Transrectal Ultrasound Magnetic Resonance Imaging Research Articles

Prostate cancer lesions in transition zone exhibit a higher propensity for pathological upgrading in radical prostatectomy.

The varying malignancy and lethality of different grades of prostate cancer (PCa) highlight the importance of accurate diagnosis. This study aims to evaluate the upgrading of transition zone (TZ) prostate cancer biopsies and identify factors to improve TZ biopsy accuracy. This retrospective study included 217 patients who underwent laparoscopic radical prostatectomy after 12 + X cores transperineal transrectal ultrasound-magnetic resonance imaging (MRI)-guided targeted prostate biopsy from 2018 to 2021 in our center. Patients with TZ lesions showed a higher incidence of International Society of Urological Pathology (ISUP) grade upgrading from 1 to higher grade compared to peripheral zone lesions (16.9% vs. 5.0%, p = 0.005). Multivariate analysis confirmed TZ lesions as an independent risk factor (OR: 4.594, 97.5% CI: 1.569-15.238, p = 0.008) for upgrading from 1 to higher. Additionally, the number of positive biopsy cores (OR: 0.586, 97.5% CI: 0.336-0.891, p = 0.029) and anterior TZ lesion location (OR: 10.797, 97.5% CI: 1.503-248.727, p = 0.048) were independent factors for the upgrading in TZ patients. This study found that PCa lesions located in the TZ, particularly the anterior TZ, have a higher risk of ISUP grade upgrading. This elevated risk arises from the insufficient distribution of biopsy cores around the TZ lesion. The findings underscore the importance of having an adequate number of biopsy cores around the lesion area to improve the accuracy of ISUP grade assessments.

Retrospective analysis of the learning curve in perineal robot-assisted prostate biopsy.

Magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-fusion biopsy (FBx) of the prostate allows targeted sampling of suspicious lesions within the prostate, identified by multiparametric MRI. Due to its reliable results and feasibility, perineal MRI/TRUS FBx is now the gold standard for prostate cancer (PC) diagnosis. There are various systems for performing FBx on the market, for example, software-based, semirobotic, or robot-assisted platform solutions. Their semiautomated workflow promises high process quality independent of the surgeon's experience. The aim of this study was to analyze how the surgeon's experience influences the cancer detection rate (CDR) via targeted biopsy (TB) and the procedure's duration in robot-assisted FBx. A total of 1716 men who underwent robot-assisted FBx involving a combination of targeted and systematic sampling between October 2015 and April 2022 were analyzed. We extracted data from the patients' electronic medical records retrospectively. Primary endpoints were the CDR by TB and the procedure's duration. For our analysis, surgeons were divided into three levels of experience: ≤20 procedures (little), 21-100 procedures (intermediate), and >100 procedures (high). Statistical analysis was performed via regression analyses and group comparisons. Median age, prostate-specific antigen level, and prostate volume of the cohort were 67 (±7.7) years, 8.13 (±9.4) ng/mL, and 53 (±34.2) mL, respectively. Median duration of the procedure was 26 (±10.9) min. The duration decreased significantly with the surgeon's increasing experience from 35.1 (little experience) to 28.4 (intermediate experience) to 24.0 min (high experience) (p < 0.001). Using TB only, significant PC (sPC) was diagnosed in 872/1758 (49.6%) of the men. The CDR revealed no significant correlation with the surgeon's experience in either group comparison (p = 0.907) or in regression analysis (p = 0.65). While the duration of this procedure decreases with increasing experience, the detection rate of sPC in TB is not significantly associated with the experience of the surgeon performing robot-assisted FBx. This robot-assisted biopsy system's diagnostic accuracy therefore appears to be independent of experience.

Detection of anterior prostate cancer using a magnetic resonance imaging-transrectal ultrasound fusion biopsy in cases with initial biopsy and history of systematic biopsies

