Imaging Fusion Biopsy Research Articles

Outcomes of active surveillance for Japanese patients with prostate cancer (PRIAS-JAPAN).

To report the outcomes of repeat biopsies, metastasis and survival in the Prostate Cancer Research International: Active Surveillance (PRIAS)-JAPAN study, a prospective observational study for Japanese patients, initiated in 2010. At the beginning,inclusion criteria were initially low-risk patients, prostate-specific antigen (PSA) density (PSAD) <0.2, and ≤2 positive biopsy cores. As from 2014, GS3+4 has also been allowed for patients aged 70 years and over. Since January 2021, the age limit for Gleason score (GS) 3 + 4 cases was removed, and eligibility criteria were expanded to PSA ≤20 ng/mL, PSAD <0.25 nd/mL/cc, unlimited number of positive GS 3 + 3 cores, and positive results for fewer than half of the total number of cores for GS 3 + 4 cases if magnetic resonance imaging fusion biopsy was performed at study enrolment or subsequent follow-up. For patients eligible for active surveillance, PSA tests were performed every 3 months, rectal examination every 6 months, and biopsies at 1, 4, 7 and 10 years, followed by every 5 years thereafter. Patients with confirmed pathological reclassification were recommended for secondary treatments. As of February 2024, 1302 patients were enrolled in AS; 1274 (98%) met the eligibility criteria. The median (interquartile range) age, PSA level, PSAD, and number of positive cores were 69 (64-73) years, 5.3 (4.5-6.6) ng/mL, 0.15 (0.12-0.17) ng/mL, and 1 (1-2), respectively. The clinical stage was T1c in 1089 patients (86%) and T2 in 185 (15%). The rates of acceptance by patients for the first, second, third and fourth re-biopsies were 83%, 64%, 41% and 22%, respectively. The pathological reclassification rates for the first, second, third and fourth re-biopsies were 29%, 30%, 35% and 25%, respectively. The 1-, 5- and 10-year persistence rates were 77%, 45% and 23%, respectively. Six patients developed metastasis, and one patient died from prostate cancer. Pathological reclassification was observed in approximately 30% of the patients during biopsy; however, biopsy acceptance rates decreased over time. Although metastasis occurred in six patients, only one death from prostate cancer was recorded.

Ultrasound-MRI Fusion Prostate Biopsy: Experience from a Cancer Center in the Midwest

Abstract Introduction/Objective Majority of literature with few exceptions suggests ultrasound-magnetic resonance imaging (MRI) fusion biopsy of prostate to be superior in diagnosing cancer compared to systematic transrectal ultrasonographic (TRUS) biopsy. However, it is highly dependent on the expertise of the person performing the biopsy and comes at a higher cost. The purpose of this study is a to evaluate the effectiveness of ultrasound-MRI fusion prostate biopsy at our institution. Methods/Case Report All prostate biopsies received at our institution from January to December 2022 were included. Data such as patient age, presence of region of interest (ROI) biopsy, presence of cancer in any core, presence of cancer in ROI core, total number of cores with cancer, highest Gleason score in ROI core, and highest Gleason score in other cores were collected. Results (if a Case Study enter NA) A total of 448 consecutive cases were identified. Of these 214 (47.8%) were transrectal ultrasonographic and 234 (52.2%) were ultrasound-MRI fusion biopsies. Mean age of patients with TRUS biopsy was 64.3±8.6 years and mean age of patients with MRI-guided biopsy was 65.4±6.9 years, a statistically comparable population (p-value 0.001). Among TRUS cases, 133 (62.1%) had tumor. Among ultrasound-MRI fusion cases, 169 (72.2%) had tumor. Among ultrasound-MRI fusion cases with tumor, 31 had cancer only in ROI core, 55 had cancer only in other cores and 83 had cancer in ROI core as well as at least one additional non-ROI core. Among 83 cases with tumor in ROI as well as non-ROI cores, 12 had higher Gleason score in ROI core, 18 had higher Gleason score in non-ROI core and in 53 cases the Gleason score in ROI core and highest Gleason score in any of the other positive cores were equal. Conclusion In our experience ultrasound-MRI fusion biopsy improves cancer detection; however, it does not improve the rate of detection of higher-grade cancer.

Combination of DNA methylation biomarkers with multiparametric magnetic resonance and ultrasound imaging fusion biopsy to detect the local spread of prostate cancer.

