Possibilities for improving the diagnosis of clinically significant prostate cancer based on 3D modeling.

Abstract

e17617 Background: The purpose of the study was improving the accuracy of diagnosis of clinically significant prostate cancer, using 3D models based on multiparametric MRI. Methods: We examined a total of 126 patients using a 12-point transrectal biopsy supplemented with an MRI targeted biopsy. The study included patients with a PSA in plasma of 1-20 ng / ml and symptoms of the lower urinary tract. We used a GE Signa HD 1.5T tomograph and an Advantage workstation. The scanning protocol included DWI, T2-FS, T2, 3D-Cube and a multiphase series with contrast. We evalueted focal changes in the structure of the prostate during MRI, using the PiRads v2.0 system, the results were processed at the GEAW 4.7 workstation, the prostate gland, urethra, seminal vesicles and sections were separated in layers. In the final 3D model, the prostate was labeled transparent, the urethra and seminal vesicles were labeled white. This model was saved and used as a visual three-dimensional image of the volume, size and localization of the foci of the prostate gland. When conducting a standard 12-point biopsy of the prostate under ultrasound control, based on a visual analysis of the 3D model, 2 additional injections were made into each part of the prostate, graded according to the PiRads≥ 3 scale. Results: We compared MRI with the histological results of a 12-point biopsy on the main 3D models of the prostate gland Among 126 patients, changes in MRI using the PiRads v2.0 system had 3 points in 48, PiRads 4 points - 32, PiRads 5 in 46 Among patients with PiRads 3 who underwent a standard 12-point biopsy, supplemented by targeted biopsy based on analysis of 3D models after MRI in 4 (8.3%) revealed clinically significant prostate cancer. Among patients with PiRads 4, clinically significant cancer was found in 11 (34.4%). In patients with PiRads 5, clinically significant cancer was found in 33 (71.7%). Conclusions: A transrectal biopsy of the prostate (using 3D modeling based on MRI with focal marking according to PI-RADS v2.0) allows to effectively identify clinically significant prostate cancer. Performing a transrectal biopsy of the prostate based on 3D modeling is the result of the effective application of an interdisciplinary approach to solving the problem of diagnosing clinically significant prostate cancer.