BackgroundProstate cancer in the anterior region may be missed on a transrectal systematic biopsy (SBx). Therefore, this study aimed to evaluate the performance of magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion targeted biopsy (TBx) in detecting anterior region cancer in patients with a history of SBxs. MethodsProstate biopsies were performed in 224 patients after multiparametric MRI, among whom 119 patients with prostate imaging reporting and data system (PI-RADS version 2) scores of 3 to 5 underwent MRI-TRUS fusion TBxs. Afterward, cancer detection rates (CDRs) and TBx-positive core regions were compared by categorizing patients into those with or without a history of SBxs. ResultsTotal CDR was 68.8% (44/64 cases) in the initial biopsy group (Initial-Bx group) and 47.3% (26/55 cases) in the previous-negative-systematic biopsy group (Pre-Neg-SBx group) (P = 0.018). Interestingly, both TBx- and SBx-core positive cases were more common in the Initial-Bx group than in the Pre-Neg-SBx group (Initial-Bx group: 75% [33/44 cases] vs. Pre-Neg-SBx group: 42.3% [11/26 cases], P = 0.006). However, only TBx-core positive cases were more common in the Pre-Neg-SBx group than in the Initial-Bx group (Initial-Bx group: 11.4% [5/44 cases] vs. Pre-Neg-SBx group: 30.8% [8/26 cases], P = 0.043). In addition, the proportion of anterior lesions detected by TBx cores was higher in the Pre-Neg-SBx group than in the Initial-Bx group (Initial-Bx group: 26.3% [10/38 cases] vs. Pre-Neg-SBx group: 52.6% [10/19 cases], P = 0.049). ConclusionUsing MRI-TRUS fusion TBx in the evaluation of previously negative SBx cases improved the detection rate of anterior lesions, which might have been missed in previous SBxs. Especially in patients with a history of SBxs mpMRI should be performed to screen for anterior lesions.

High accuracy of the magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided biopsy in clinically significant prostate cancer

High accuracy of the magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided biopsy in clinically significant prostate cancer

Minimally invasive magnetic resonance image-guided prostate interventions.

Whole gland prostate cancer treatment, i.e. radical prostatectomy or radiation therapy, is highly effective but also comes with a significant impact on quality of life and possible overtreatment in males with low to intermediate risk disease. Minimal-invasive treatment strategies are emerging techniques. Different sources of energy are used to aim for targeted treatment in order to reduce treatment-related complications and morbidity. Imaging plays an important role in targeting and monitoring of treatment approaches preserving parts of the prostatic tissue. Multiparametric magnetic resonance imaging (mpMRI) is widely used during image-guided interventions due to the multiplanar and real-time anatomical imaging while providing an improved treatment accuracy. This review evaluates the available image-guided prostate cancer treatment options using MRI or magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion guided imaging. The discussed minimal invasive image-guided prostate interventions may be considered as safe and feasible partial gland ablation in patients with (recurrent) prostate cancer. However, most studies focusing on minimally invasive prostate cancer treatments only report early stages of research and subsequent high-level evidence is still needed. Ensuring a safe and appropriate utilization in patients that will benefit the most, and applied by physicians with relevant training, has become the main challenge in minimally invasive prostate cancer treatments.

Detection Rate of Prostate Cancer by Using Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Image-Guided Prostate Biopsy at Phramongkutklao Hospital

Objective: To determine the accuracy of prostate cancer detection by using magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion image-guided prostate biopsy. Materials and Methods: Retrospective data were collected from the patients that underwent targeted prostate biopsy guided by MRI-TRUS fusion imaging of the prostate between January 2017 and October 2018. The data including age, serum prostate-specific antigen (PSA) levels, PSA density, prostate size, lesion size from multiparametric magnetic resonance imaging of the prostate (mpMRI), Prostate Imaging and Reporting Archiving Data System score (PI-RADS), number of targeted core biopsy, and result from the pathological diagnosis were collected. Detection rate of prostate cancer was analyzed. Results: Ninety-five prostate cancer suspected patients underwent prostate biopsy for 143 lesions. Patients’ analyses showed better overall detection rate of prostate cancer from the MRI-TRUS fusion image-guided prostate biopsy compared to the extended 12-core systematic biopsy at 49.5% versus 17.9%. Significant prostate cancer with a Gleason score of more than 6 was detected by MRI-TRUS fusion image-guided prostate biopsy at 33.7%. Prostate cancer detection rates from MRI-TRUS fusion image-guided prostate biopsy categorized by PI-RADS score 3, 4, and 5 were 21%, 48%, and 74%, respectively, which showed statistically significant detection rate with higher PI-RADS score (p&lt;0.001). Conclusion: The present study showed better prostate cancer detection rate using MRI-TRUS fusion image-guide prostate biopsy with correlation to higher PI-RADS score. Keywords: Gleason score; PI-RADS score; mpMRI; MRI-TRUS fusion image-guided prostate biopsy

The Prostate Health Index aids multi-parametric MRI in diagnosing significant prostate cancer

To evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707–0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792–0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.