This study aimed to investigate the extent of field cancerization adjacent to index lesions in prostate cancer (PCa) by measuring DNA methylation of selected tumor suppressor genes in the perifocal tissue of PCa not visible on multiparametric magnetic resonanse imaging (mpMRI) for the safe zone of focal therapy identification. A total of 272 patients were enrolled in this study, 44 patients' tissue biosamples were included in the field cancerization research, and 272 urine samples were included in the urine-based test development. Targeted biopsies were performed using the mpMRI/ultrasoundimage fusion system. Quantitative analysis revealed significantly higher DNA methylation levels of RARB, RASSF1, GSTP1 &APC genes in the index lesion compared with perifocal tissue samples 10 mm away from it (p < 0.0001). Notably, the RARB, GSTP1 & APC and RARB, RASSF1, GSTP1 & APC biomarker combinations exhibited the highest sensitivity and specificity comparing the extent of DNA methylation in index lesions and noncancerous prostate tissues 20 mm away (both area under the curve [AUC] = 0.98; p < 0.0001). The analysis of the potential urinary biomarkers showed that the combination of all four DNA methylation biomarkers with prostate-specific antigen (PSA) or PSA density (PSAD) in the blood significantly improves the detection of clinically significant PCa (csPCa). The combination of the four-biomarker test with PSAD allowed the identification of csPCa with ≥90% sensitivity and specificity. Thus, this study suggests that for focal therapy by region target hemi-ablation, the safe distance from the index lesion is no less than 10 mm. Noninvasive urine DNA methylation tests in combination with PSAD could be used for further follow-up of the patients, but larger prospective studies with external validation are needed.

Промежностная фьюжн-биопсия предстательной железы. Диагностическая ценность в сравнении со стандартной биопсией.

Introduction. A significant improvement in the quality of prostate imaging by magnetic resonance (MRI), as well as the possibility of combining MRI and ultrasound images (fusion technology) for biopsy, open up new possibilities for the diagnosis of prostate cancer. The arsenal of methods of treating prostate cancer includes active surveillance and focal therapy for patients with low risk disease. That raises the question of improving the accuracy of diagnosis of tumor volume, stage and differentiation, which will largely determine the tactics of patient management. The aim of our work was to determine the diagnostic effectiveness of targeted MRI-assisted fusion biopsy of the prostate in comparison with standard biopsy. Materials and methods. We analyzed data of 356 patients who underwent tranperineal fusion biopsy. The age of the patients ranged from 48 to 72 years with an average value of 68.2 ± 2.1 years. The selection criteria for the study were an increase in the level of PSA (345 patients) – the range from 4 to 44.5 ng/ml (on average 6.02±0.21) or the detection of tumor-suspicious areas during finger rectal examination or transrectal ultrasound examination (TRUS) of the prostate gland (41 patients). Further methods of examination included multiparametric magnetic resonance imaging (MRI) and subsequent transperineal fusion biopsy in combination with standart biopsy. Results. In our study, the detection rate of prostate cancer was (82.6%) – the diagnosis was confirmed in 294 out of 356 examined patients. At the same time, with an increase in the PI-RADS gradation, the frequency of histological confirmation of cancer increased: 62.4% for PI-RADS 3 lesions, 89.6% for 4 and 96.7% for PI-RADS 5. Targeted biopsies confirmed the presence of prostate cancer in 246 cases out of 356 patients (69.1%). In relation to all cases of cancer detection, the proportion of positive targeted biopsies was 83.7%. Conclusion. Targeted MRI-assisted fusion biopsy allows detecting prostate cancer in 69.1%, but when supplemented with a polyfocal biopsy at standard points, the diagnostic accuracy increases to 82.6%. Thus, the data obtained allow us to conclude that based on the examination of patients with suspected prostate cancer using mpMRI with targeted fusion biopsy, supplemented by polyfocal biopsies at standard points, it is possible to determine the localization, extent and degree of malignancy of the tumor with a high degree of certainty.

Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy.

