PD44-12 FEASIBILITY AND INITIAL RESULTS OF 18 FLUOROCHOLINE PET/MRI/TRUS FUSION PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 2015PD44-12 FEASIBILITY AND INITIAL RESULTS OF 18FLUOROCHOLINE PET/MRI/TRUS FUSION PROSTATE BIOPSY Jeffrey Montgomery, Matthew Davenport, Lakshmi Kunju, Charles Meyer, Ganesh Palapattu, Todd Morgan, Alon Weizer, David Miller, Brent Hollenbeck, and Morand Piert Jeffrey MontgomeryJeffrey Montgomery More articles by this author , Matthew DavenportMatthew Davenport More articles by this author , Lakshmi KunjuLakshmi Kunju More articles by this author , Charles MeyerCharles Meyer More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , Todd MorganTodd Morgan More articles by this author , Alon WeizerAlon Weizer More articles by this author , David MillerDavid Miller More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , and Morand PiertMorand Piert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2558AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI)/trans-rectal ultrasound (TRUS) fusion prostate biopsy is an emerging technique for the diagnosis of prostate cancer. The addition of 18Fluorocholine positron emission tomography (PET) to multi-sequence MRI may further improve the detection of clinically significant primary prostate cancer, aiding accurate diagnosis. METHODS With IRB approval, PET and multi-sequence 3 Tesla MRI (including diffusion-weighted and contrast-enhanced sequences) were obtained in men referred for prostate biopsy. Targets for biopsy were selected based on visual appearance on both modalities. PET and T2-weighted (T2W) MRI volumes of the prostate were spatially registered using mutual information software. All targets, whether identified on MRI alone, PET and MRI or PET alone, were embedded into a 3-dimensional T2W MRI volume and loaded into an ultrasound system (GE Logiq E9) allowing for rigid registration of real-time TRUS with MRI using a magnetic navigation system. Targeted in addition to standard 12-core template biopsies were obtained in all patients. Histologic evaluation of all cores was performed. RESULTS At the time of this interim analysis, a total of 32 men with a mean age of 64 (range 56-77) with suspected (n=20) or previously identified (n=12) prostate cancer were included. The median PSA was 8.6 ng/ml (range 3.6-153). Targeted biopsies revealed significantly more (n=12) sites of intermediate and high risk disease (Gleason ≥3+4) than template biopsies (n=5; p < 0.01). The number of sites of low risk disease (Gleason 3+3) identified was significantly reduced for targeted biopsies (n=1) vs template biopsies (n=13; p < 0.01). One successfully targeted Gleason 4+3 cancer was identified on PET only. If targeting was judged as ‘excellent’ at the time of biopsy (41 of 62 targeted cores from 12 lesions), Gleason ≥3+4 prostate cancer was found in 85% of cores. Of the cores that identified Gleason ≥3+4 disease, the average core percent occupied by disease was 76% (range 40-100%) for targeted vs 33% (range 5-85%) for template biopsies. CONCLUSIONS Fusion PET/MRI/TRUS image registration and accurate targeted biopsy are feasible and enhance the detection of clinically significant prostate cancer (Gleason ≥3+4) missed with standard template biopsy. Since most low-grade disease (Gleason 3+3) escapes detection on PET and MRI, image-guided prostate biopsy tends to avoid the detection of low-risk disease. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e901-e902 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Montgomery More articles by this author Matthew Davenport More articles by this author Lakshmi Kunju More articles by this author Charles Meyer More articles by this author Ganesh Palapattu More articles by this author Todd Morgan More articles by this author Alon Weizer More articles by this author David Miller More articles by this author Brent Hollenbeck More articles by this author Morand Piert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...