Institutional Adoption and Apprenticeship of Fusion Targeted Prostate Biopsy: Does Experience Affect the Cancer Detection Rate?

Introduction: There are limited data on the learning curve of magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion targeted prostate biopsies (tBx). Objective: The aim of this study was to investigate the difference in prostate cancer (PCa) detection rate between an experienced urologist and novice resident performing tBx. Methods: A total of 183 patients underwent tBx from 2012 to 2016 for a total of 518 tBx cores. Biopsies in this study were performed by an experienced urologist (investigator A) or a novice resident (investigator B). The outcome was the detection of PCa on tBx. Using a multivariable logistic regression model, we estimated odds ratios for the detection of PCa. Inverse probability treatment weighting (IPTW) was used to balance patients’ baseline characteristics and compare detection rates of PCa. Before performance of tBx, all patients underwent MRI. Results: On multivariable logistic regression analysis, investigator experience was associated with a higher odds of detection of PCa (OR = 1.003; 95% confidence interval 1.002–1.006, p = 0.037). After IPTW adjustment, there was no significant difference between the detection rate of investigator A (23%) and investigator B (32%; p = 0.457). Conclusions: Data revealed a positive association between investigator experience and the odds of PCa detection, although there was no difference in the detection rates of the investigators.

MRI/TRUS FUSION guided biopsy as first approach in ambulatory setting: Feasibility and performance of a new fusion device.

To evaluate the detection rate of Magnetic Resonance Imaging/Transrectal Ultrasound (MRI/TRUS) Fusion Biopsy performed in a series of patients with suspicious prostate cancer in an ambulatory setting. Between March 2018 and January 2019 a series of 155 patients undergoing MRI/TRUS fusionguided biopsy were prospectively enrolled. All patients presented a suspected diagnosis for prostate cancer because of raised Prostate Specific Antigen (PSA) serum level and/or abnormal physical examination (digital rectal examination), and showed at least one suspicious area at the multiparametric Magnetic Resonance Imaging (mpMRI). Of 155 patients, 58 (37.4%) were biopsy-naïve, 97 (62.6%) had at least 1 previous negative TRUS-guided biopsy. The median age of the patient cohort was 66 years (IQR, 61- 69); the median prebiopsy PSA value was 7.1 ng/ml (IQR, 5- 8.9). Overall, the Fusion-TB findings were positive in 94 of 155 patients with a detection rate (DR) of 60%; a significantly high DR was obtained in terms of clinically significant prostate cancer (csPCa) by Fusion-TB (61 pts; 41.9%). The overall DR in the 121 biopsy-naive patients was 60.6%. In the subgroup of the 34 patients with at least 1 previous set of TRUS-GB, overall DR was 39.3% (35/50). The targeted MRI/TRUS fusion-guided biopsy represents a safe and accurate approach for diagnosis of csPCa, especially in patient with previous TRUS guided biopsy negative and suspicious prostate cancer.

Is targeted magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy enough for the detection of prostate cancer in patients with PI-RADS ≥3: Results of a prospective, randomized clinical trial

To evaluate targeted magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion prostate biopsy versus systematic prostate biopsy and the two approaches combined for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in our center. From September 2018 to June 2020, a total of 161 patients with PI-RADS ≥3 were enrolled in this study. They were randomly to undergo either systematic prostate biopsy (systematic group) or targeted MRI/TRUS fusion prostate biopsy + systematic prostate biopsy (combined group). The clinical data and pathological results of biopsies were analyzed. The detection rate of PCa by targeted MRI/TRUS fusion prostate biopsy was higher than systematic prostate biopsy (38/81 vs. 33/81) in combinated group, but there was no significantly difference. The PCa detection rate in combinated group was significantly higher than systematic group (47/81 vs. 34/80, P = 0.049). There were 40 patients in combinated group and 22 patients in systematic group diagnosed as csPCa, respectively. The ratio of detected csPCa was much higher in combinated group (P = 0.032). In Gleason score no more than 6, the detected ratio of targeted MRI/TRUS fusion prostate biopsy was significantly lower than systematic biopsies in combinated group (P = 0.044). While, in Gleason score higher than 6, the detected ratios of targeted MRI/TRUS fusion prostate biopsy were all higher than systematic biopsies. Among patients with PI-RADS ≥ 3, targeted MRI/TRUS fusion prostate biopsy is superior to systematic prostate biopsy in the detection rate of PCa and csPCa, but it still misses some PCa patients, including csPCa. Combining targeted MRI/TRUS fusion prostate biopsy and systematic prostate biopsy can led to more detection of all PCas, especially csPCa.