When performing targeted biopsy (TBx), the need to add systematic biopsies (SBx) is often debated. Aim of the study is to evaluate the added value of SBx in addition to TBx in terms of prostate cancer (PCa) detection rates (CDR), and to test the concordance between multiparametric magnetic resonance imaging (mpMRI) findings and fusion biopsy results in terms of cancer location. We performed a retrospective, multicentric study that gathered data on 1992 consecutive patients who underwent elastic fusion biopsy between 2011 and 2020. A standardized approach was used, with TBx (2-4 cores per target) followed by SBx (12-14 cores). We assessed CDR of TBx, of SBx, and TBx+SBx for all cancers and clinically significant PCa (csPCa), defined as ISUP score ≥2. CDR was evaluated according to radiological and clinical parameters, with a particular focus on PI-RADS 3 lesions. In a subgroup of 1254 patients we tested the discordance between mpMRI findings and fusion biopsy results in terms of cancer location. Uni- and multivariable logistic regression analyses were performed to identify predictors of CDR. CDR of TBx+SBx was 63.0% for all cancers and 38.8% of csPCa. Per-patient analysis showed that SBx in addition to TBx improved CDR by 4.5% for all cancers and 3.4% for csPCa. Patients with lesions scored as PI-RADS 3, 4, and 5 were diagnosed with PCa in 27.9%, 72.8%, and 92.3%, and csPCa in 10.7%, 43.6%, and 69.3%, respectively. When positive, PI-RADS 3 lesions were ISUP grade 1 in 61.1% of cases. Per-lesion analysis showed that discordance between mpMRI and biopsy was found in 56.6% of cases, with 710 patients having positive SBx outside mpMRI targets, of which 414 (58.0%) were clinically significant. PSA density ≥0.15 was a strong predictor of CDR. The addition of systematic mapping to TBx contributes to a minority of per-patient diagnoses but detects a high number of PCa foci outside mpMRI targets, increasing biopsy accuracy for the assessment of cancer burden within the prostate. High PSA-density significantly increases the risk of PCa, both in the whole cohort and in PI-RADS 3 cases.

Artificial intelligence trained with integration of multiparametric MR-US imaging data and fusion biopsy trajectory-proven pathology data for 3D prediction of prostate cancer: A proof-of-concept study.

We aimed to develop an artificial intelligence (AI) algorithm that predicts the volume and location of clinically significant cancer (CSCa) using convolutional neural network (CNN) trained with integration of multiparametric MR-US image data and MRI-US fusion prostate biopsy (MRI-US PBx) trajectory-proven pathology data. Twenty consecutive patients prospectively underwent MRI-US PBx, followed by robot-assisted radical prostatectomy (RARP). The AI algorithm was trained with the integration of MR-US image data with a MRI-US PBx trajectory-proven pathology. The relationship with the 3D-cancer-mapping of RARP specimens was compared between AI system-suggested 3D-CSCa mapping and an experienced radiologist's suggested 3D-CSCa mapping on MRI alone according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2. The characteristics of detected and undetected tumors at AI were compared in 22,968 image data. The relationships between CSCa volumes and volumes predicted by AI as well as the radiologist's reading based on PI-RADS were analyzed. The concordance of the CSCa center with that in RARP specimens was significantly higher in the AI prediction than the radiologist' reading (83% vs. 54%, p = 0.036). CSCa volumes predicted with AI were more accurate (r = 0.90, p < 0.001) than the radiologist's reading. The limitations include that the elastic fusion technology has its own registration error. We presented a novel pilot AI algorithm for 3D prediction of PCa. AI was trained by integration of multiparametric MR-US image data and fusion biopsy trajectory-proven pathology data. This deep learning AI model may more precisely predict the 3D mapping of CSCa in its volume and center location than a radiologist's reading based on PI-RADS version 2, and has potential in the planning of focal therapy.

Prediction of Prostate Cancer Aggressiveness Using a Novel Multiparametric Magnetic Resonance Imaging Parameter: Tumor Heterogeneity Index

