You have accessJournal of UrologyProstate Cancer: Detection & Screening (II)1 Apr 20131473 PROSPECTIVE EVALUATION OF MRI-ULTRASOUND FUSION BIOPSY TO DIAGNOSE PROSTATE CANCER IN MEN WITH PRIOR NEGATIVE BIOPSIES Geoffrey Sonn, Shyam Natarajan, Daniel Margolis, Edward Chang, Malu Macairan, Patricia Lieu, Jiaoti Huang, Frederick Dorey, and Leonard Marks Geoffrey SonnGeoffrey Sonn Los Angeles, CA More articles by this author , Shyam NatarajanShyam Natarajan Los Angeles, CA More articles by this author , Daniel MargolisDaniel Margolis Los Angeles, CA More articles by this author , Edward ChangEdward Chang Los Angeles, CA More articles by this author , Malu MacairanMalu Macairan Los Angeles, CA More articles by this author , Patricia LieuPatricia Lieu Los Angeles, CA More articles by this author , Jiaoti HuangJiaoti Huang Los Angeles, CA More articles by this author , Frederick DoreyFrederick Dorey Los Angeles, CA More articles by this author , and Leonard MarksLeonard Marks Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2938AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with persistently elevated PSA but negative prostate biopsy pose a diagnostic dilemma. MR-US fusion biopsy may improve prostate cancer (CaP) detection in these men. We describe results of a prospective study powered to detect differences in CaP detection between conventional trans-rectal ultrasound (TRUS) and fusion biopsy in men with prior negative biopsies. METHODS The study was designed to identify a 50% improvement in CaP detection (primary outcome) over repeat TRUS biopsy at 80% power and α=0.05. Secondary outcomes included detection of clinically significant cancer (Gleason ≥3+4 or maximum core length ≥4mm), cancer detection stratified by MRI result, and comparison of targeted vs. systematic cores. 105 consecutive men with prior negative biopsies (median = 2) and persistently elevated PSA were prospectively enrolled from 3/2010 to 8/2012 for this IRB-approved study. All men underwent a multiparametric MRI at 3-Tesla using a pelvic phase-array coil and fusion biopsy using the Artemis device (Eigen, Grass Valley, CA). The protocol included both targeted biopsies of lesions identified and scored on MRI (image grade 1-5) and systematic biopsies (median = 11 cores). Biopsies were performed in the urology clinic under local anesthesia. RESULTS 105 subjects (mean age 65 ± 8.3 y.o.) underwent MR-US fusion biopsy. At biopsy, median PSA was 7.5 ng/ml (I.Q.R. 5-11, 35% ≥10) and median prostate volume was 58 cc (I.Q.R. 38-82). Mean time from probe insertion to last biopsy was ∼20 minutes. CaP detection in 36 men (34%, 95% CI 25%-45%) significantly exceeded the 14% of men predicted to have CaP on repeat TRUS biopsy using historical controls. Of the 36 men with CaP, 72% had clinically significant cancer, 61% had Gleason ≥7 and 31% had Gleason ≥8. 15 of 28 cancers (54%) detected by systematic cores were clinically significant. 21 of 23 cancers (91%) detected by targeted cores were clinically significant (Figure). Image grade on MRI was a more powerful predictor of significant cancer on multivariate analysis than age, prostate volume, or PSA. Among men with the most suspicious MRI lesions (image grade 5), 12 of 14 (86%) had CaP. CONCLUSIONS Office-based MR-US fusion biopsy improves detection of prostate cancer in men with prior negative biopsies and elevated PSA. The majority of detected cancers will be clinically significant, with targeted biopsies alone detecting almost all serious cancers. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e604 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Geoffrey Sonn Los Angeles, CA More articles by this author Shyam Natarajan Los Angeles, CA More articles by this author Daniel Margolis Los Angeles, CA More articles by this author Edward Chang Los Angeles, CA More articles by this author Malu Macairan Los Angeles, CA More articles by this author Patricia Lieu Los Angeles, CA More articles by this author Jiaoti Huang Los Angeles, CA More articles by this author Frederick Dorey Los Angeles, CA More articles by this author Leonard Marks Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...