PD54-06 THE IMPACT OF MULTIPARAMETRIC ULTRASOUND IN THE DETECTION OF GLEASON 7 OR GREATER CANCER DURING MRI FUSION BIOPSY

Abstract

INTRODUCTION AND OBJECTIVE: Transrectal Ultrasound Guided biopsy (TRUS BX) is standard of care for prostate cancer (CAP) diagnosis. MRI fusion biopsy (MRIF) is now recommended to improve identification of CAP. We hypothesize that TRUS BX has significant benefit in CAP diagnosis in patients undergoing MRIF. METHODS: We reviewed our prospectively maintained, IRB approved, database to evaluate the impact of US abnormalities on MRIF BX outcomes. MRIF biopsy was performed by one Urologist (CP) using multiparameteric mpMRI (endorectal coil,1.5T) read by 2 radiologist specializing in prostate MRI. MRI positivity (pos) was defined as PIRADS 3 or greater. Multiparametric Ultrasound (mpUS) positivity was defined as the presence of calcifications, and/or significant hypoechoic areas, power Doppler or color Doppler. Correlation was identified when lesion location and positive biopsy (any histology) were in the same sextant. RESULTS: Table 1 illustrates the demographics in 82 consecutive men undergoing BX. No statistical difference in age or PSA was noted between groups (p>0.1). 38 men (46%) had CAP. Multiparametric US was positive in 15/52 (29%) of men with CAP, and 11/15 (73%) had >/= Gleason (GL) 7. In men with mpMRI PIRADS >/= 3 CAP was detected in 24/68 (35%) and 15/24 (62%) had >/= Gl 7. Ultrasound targeted biopsies alone would have missed cancer in 23/38 (60%) patients and Gleason 7 or greater would have been missed in 11/22 (50%). MRI targeted biopsies alone would have missed cancer in 14/38 (37%) patients and Gleason 7 or greater in 7/22 (32%). In men with both positive mpUS and positive mpMRI CAP would have been missed in 10/38 (26%) and Gleason >/= 7 disease 5/22 (23%). MRI had a sensitivity and specificity for CAP in our cohort of 85% and 18% respectively. For Gleason >/= 7 lesions MRI had a sensitivity and specificity of 68% and 20% respectively. Ultrasound had a sensitivity and specificity of 53% and 31% for CAP and for Gleason >/= 7 disease 52% and 42% respectively. CONCLUSIONS: Our analysis in an experienced center indicates that both mpMRI and mpUS are important in the site specific detection of Gleason Grade >/= 7 disease. These findings will require corroboration in other centers. Given our findings regarding the importance of mpUS, we believe both mpUS and mpMRI should be used during MRIFBX to improve the diagnosis of GL >/=7 CAP.Source of Funding: None