PD38-05 MAGNETIC RESONANCE IMAGING/ULTRASOUND FUSION-GUIDED BIOPSY DETECTS CLINICALLY SIGNIFICANT PROSTATE CANCER IN THE CENTRAL GLAND CORRELATING WITH INDEX LESION

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 2015PD38-05 MAGNETIC RESONANCE IMAGING/ULTRASOUND FUSION-GUIDED BIOPSY DETECTS CLINICALLY SIGNIFICANT PROSTATE CANCER IN THE CENTRAL GLAND CORRELATING WITH INDEX LESION Michele Fascelli, Thomas Frye, Arvin George, Steven Abboud, Raju Chelluri, Richard Ho, Annerleim Walton Diaz, Sandeep Sankineni, Maria Merino, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto Michele FascelliMichele Fascelli More articles by this author , Thomas FryeThomas Frye More articles by this author , Arvin GeorgeArvin George More articles by this author , Steven AbboudSteven Abboud More articles by this author , Raju ChelluriRaju Chelluri More articles by this author , Richard HoRichard Ho More articles by this author , Annerleim Walton DiazAnnerleim Walton Diaz More articles by this author , Sandeep SankineniSandeep Sankineni More articles by this author , Maria MerinoMaria Merino More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter ChoykePeter Choyke More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2426AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Central gland (CG) prostatic adenocarcinomas (CaP) are historically reported with lesser incidence, smaller tumor volume, and higher Gleason scores when compared to the peripheral zone (PZ). Additionally, index tumor lesions as defined by highest grade may be missed when residing in the CG. MRI/US fusion-guided biopsy allows targeting of lesions seen on MRI, potentially better identifying cancer outside the traditional TRUS biopsy template. METHODS Retrospective review was performed of 1003 patients who underwent MR/US fusion-guided biopsy of 2119 suspicious lesions. Targets were stratified by zonal distribution of the lesion on multiparametric MRI (mpMRI) in the CG or PZ. Detection rates for Gleason ≥4+3 cancers were tabulated by location and correlated with PSA, Gleason score, prostate volume and MRI suspicion. RESULTS MR/US fusion-guided biopsy targeted lesions in the central (n=711, 34%) or peripheral (n=1408, 66%) prostatic zones. Cancer detection rate was similar between zonal distributions, 35.2% in the CG compared to 33.6% in the PZ (p=0.497) (Table 1). Cancer detection of clinically significant disease (Gleason ≥4+3) was found to be similar in the CG and PZ (11.4% vs 11%, p=0.128) despite a higher prostate volume in those with CG lesions (p= 0.004). In contrast to random 12-core TRUS biopsy, upgrading occurred in 18.5% of patients with CG lesions versus 13.3% for PZ targets (p=0.024). When MRI detected suspicious lesions in the CG, 36.6% (77/210) of these represented the highest risk lesion. These CG index lesions translated to 13% (77/592) of the entire cohort of men with biopsy-proven CaP. CONCLUSIONS Prostate cancer of the central gland occurs at a similar frequency than in peripheral zone. Targeted lesions of the CG were more likely to be upgraded from 12-core biopsy, frequently representing the index lesion as determined by Gleason grade. In all patients upgraded by a CG lesion, CG targeted cores constituted the highest Gleason grade index lesion in a third of all males with prostate cancer. Multiparametric MRI and fusion-guided biopsy aids in identifying clinically significant disease of the CG not captured on traditional TRUS biopsy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e826 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michele Fascelli More articles by this author Thomas Frye More articles by this author Arvin George More articles by this author Steven Abboud More articles by this author Raju Chelluri More articles by this author Richard Ho More articles by this author Annerleim Walton Diaz More articles by this author Sandeep Sankineni More articles by this author Maria Merino More articles by this author Baris Turkbey More articles by this author Peter Choyke More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...