Background and Aims: The aim of this study was to evaluate if the tumor heterogeneity index can predict the aggressiveness of prostate cancer (PCa) in patients diagnosed by magnetic resonance imaging (MRI) fusion biopsy. Material and Methods: Patients who underwent MRI fusion prostatic biopsy between July 2019 and December 2020 were retrospectively reviewed. Tumor heterogeneity index (coefficient of variation [CV]) and PI-RADS v2.1 scoring were analyzed by using multiparametric MRI. The patients were divided into 3 groups according to the risk classification, and the correlation between tumor heterogeneity index and PCa aggressiveness was studied by using apparent diffusion coefficient (ADC_mean and ADC_cv), Gleason score (GS), and risk classifications. Results: One hundred two patients were included in this study. Patients were evaluated as low-risk (group 1) (n = 35), moderate-risk (group 2) (n = 37), and high-risk (group 3) (n = 30). ADC_mean values for all groups were significantly different (p < 0.0001). ADC_cv tumor heterogeneity index values were higher in group 2 and group 3 by the score increases in subgroups according to GS, while being higher than group 1 (p < 0.001). The multivariate analysis revealed that prostate-specific antigen, PI-RADS, ADC_mean, and ADC_cv values were predictive for tumor aggressiveness. Conclusion: ADC_cv value as a tissue texture parameter can be used as a new biomarker to evaluate tumor aggressiveness in patients with PCa.

TRUS-Guided Target Biopsy for a PI-RADS 3-5 Index Lesion to Reduce Gleason Score Underestimation: A Propensity Score Matching Analysis.

BackgroundMagnetic resonance imaging (MRI) and transrectal ultrasound (TRUS)-guided cognitive or image fusion biopsy is performed to target a prostate imaging reporting and data system (PI-RADS) 3–5 lesion. Biopsy Gleason score (GS) is frequently underestimated compared to prostatectomy GS. However, it is still unclear about how many cores on target are necessary to reduce undergrading and if additional cores around the target may improve grade prediction on surgical specimen.PurposeTo determine the number of target cores and targeting strategy to reduce GS underestimation.Materials and MethodsBetween May 2017 and April 2020, a total of 385 patients undergoing target cognitive or image fusion biopsy of PI-RADS 3–5 index lesions and radical prostatectomies (RP) were 2:1 matched with propensity score using multiple variables and divided into the 1–4 core (n = 242) and 5–6 core (n = 143) groups, which were obtained with multiple logistic regression with restricted cubic spline curve. Target cores of 1–3 and 4–6 were sampled from central and peripheral areas, respectively. Pathologic outcomes and target cores were retrospectively assessed to analyze the GS difference or changes between biopsy and RP with Wilcoxon signed-rank test.ResultsThe median of target cores was 3 and 6 in the 1–4 core and 5–6 core groups, respectively (p < 0.001). Restricted cubic spline curve showed that GS upgrade was significantly reduced from the 5th core and there was no difference between 5th and 6th cores. Among the matched patients, 35.4% (136/385; 95% confidence interval, 0.305–0.403) had a GS upgrade after RP. The GS upgrades in the 1–4 core and 5–6 core groups were observed in 40.6% (98/242, 0.343–0.470) and 26.6% (38/143, 0.195–0.346), respectively (p = 0.023). Although there was no statistical difference between the matched groups in terms of RP GS (p = 0.092), the 5–6 core group had significantly higher biopsy GS (p = 0.006) and lower GS change from biopsy to RP (p = 0.027).ConclusionFive or more target cores sampling from both periphery and center of an index tumor contribute to reduce GS upgrade.

Role of multi-parametric magnetic resonance imaging fusion biopsy in active surveillance of prostate cancer: a systematic review.

Background:Our goal is to review current literature regarding the role of multi-parametric magnetic resonance imaging (mpMRI) in the active surveillance (AS) of prostate cancer (PCa) and identify trends in rate of reclassification of risk category, performance of fusion biopsy (FB) versus systematic biopsy (SB), and progression-free survival.Methods:We performed a comprehensive literature search in PubMed and identified 121 articles. A narrative summary was performed.Results:Thirty-two articles were chosen to be featured in this review. SB and FB are complementary in detecting higher-grade disease in follow-up. While FB was more likely than SB to detect clinically significant disease, FB missed 6.4–11% of clinically significant disease. Imaging factors that predicted upgrading include number of lesions on magnetic resonance imaging (MRI), lesion density, and MRI suspicion level.Conclusion:Incorporating mpMRI FB in conjunction with SB should be part of contemporary AS protocols. mpMRI should additionally be used routinely for follow-up; however, mpMRI is not currently sensitive enough in detecting disease progression to replace biopsy in the surveillance protocol.

How to Improve TRUS-Guided Target Biopsy following Prostate MRI.

