Richard Huang More articles by this author James S. Wysock More articles by this author Fang-Ming Deng More articles by this author Ming Zhou More articles by this author William C. Huang More articles by this author Herbert Lepor More articles by this author Samir S. Taneja More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...