You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2016PD08-10 FURTHER REDUCTION OF DISQUALIFICATION RATES BY ADDITIONAL MRI-TARGETED BIOPSY WITH TRANSPERINEAL SATURATION BIOPSY COMPARED TO STANDARD 12-CORE SYSTEMATIC BIOPSIES FOR SELECTION OF PROSTATE CANCER PATIENTS FOR ACTIVE SURVEILLANCE. Jan Philipp Radtke, Timur Hasan Kuru, David Bonekamp, Martin Freitag, Claudia Verena Kesch, Maya Wolf, Celine Alt, Gencay Hatiboglu, Silvan Boxler, Sascha Pahernik, Wilfried Roth, Matthias Claudius Roethke, Heinz-Peter Schlemmer, Markus Hohenfellner, and Boris Hadaschik Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Timur Hasan KuruTimur Hasan Kuru More articles by this author , David BonekampDavid Bonekamp More articles by this author , Martin FreitagMartin Freitag More articles by this author , Claudia Verena KeschClaudia Verena Kesch More articles by this author , Maya WolfMaya Wolf More articles by this author , Celine AltCeline Alt More articles by this author , Gencay HatibogluGencay Hatiboglu More articles by this author , Silvan BoxlerSilvan Boxler More articles by this author , Sascha PahernikSascha Pahernik More articles by this author , Wilfried RothWilfried Roth More articles by this author , Matthias Claudius RoethkeMatthias Claudius Roethke More articles by this author , Heinz-Peter SchlemmerHeinz-Peter Schlemmer More articles by this author , Markus HohenfellnerMarkus Hohenfellner More articles by this author , and Boris HadaschikBoris Hadaschik More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2826AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is commonly based on standard 10-12 core prostate biopsies, which misclassify approximately 50% of prostate cancers compared to radical prostatectomy. We assessed the value of multiparametric magnetic resonance imaging (mpMRI)-targeted transperineal fusion-biopsies as a prerequisite to indicate or continue AS. METHODS 149 low-risk prostate cancer (PC) patients were included in AS between 2010 and 2015. 45 patients were initially diagnosed by combined 24-core systematic transperineal saturation biopsy (SB) and MRI/TRUS-fusion targeted lesion biopsy (TB). 104 patients first underwent 12-core TRUS-biopsy. All patients were followed up by combined SB and TB for restratification after one and two years. All mpMRI examinations were analyzed using PIRADS. AS was performed according to PRIAS-criteria and a NIH-nomogram for AS-disqualification was investigated. AS-disqualification rates for men initially diagnosed by standard or fusion-biopsy were compared using Kaplan-Meier estimates and log-rank tests. Differences in detection rates of the SB and TB components were evaluated with a paired sample analysis. Regression analyses were performed to predict AS-disqualification. RESULTS 48.1% of patients diagnosed by 12-core TRUS-biopsy were disqualified from AS based on MRI/TRUS-fusion biopsy results. In the initial fusion-biopsy cohort, upgrading occurred significantly less frequently during two-year follow-up (20%, p<0.001). TB alone were significantly superior compared to SB alone to detect Gleason score-upgrading. NPV for Gleason-upgrading was 93.5% for PIRADS<=2. PSA-level, PSA-density, NIH-nomogram, initial PIRADS score (p<0.001 each) and PIRADS-progression on consecutive MRI (p=0.007) were significant predictors of AS-disqualification. CONCLUSIONS Standard TRUS-biopsies lead to significant underestimation of PC under AS. MRI/TRUS-fusion biopsies, and especially the TB component allow more reliable risk classification, leading to a significantly decreased chance of subsequent AS-disqualification. Cancer detection with mpMRI alone is not yet sensitive enough to omit SB on follow-up after initial 12-core TRUS-biopsy. After MRI/TRUS-fusion biopsy confirmed AS, it may be appropriate to biopsy only those men with suspected progression on MRI. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e232 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jan Philipp Radtke More articles by this author Timur Hasan Kuru More articles by this author David Bonekamp More articles by this author Martin Freitag More articles by this author Claudia Verena Kesch More articles by this author Maya Wolf More articles by this author Celine Alt More articles by this author Gencay Hatiboglu More articles by this author Silvan Boxler More articles by this author Sascha Pahernik More articles by this author Wilfried Roth More articles by this author Matthias Claudius Roethke More articles by this author Heinz-Peter Schlemmer More articles by this author Markus Hohenfellner More articles by this author Boris Hadaschik More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...