Simple SummaryRadiologists or urologists prefer to use transrectal ultrasound (TRUS) for detecting a prostate cancer. Therefore, it is of great importance to depict and target an index lesion with TRUS after the prostate MRI is scanned. They need to know the new TRUS protocols, imaging features, and biopsy techniques. The new TRUS protocols include using fundamental imaging rather than harmonic imaging and lowering dynamic range to increase tumor-to-normal tissue contrast. The new TRUS features show how to identify an index lesion and how to differentiate insignificant and significant cancers in terms of tumor size, echogenicity, echotexture, margin, and perfusion. The new biopsy techniques include how to understand different tumor locations, sizes, and shapes between magnetic resonance imaging (MRI) and TRUS and how to target an index lesion regarding biopsy strategy and cores. Systematic biopsy is necessary but can be skipped in patients with invasive behaviors such as extra-capsular extension, seminal vesicle invasion, or metastasis. Image fusion biopsy as well as cognitive biopsy can be improved if radiologists or urologists are familiar with the new TRUS protocol, imaging features, and biopsy techniques.TRUS is a basic imaging modality when radiologists or urologists perform cognitive fusion or image fusion biopsy. This modality plays the role of the background images to add to an operator’s cognitive function or MRI images. Operators need to know how to make TRUS protocols for lesion detection or targeting. Tumor location, size, and shape on TRUS are different from those on MRI because the scan axis is different. TRUS findings of peripheral or transition tumors are not well known to radiologists and urologists. Moreover, it remains unclear if systematic biopsy is necessary after a tumor is targeted. The purpose of this review is to introduce new TRUS protocols, new imaging features, new biopsy techniques, and to assess the necessity of systematic biopsy for improving biopsy outcomes.

The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy in clinically significant prostate cancer detection in patients with biopsy-naïve men according to PSA levels: Apropensity score matching analysis.

ObjectivesTo evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear.Materials and methodsWe retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA <4, 4–10, >10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared.ResultsData from a total of 670 males were included in the analysis (standard TRUS, n = 333; MRI/US fusion, n = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4–10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, P = 0.033). However, patients with PSA <4 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (12.0% vs. 16.0%, P = 0.342), whereas, patients with PSA >10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, P = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31–4.60, P = 0.005) were significantly associated with a detection of csPCa.ConclusionsDetection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naïve men with PSA 4–10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA <4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations.

Prostate Cancer Detection Using 3-D Shear Wave Elasticity Imaging

Transrectal ultrasound (TRUS) B-mode imaging provides insufficient sensitivity and specificity for prostate cancer (PCa) targeting when used for biopsy guidance. Shear wave elasticity imaging (SWEI) is an elasticity imaging technique that has been commercially implemented and is sensitive and specific for PCa. We have developed a SWEI system capable of 3-D data acquisition using a dense acoustic radiation force (ARF) push approach that leads to enhanced shear wave signal-to-noise ratio compared with that of the commercially available SWEI systems and facilitates screening of the entire gland before biopsy. Additionally, we imaged and assessed 36 patients undergoing radical prostatectomy using 3-D SWEI and determined a shear wave speed threshold separating PCa from healthy prostate tissue with sensitivities and specificities akin to those for multiparametric magnetic resonance imaging fusion biopsy. The approach measured the mean shear wave speed in each prostate region to be 4.8 m/s (Young's modulus E = 69.1 kPa) in the peripheral zone, 5.3 m/s (E = 84.3 kPa) in the central gland and 6.0 m/s (E = 108.0 kPa) for PCa with statistically significant (p < 0.0001) differences among all regions. Three-dimensional SWEI receiver operating characteristic analyses identified a threshold of 5.6 m/s (E = 94.1 kPa) to separate PCa from healthy tissue with a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of 81%, 82%, 69%, 89% and 0.84, respectively. Additionally, a shear wave speed ratio was assessed to normalize for tissue compression and patient variability, which yielded a threshold of 1.11 to separate PCa from healthy prostate tissue and was accompanied by a substantial increase in specificity, PPV and AUC, where the sensitivity, specificity, PPV, NPV and AUC were 75%, 90%, 79%, 88% and 0.90, respectively. This work illustrates the feasibility of using 3-D SWEI data to detect and localize PCa and demonstrates the benefits of normalizing for applied compression during data acquisition for use in biopsy targeting studies.

Comparison of TRUS and combined MRI-targeted plus systematic prostate biopsy for the concordance between biopsy and radical prostatectomy pathology.

