PD23-04 ADDED VALUE OF SYSTEMATIC BIOPSIES IN MEN WITH ABNORMAL MULTIPARAMETRIC MRI UNDERGOING MRI-TRUS FUSION PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2018PD23-04 ADDED VALUE OF SYSTEMATIC BIOPSIES IN MEN WITH ABNORMAL MULTIPARAMETRIC MRI UNDERGOING MRI-TRUS FUSION PROSTATE BIOPSY Yuval Freifeld, Yin Xi, Claus Roehrborn, Franto Francis, Niccolo Passoni, Yair Lotan, Kenneth Goldberg, Brad Hornberger, Vitaly Margulis, Ivan Pedrosa, Ganesh Raj, Jeffrey Cadeddu, and Daniel Costa Yuval FreifeldYuval Freifeld More articles by this author , Yin XiYin Xi More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , Franto FrancisFranto Francis More articles by this author , Niccolo PassoniNiccolo Passoni More articles by this author , Yair LotanYair Lotan More articles by this author , Kenneth GoldbergKenneth Goldberg More articles by this author , Brad HornbergerBrad Hornberger More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Ivan PedrosaIvan Pedrosa More articles by this author , Ganesh RajGanesh Raj More articles by this author , Jeffrey CadedduJeffrey Cadeddu More articles by this author , and Daniel CostaDaniel Costa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1185AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Targeted prostate biopsy (TBx) using MRI-TRUS fusion has emerged as the most common approach for sampling suspicious lesions identified on multiparametric MRI (mpMRI). Concurrent systematic biopsies (SBx) are usually performed as the standard of care. To minimize over-diagnosis of indolent tumors, patient discomfort, duration of the biopsy procedure and, potentially, decrease the risk of bleeding and infection, some groups have advocated for replacing the 12-core scheme with either a targeted only or a targeted plus modified systematic approach. The goal of our study was to determine the incremental diagnostic value of systematic cores obtained from the same (ipsi-SBx) and contralateral (contra-SBx) side for the diagnosis of clinically significant prostate cancer (csPCa) in men with abnormal mpMRI. METHODS Using a prospectively maintained database, we identified all men with abnormal 3T endorectal coil mpMRI examinations (single lesion, PIRADS v2 score ≥3) between Jan/14-Jun/17, without prior treatment, who subsequently had a concurrent systematic and targeted biopsy using a MRI-TRUS fusion system (UroStation, Koelis, or UroNav, DynaCAD). TBx usually consisted of 2 cores from the suspicious area and SBx included the usual 12-core template. csPCa was defined as ISUP grade group 2 (i.e., Gleason 3+4) or greater tumors. Combined TBx and SBx were used as the standard of reference. Sensitivity and 95% confidence intervals for detection of csPCa using TBx only, TBx plus ipsi-SBx and TBx plus contra-SBx were calculated. RESULTS Combined, SBx and TBx detected csPCa in 47% (55/117) of the 117 eligible men. TBx alone, TBx plus ipsi-SBx and TBx plus contra-SBx would have missed csPCa in 6.8% (8/117), 1.7% (2/117) and 3.4% (4/117), respectively. TBx alone, TBx plus ipsi-SBx, TBx plus contra-SBx, and SBx alone would have exclusively diagnosed non-csPCa in 7.7% (9/117), 15.4% (18/117), 13% (15/117), and 12.8% (15/117) of the men, respectively. Of the 36 men who underwent radical prostatectomy (RP), index lesion on whole-mount radical prostatectomy specimen was site-concordant with the MRI lesion in 91.7% (33/36) of the cases. CONCLUSIONS Most of the csPCa missed by TBx seem related to imperfections of the MRI-TRUS image registration and, in most men, may be overcome by obtaining ipsi-SBx. By not performing contra-SBx, the number of cores obtained can be decreased nearly by half, with a potential small number of missed csPCa, decrease in detection of indolent tumors, and improved patient experience. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e481-e482 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Yuval Freifeld More articles by this author Yin Xi More articles by this author Claus Roehrborn More articles by this author Franto Francis More articles by this author Niccolo Passoni More articles by this author Yair Lotan More articles by this author Kenneth Goldberg More articles by this author Brad Hornberger More articles by this author Vitaly Margulis More articles by this author Ivan Pedrosa More articles by this author Ganesh Raj More articles by this author Jeffrey Cadeddu More articles by this author Daniel Costa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...