MR/US Image-Fusion Targeted Biopsy for Diagnosis of Clinically Significant Prostate Cancer

Abstract

Recent reports suggest the multi-parametric magnetic-resonance image (MRI) for prostate have high accuracy to visualize the clinically significant cancer (CSCa). The utility of MR/US image-fusion targeted biopsy (MRUS-TB) has been reported using computer-software assisted elastic image-fusion system (Koelis). The aim of this study is to report our experience of MRUS-TB for diagnosis of prostate cancer. A retrospective review of total 262 consecutive patients with age of 69 y.o. (37-88), and PSA of 7.1ng/ml (4.0-19.8), who had pre-biopsy MRI with suspicious lesion for CSCa and underwent combination of systematic biopsy (SBx) (6 cores) and MRUS-TB (2 cores). Positive rate of any cancer, positive rate of CSCa, Gleason score (GS), and maximum cancer core length (MCCL) were compared between SBx versus MRUS-TB. The CSCa was defined as GS6 cancer with MCCL≧5mm or any cancer with GS≧7. Overall, the positive rate of any cancer per patients was 61% (160/262) in SBx vs. 79% (207/262) in MRUS-TB (p<0.0001); and that of CSCa per patients was 46% (120/262) in SBx vs. 70% (181/262) in MRUS-TB (p<0.0001). Positive rate of any cancer per core was 21.7% (330/1523) in SBx vs. 68.6% (406/592) in MRUS-TB (p<0.0001), and that of CSCa per core was 12.7% (193/1423) in SBx vs. 60.3% (357/592) in MRUS-TB (p<0.0001). Distribution of Gleason score (6/7/8/9/10) was 59/71/23/6/1 in SBx vs. 48/105/36/15/2 (p=0.005). MCCL was 5mm (0.5-16) in SBx vs. 8mm (1-19mm) in MRUS-TB (p<0.0001). MRUS-TB was associated with higher detection rate of CSCa than SBx.