To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing conventional 12-core TRUS-Bx at radical prostatectomy specimens (RP). Consecutive patients diagnosed prostate cancer (127 with combination of both targeted biopsy (TBx) plus systematic biopsies (SBx) and separate patient cohort of 330 conventional TRUS-Bx without mpMRI) with a PSA level of <20ng/mL prior to RP were included. The primary end point was the grade group concordance between biopsy and RP pathology according to biopsy technique. Clinically significant prostate cancer detection was 51.2% for TRUS-Bx, 49.5% for SBx, 67% for TBx and 75.7% for TBx+SBx. Upgrading and downgrading of at least one Gleason Grade Group (GGG) was recorded in 43.3%/ 6.7% patients of the TRUS-Bx and in 20.5%/ 22% of the TBX+SBx group, respectively (all P<.001). Concordance level was detected to be significantly higher for ISUP 1 in combined TBx+SBx method compared to conventional TRUS-Bx (61.3% vs 37.9%, P=.014). In ISUP 1 exclusively, significant upgrading was seen in TRUS-Bx (62.1%) when compared to TBx (41.4%) and TBx+SBx (38.7%). MRI-targeted biopsies detected more significant PCa than TRUS-Bx but, superiority in significant cancer detection appears as a result of inadvertant selective sampling of small higher grade areas. Within an otherwise low grade cancer and does not reflect accurate GGG final surgical pathology. TBx+SBx has the greatest concordance in ISUP Grade 1 with less upgrading which is utmost important for active surveillance.

Re: MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis.

No AccessJournal of UrologyUrological Survey1 Dec 2020Re: MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis Samir S. TanejaMD Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001283.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis." The Journal of Urology, 204(6), pp. 1382–1383 Suggested Reading : Missing the mark: prostate cancer upgrading by systematic biopsy over magnetic resonance imaging/transrectal ultrasound fusion biopsy. J Urol 2017; 197: 327. Link, Google Scholar : Reproducibility of multiparametric magnetic resonance imaging and fusion guided prostate biopsy: multi-institutional external validation by a propensity score matched cohort. J Urol 2016; 195: 1737. Link, Google Scholar : Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol 2012; 188: 2152. Link, Google Scholar : The institutional learning curve of magnetic resonance imaging-ultrasound fusion targeted prostate biopsy: temporal improvements in cancer detection in 4 years. J Urol 2018; 200: 1022. Link, Google Scholar : Is it time to perform only magnetic resonance imaging targeted cores? Our experience with 1,032 men who underwent prostate biopsy. J Urol 2018; 200: 774. Link, Google Scholar : Magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in a consecutive cohort of men with no previous biopsy: reduction of over detection through improved risk stratification. J Urol 2015; 194: 1601. Link, Google Scholar : Detection of significant prostate cancer with magnetic resonance targeted biopsies—should transrectal ultrasound-magnetic resonance imaging fusion guided biopsies alone be a standard of care?J Urol 2015; 193: 1198. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 6December 2020Page: 1382-1383 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samir S. Taneja More articles by this author Expand All Advertisement PDF DownloadLoading ...

Prostate Mapping for Cancer Diagnosis: The Madrid Protocol. Transperineal Prostate Biopsies Using Multiparametric Magnetic Resonance Imaging Fusion and Micro-Ultrasound Guided Biopsies.

We assessed the prostate cancer detection accuracy of transperineal prostate biopsy using multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy and micro-ultrasound during the same procedure. Micro-ultrasound is a new high-resolution imaging system that allows real-time targeted biopsy. A total of 194 consecutive patients underwent transperineal prostate biopsies using real-time targeted micro-ultrasound (ExactVu™) and ultrasound fusion targeted biopsy (BiopSee®) in the same procedure, from February 2018 to September 2019. Biopsies were performed using a transperineal needle guide attached to the 29 MHz high-resolution micro-ultrasound transducer. The overall positive rate was 56% (108) for prostate cancer and 42% (81) for clinically significant prostate cancer (Gleason Grade Group greater than 1), and adding micro-ultrasound and magnetic resonance imaging detected significantly more clinically significant prostate cancer than systematic biopsy (p <0.001). Micro-ultrasound found 12 of 108 (11%) prostate cancers that were missed by all other techniques and 11 (92%) were clinically significant prostate cancer. PI-RADS® and PRI-MUS™ (Prostate Risk Identification Using Micro-Ultrasound) were strong predictors of clinically significant prostate cancer in a logistic regression model (AUC 0.76). For prostate specific antigen greater than 4 ng/ml, PI-RADS greater than 3, there was an improvement in detection rate between PRI-MUS 4 and PRI-MUS 5 (52% Gleason Grade Group greater than 1 to 92% Gleason Grade Group greater than 1). No fever or clinical infection was observed and 17 (8.7%) patients presented with minor complications (Clavien Dindo I). This is the first study using a transperineal approach for micro-ultrasound guided biopsy and multiparametric magnetic resonance imaging fusion biopsy. The results show a high accuracy for prostate cancer and clinically significant prostate cancer diagnosis, without infectious complications. The proposed method should be validated in large randomized clinical trials.