The role of MRI/TRUS fusion biopsy in the diagnosis of clinically significant prostate cancer.

Background:The aim of this work is to evaluate the detection rate of magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion-guided biopsy for clinically significant prostate cancers (Cs PCas), with particular interest in biopsy-naive patients and patients in active surveillance. MRI-targeted biopsy improves cancer detection rate (DR) in patients with prior negative biopsies; the current literature focuses on biopsy naive patients. We also evaluated the pathologic concordance between biopsies and surgical specimens.Methods:MRI/TRUS fusion-guided biopsies were performed between February 2016 and February 2019. Patients with previous negative biopsies, biopsy-naive or in active surveillance (AS) were included. Cs PCas were defined through Epstein’s criteria.Results:A total of 416 men were enrolled. The overall DRs and Cs PCa DRs were 49% and 34.3%, respectively. Cs PCas were 17.2%, 44.9% and 73.4%, respectively for PI-RADS 3, 4 or 5. Among biopsy-naive patients, 34.8% were found to have a Cs PCa, while a 43.6% tumour upgrading was achieved in men with a low risk of PCa. In patients who underwent radical prostatectomy (RP), the concordance between biopsy Gleason score (GS) (bGS) and pathological GS (pGS) was 90.8%.Conclusion:Our study highlights the role of MRI/TRUS fusion prostate biopsy in the detection of PCa in patients with previous negative biopsies focusing on Cs PCa diagnosis. The MRI/TRUS fusion biopsy is also emerging as a diagnostic tool in biopsy-naïve patients and deserves a fundamental role in AS protocols. A greater concordance between bGS and pGS can be achieved with targeted biopsies.

Comparative analysis of adverse events using different methods of prostate biopsy

Background . The indicator of detected cases of prostate cancer (PCa) in 2015 was 38,812. The standardized incidence rate was 40.23per 100,000population. Increase in the incidence of PCa from 2005 to 2015 — 135.5 %. The average annual growth rate is 7.76 %. The histological verification of PCa is of great importance in the diagnosis and subsequent choice of treatment tactics. Currently, the most common method of transrectal “blind” prostate biopsy is to control the control, which does not have sufficient sensitivity and specificity for detecting PCa, and the morphological result contains limited information about the aggressiveness and stage of cancer. In connection with the development of modern methods of magnetic resonance diagnostics, such as multiparametric magnetic resonance imaging, which is currently the most sensitive and specific imaging method for the diagnosis of PCa, methods of targeted prostate biopsy are increasingly used in clinical practice. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging (MRI) as the most sensitive and specific imaging tool for detection, lesion characterisation and staging of PCa. Objective is to the safety and frequency of complications of transperineal, transrectal, MRI/TRUS (magnetic resonance imaging/transrectal ultrasound) fusion targeted-biopsy. Materials and methods. The fusion of magnetic resonance imaging data with transrectal ultrasound enables the targeted biopsy of suspicious areas. 142 consecutively selected patients were examined, mean age of 62.0 + 6.5 years. According to aim we assigned patients to 3 groups: 1 st group (n = 49) underwent repeated transrectal biopsy of the prostate; in patients of 2 nd group (n = 39) perineal biopsy of the prostate; in 3 rd group there were patients (n = 54) a targeted fusion biopsy with magnetic resonance imaging and transrectal ultrasound-navigation. Results. PCa was diagnosed in 26.5, 46.2 and 61.1 % respectively. The most frequent complication of biopsy of the prostate gland was hematuria. This symptom was found in 33.3 % patients of the 1 st group, 42.5 % in the 2 nd group and 42.2 % in the 3 rd group. The prolongation of hospitalization due to hematuria was required by 5patients (11.9 %) from 1 st group, 8 (17.0 %) from 2 nd and 5 (7.8 %) from group 3. Hospitalization and additional treatment was required in 8 (16.3 %) patients in 1 st group and 1 (2.5 %) in 2 nd group. Infectious-inflammatory complications are often diagnosed and require additional treatment. In 1 st group patients, this type of complication was observed in 16.3 %, 2 nd and 3 rd groups 5.1 % and 1.9 %, respectively. In 4.7 % of the patients in the 1 st group, sepsis was diagnosed, complications were not recorded in patients of groups 2 nd and 3 rd of the data group. When assessing the complications, there was a slight predominance of the complication rate of the standard transrectal biopsy procedure, but this difference was statistically insignificant (p >0.05). Conclusion . We compared the security of standard biopsy and perineal biopsy to diagnose PCa against a novel approach using software to overlay the images from magnetic resonance imaging and ultrasound to guide biopsies towards the suspicious areas of the prostate. We found consistentfindings showing the superiority of this novel targeted approach, although further high-quality evidence is needed to change current practice. No significant statistical differences were found in the complications rates between.

