MP83-02 COMBINATION OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING (MP-MRI) AND TRANSPERINEAL TEMPLATE-GUIDED MAPPING BIOPSY (TTMB) OF THE PROSTATE TO IDENTIFY CANDIDATES FOR HEMI-ABLATIVE FOCAL THERAPY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 2015MP83-02 COMBINATION OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING (MP-MRI) AND TRANSPERINEAL TEMPLATE-GUIDED MAPPING BIOPSY (TTMB) OF THE PROSTATE TO IDENTIFY CANDIDATES FOR HEMI-ABLATIVE FOCAL THERAPY Minh Tran, James Thompson, Maret Boehm, Marley Pulbrook, Daniel Moses, Ron Shnier, Phillip Brenner, Warick Delprado, Anne-Maree Haynes, Richard Savdie, and Phillip Stricker Minh TranMinh Tran More articles by this author , James ThompsonJames Thompson More articles by this author , Maret BoehmMaret Boehm More articles by this author , Marley PulbrookMarley Pulbrook More articles by this author , Daniel MosesDaniel Moses More articles by this author , Ron ShnierRon Shnier More articles by this author , Phillip BrennerPhillip Brenner More articles by this author , Warick DelpradoWarick Delprado More articles by this author , Anne-Maree HaynesAnne-Maree Haynes More articles by this author , Richard SavdieRichard Savdie More articles by this author , and Phillip StrickerPhillip Stricker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Focal therapy (FT) is an emerging treatment option for patients with localized prostate cancer (PCa) aiming to reduce the morbidity of whole-gland therapy. Successful patient selection requires accurate identification and localization of clinically significant lesions within the prostate. Transperineal mapping biopsy (TTMB) is considered the gold standard diagnostic tool to identify candidates for FT. Multi-parametric magnetic resonance imaging (mp-MRI) has recently been shown to have a high NPV in detecting clinically significant PCa. We evaluated the accuracy of combined mp-MRI and TTMB for identifying lobes with significant cancer for application of hemi-ablative FT. METHODS From January 2012–January 2014, 89 consecutive patients aged ≥40 with PSA ≤15 underwent in sequential order: mp-MRI, TTMB and radical prostatectomy (RP) at a single centre. Analysis was performed on 50 patients that met consensus guidelines for FT (clinical stage ≤T2a, Gleason ≤3+4 and no evidence of extracapsular extension or seminal vesicle invasion on mp-MRI or TTMB). Lobes were stratified into lobes with significant cancer (LSC), insignificant cancer (LIC) and no cancer (LNC). Using histopathology at RP, the predictive performance of combined mp-MRI and TTMB in identifying LSC was evaluated. RESULTS The sensitivity, specificity and PPV for combined mp-MRI+TTMB for LSC was 97%, 64% and 84% respectively. Due to the risk of undertreating significant lesions, NPV was considered the primary parameter of interest. The NPV for combined mp-MRI+TTMB for LSC was 91%. Of the 50 patients, 22 had significant unilateral disease on mp-MRI+TTMB and were thus potential candidates for hemi-ablative FT. Two (91%) of the 22 patients had a significant lesion crossing the sagittal midline with contralateral extension of 4mm and 6mm respectively. One of these two patients additionally had a separate small but moderate risk lesion (<0.1cc Gleason 3+4 with 10% Gleason pattern 4) undetected by mp-MRI+TTMB. CONCLUSIONS In candidates for focal therapy based on consensus guidelines, mp-MRI reported by expert radiologists and TTMB provide an excellent negative predictive value in the application for hemi-ablative focal therapy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1050 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Minh Tran More articles by this author James Thompson More articles by this author Maret Boehm More articles by this author Marley Pulbrook More articles by this author Daniel Moses More articles by this author Ron Shnier More articles by this author Phillip Brenner More articles by this author Warick Delprado More articles by this author Anne-Maree Haynes More articles by this author Richard Savdie More articles by this author Phillip Stricker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...