Initial Experience of Magnetic Resonance Imaging Fusion Biopsy in the Community Setting.

Magnetic resonance imaging fusion biopsy is diagnostically superior to transrectal ultrasound guided biopsy for detecting clinically significant prostate cancer. Fusion biopsy has an expanding role at major academic centers. However, the reproducibility of outcomes in the community setting is unknown. Our goal was to determine if there are significant differences in the yield of clinically significant prostate cancer upon implementation of fusion biopsy in the community setting. We compared biopsy results from the first consecutive 175 patients undergoing fusion biopsy at an academic setting to the first 175 patients undergoing fusion biopsy at a community practice. Patients treated at an academic setting were matched to nonacademic setting treated patients using Mahalonobis distance matching. A treatment effects model was used to evaluate the effect of practice setting on the rate of clinically significant prostate cancer detection. The matching model resulted in 160 community based patients matched to 150 academic based patients. Balance was verified by reduction in standardized differences and variances ratios between samples. Standard errors and the 95% CI were calculated from 3,000 bootstrap samples. Practice setting had no significant effect on clinically significant prostate cancer detection, clinically significant prostate cancer detection by fusion biopsy, upgrading by fusion cores, upgrading by template cores, clinically significant prostate cancer missed by template cores or clinically significant prostate cancer missed by fusion cores. A sample-matched analysis of the first consecutive patients enrolled in fusion biopsy at an academic versus a community setting indicates that practice setting did not have a significant effect on the overall detection of clinically significant prostate cancer. This lends support to the use of fusion biopsy outside of academic centers.

MP23-15 MRI FUSION BIOPSY IN ACTIVE SURVEILLANCE – A TEMPORAL ANALYSIS OF THE LARGEST DATASET

INTRODUCTION AND OBJECTIVE:Multiparametric magnetic resonance imaging (mpMRI) fusion biopsy has been commonly utilized in the management of patients with prostate cancer on active surveillance (AS)...

MP20-15 INTERNATIONAL SOCIETY OF UROLOGICAL PATHOLOGY GRADE MIGRATION IN THE PROSTATE CANCER PATIENTS

INTRODUCTION AND OBJECTIVE: The aim of our study was to compare the ratios of International Society of Urological Pathology (ISUP) grade migration after robot assisted radical prostatectomy between ultrasound (US) guided systemic biopsy and ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy pathways. METHODS: Out of 304 prostate cancer patients from January, 2017 to September, 2019, 111 patients who underwent the prostate biopsy and the robot assisted radical prostatectomy at our institute were enrolled. 68 patients underwent the concurrent US guided systemic and US-MRI fusion biopsy, and 43 patients underwent the US guided systemic biopsy only. ISUP grade migration ratios were compared between US guided systemic biopsy and US-MRI fusion biopsy pathways using Chi-square test. RESULTS: Median age, prostate-specific antigen (PSA) level and PSA density were 66 years, 7.1 ng/ml and 0.18 ng/ml2, respectively. 103 out of 111 (92.8%) patients were biopsy naïve. Mean core numbers of US guided systemic and US-MRI fusion biopsy were 12.0 and 3.9, respectively. Mean positive core numbers were 4.3 and 2.4 in US guided systemic and US-MRI fusion biopsy, respectively. ISUP grade distributions of two biopsy pathways were similar each other (p = 0.873), but significantly different from that of pathological results after prostatectomy, respectively (all p < 0.001). We could not identify the significant differences in ISUP grade migration between two biopsy pathways; upgrade rates of US guided systemic and US-MRI fusion biopsy were 30.6% and 30.9% (p = 0.963), respectively and downgrade rates were 25.9% vs 21.8% (p = 0.564), respectively. CONCLUSIONS: US guided systemic and US-MRI fusion biopsy pathways showed the similar results of ISUP grade distribution and migration. And we could identify US-MRI fusion biopsy with less biopsy cores was comparable with US guided systemic biopsy from the perspective of ISUP grade migration after prostatectomy.Source of Funding: none

