You have accessJournal of UrologyProstate Cancer: Detection & Screening (V)1 Apr 20132219 GLEASON SCORE UPGRADING ON MRI/ULTRASOUND FUSION GUIDED PROSTATE BIOPSY VERSUS SYSTEMATIC 12-CORE TRUS BIOPSY M. Minhaj Siddiqui, Soroush Rais-Bahrami, Lambros Stamatakis, Srinivas Vourganti, Anthony Hoang, Jeffrey Nix, Hong Truong, Annerleim Walton-Diaz, Jennifer Logan, Michael Weintraub, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto M. Minhaj SiddiquiM. Minhaj Siddiqui Bethesda, MD More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami Bethesda, MD More articles by this author , Lambros StamatakisLambros Stamatakis Bethesda, MD More articles by this author , Srinivas VourgantiSrinivas Vourganti Bethesda, MD More articles by this author , Anthony HoangAnthony Hoang Bethesda, MD More articles by this author , Jeffrey NixJeffrey Nix Bethesda, MD More articles by this author , Hong TruongHong Truong Bethesda, MD More articles by this author , Annerleim Walton-DiazAnnerleim Walton-Diaz Bethesda, MD More articles by this author , Jennifer LoganJennifer Logan Bethesda, MD More articles by this author , Michael WeintraubMichael Weintraub Bethesda, MD More articles by this author , Baris TurkbeyBaris Turkbey Bethesda, MD More articles by this author , Peter ChoykePeter Choyke Bethesda, MD More articles by this author , Bradford WoodBradford Wood Bethesda, MD More articles by this author , and Peter PintoPeter Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2128AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason score (GS) upgrading from systematic 12-core prostate biopsy has been reported in 25-33% of prostatectomy patients. Previous studies have shown multiparametric magnetic resonance imaging (MP-MRI) of the prostate correlates well with high grade prostate cancer lesions. We assessed in this study, the rate of GS upgrading with an MRI/US fusion guided prostate biopsy. METHODS Patients were enrolled at the National Cancer Institute between 2007 and 2012 in a prospective trial comparing traditional extended sextant 12-core TRUS prostate biopsy to targeted MRI/US fusion guided prostate biopsy with electromagnetic tracking. All patients underwent a 3.0T MP-MRI with endorectal coil prior to biopsy. Imaging was reviewed and lesions were assigned a suspicion level based on predefined criteria. Patients underwent MRI/US fusion guided biopsies of suspicious lesions and a systematic 12-core biopsy in the same session. Pathology was reviewed and the highest GS from the 12-core biopsies in each patient was compared to the GS of targeted biopsies. Chi-square statistics was used to test for differences between target and systematic biopsy as well as an association of GS upgrading and MRI suspicion. RESULTS Of the 587 patients in the trial, 582 patients had sufficient data for analysis. Diagnosis of prostate cancer (PC) was made in 315 (54%) of the patients. Traditional 12-core and targeted biopsies both demonstrated cancer in 61% of the PC cases. In the remaining 39% of PC patients, only one modality (targeted or traditional biopsy) demonstrated cancer while the other was negative. PC seen on traditional template but not targeted biopsies tended to be lower grade (72% Gleason 6, 27% Gleason 7, 2% Gleason 8+) versus cancers seen only in targeted biopsy (41% Gleason 6, 36% Gleason 7, 24% Gleason 8+) (p<0.001 for the difference). Overall, GS upgrading by target biopsy was seen in 31% of the cases. MRI suspicion was correlated with GS upgrading in 38% of high and moderate suspicion lesions versus 12% of low suspicion lesions (p<0.0001). Upon multivariate analysis controlling for PSA, prostate size, and number of lesions, MRI suspicion remained a significant predictor of GS upgrading (p=0.03). CONCLUSIONS MRI/US fusion guided biopsy identifies higher GS prostate cancer than that identified by systematic 12-core biopsy in 31% of patients. High suspicion lesions on MP-MRI were furthermore associated with higher rate of GS upgrading with targeted versus traditional biopsy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e910 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information M. Minhaj Siddiqui Bethesda, MD More articles by this author Soroush Rais-Bahrami Bethesda, MD More articles by this author Lambros Stamatakis Bethesda, MD More articles by this author Srinivas Vourganti Bethesda, MD More articles by this author Anthony Hoang Bethesda, MD More articles by this author Jeffrey Nix Bethesda, MD More articles by this author Hong Truong Bethesda, MD More articles by this author Annerleim Walton-Diaz Bethesda, MD More articles by this author Jennifer Logan Bethesda, MD More articles by this author Michael Weintraub Bethesda, MD More articles by this author Baris Turkbey Bethesda, MD More articles by this author Peter Choyke Bethesda, MD More articles by this author Bradford Wood Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...