Comparing Prostate Imaging-Reporting and Data System Version 2 (PI-RADSv2) Category 1 and 2 Groups: Clinical Implication of Negative Multiparametric Magnetic Resonance Imaging.

Objectives To evaluate the clinicopathological differences between Prostate Imaging-Reporting and Data System (PI-RADS) version 2 (v2) category 1 and 2 groups. Materials and Methods. We retrospectively reviewed our two institutional clinical databases: (1) transrectal ultrasound (TRUS)/magnetic resonance imaging (MRI) fusion biopsy cohort (n = 706) and (2) radical prostatectomy (RP) cohort (n = 1403). Subsequently, we performed comparative analyses between PI-RADSv2 category 1 and 2 groups. Clinically significant prostate cancer (csPCa) was defined as the presence of Gleason score (GS) ≥ 3 + 4 in a single biopsy core, and adverse pathology (AP) was defined as high-grade (primary Gleason pattern 4 or any pattern 5) and/or non-organ-confined disease (pT3/N1). We also performed multivariate logistic regression analyses for AP. Results In the TRUS/MRI fusion biopsy cohort, no significant differences in detection rates of all cancer (18.2% vs. 29.0%, respectively, P = 0.730) or csPCa (9.1% vs. 9.9%, respectively, P = 0.692) were observed between PI-RADSv2 category 1 and 2 groups. There were no significant differences in pathologic outcomes including Gleason score (≥4 + 3, 21.2% vs. 29.9%, respectively, P = 0.420) or detection rate of AP (27.3% vs. 33.8%, respectively, P = 0.561) between the two groups in the RP cohort either. PI-RADSv2 category 1 or 2 had no significant association with AP, even in univariate analysis (P = 0.299). Conclusions PI-RADSv2 categories 1 and 2 had similar performance to predict clinicopathological outcomes. Consequently, these two categories may be unified into a single category. Negative mpMRI does not guarantee the absence of AP, as with csPCa.

The effect of 5 alpha-reductase inhibitor therapy on prostate cancer detection in the era of multi-parametric magnetic resonance imaging

We aimed to evaluate the effect of 5 alpha-reductase inhibitor (5-ARI) treatment on prostate cancer (PCa) and clinically significant PCa (csPCa) detection in patients undergoing transrectal ultrasound (TRUS)/magnetic resonance imaging (MRI) fusion biopsy in the current era of multi-parametric MRI (mpMRI). We retrospectively reviewed our TRUS/MRI fusion biopsy database (n = 706). Eighty (11.3%) patients who had used 5-ARI for more than one year at the time of biopsy were stratified as 5-ARI group. Subsequently, we performed comparative analyses of 5-ARI and non-5-ARI groups. csPCa was defined by a Gleason score ≥3 + 4 in a single biopsy core. Chi-squared test was used to evaluate the performance of mpMRI in predicting PCa/csPCa between the two groups. Multivariate logistic regression analyses were performed to evaluate the significant variables associated with PCa detection. There were no significant differences in PCa/csPCa detection rates between 5-ARI and non-5-ARI groups (all, P > 0.05). In multivariate logistic regression analyses for the evaluation of variables associated with csPCa detection, age (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.035–1.090; P < 0.001), pre-biopsy PSA (OR, 1.062; 95% CI, 1.034–1.090; P < 0.001), prostate volume on TRUS (OR, 0.956; 95% CI, 0.943–0.970, P < 0.001), and PI-RADsV2 category (OR, 5.528; 95% CI, 3.017–10.131; P < 0.001) were found to be significant predictors. However, 5-ARI had no significant association with PCa detection (P = 0.384). Conclusively, 5-ARI therapy did not adversely affect PCa/csPCa detection after TRUS/MRI fusion biopsy, which suggests that exposure to 5-ARI may not impair the performance of mpMRI.