Evaluation of the Performance of the Ultrasound (US) Elastographic Q-Analysis Score Combined With the Prostate Imaging Reporting and Data System for Malignancy Risk Stratification in Prostate Nodules Based on Transrectal US-Magnetic Resonance Imaging Fusion Imaging.

This study retrospectively evaluated the prognostic performance of the ultrasound elastographic Q-analysis score (EQS) combined with the Prostate Imaging Reporting and Data System (PI-RADS) for malignancy risk stratification in prostate nodules based on transrectal ultrasound-magnetic resonance imaging fusion imaging. Sixty-two patients who were suspected to have PCa between October 2017 and May 2018 in our hospital were retrospectively evaluated. The performance of the EQS and PI-RADS was evaluated by patients' receiver operating characteristic curves in differentiating malignant and benign prostate nodules. The combination of the EQS and PI-RADS methods for prostate imaging was evaluated. Sixty-two prostate nodules in 62 patients were included. All of the patients underwent biopsy; 29 cases were prostate cancer, and the rest were benign prostate lesions. Both the EQS and PI-RADS were significantly higher in malignant nodules than in benign nodules. The sensitivity, specificity, area under the curve, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and Youden index of an EQS cutoff of 2.05 were 86.2%, 81.8%, 85.9%, 4.73, 0.169, 80.6%, 87.1%, and 68%, respectively. The corresponding numbers for a PI-RADS cutoff of 4 were 82.7%, 69.7%, 84.2%, 2.72, 0.25, 70.6%, 82.1%, and 52.4%. The "tandem" method had a higher diagnostic specificity (87.9%), positive likelihood ratio (6.55), and positive predictive value (85.1%). The "parallel" method had a higher diagnostic sensitivity (96.5%), negative likelihood ratio (0.06), and negative predictive value (95.2%). both the EQS and PI-RADS had good diagnostic performance in differentiating between malignant and benign prostate lesions. The combination of the EQS and PI-RADS improved the diagnostic performance to a certain degree.

Role of magnetic resonance imaging-transrectal ultrasound fusion targeted biopsy in the detection of prostate cancer in biopsy-naïve men: A literature based meta-analysis of randomized trials.

70 Background: Magnetic Resonance Imaging-Transrectal Ultrasound (MRI/TRUS) fusion targeted biopsy (TB) has been demonstrated to increase detection rates (DRs) of prostate cancer (PCa) in repeat-biopsy setting. However, its role in biopsy-naïve men remains controversial. We performed a meta-analysis based on well-designed randomized controlled trials (RCTs) to compare the diagnostic accuracy of MRI/TRUS fusion TB and systematic biopsy (SB) in the detection of PCa in biopsy-naïve men. Methods: A systematic review of PubMed (Medline), Embase, Ovid and the Cochrane Library up to 1st October, 2018 was conducted. The statistical analyses were performed with Revman 5.3. We compared the diagnostic accuracy between the intervention group (assisted with fusion TB) and the control group (SB only) by calculating the risk ratio (RR) with 95% confidence intervals (CIs) of overall PCa and clinically significant PCa (csPCa) DRs. Subgroup analysis was performed to highlight the independent role of MRI/TRUS fusion TB alone or combining fusion TB and SB together in the detection of PCa. Results: Six RCTs with 2187 participants were evaluated for the DRs of overall PCa. Pooled analysis revealed slight higher DRs of 62.7% (687/1095) in the intervention group compared with that of 41.3% (451/1092) in the control group (RR 1.40, 95% CI: 1.00-1.95). Four studies with 962 participants were evaluated for the DRs of csPCa. There is a trend favoring the intervention group which detected more csPCa (42.8%, 206/481) compared with SB in the control group (31.6%, 152/481) but with no significant difference (RR 1.36, 95% CI: 0.95-1.95). Subgroup analysis revealed fusion TB alone with less biopsy cores may equal the DRs of csPCa compared with SB alone (RR 1.24, 95% CI: 0.79-1.93). However, the DRs of overall PCa when combining MRI/TRUS fusion TB and SB was comparable to that applying SB alone (RR 1.48, 95% CI: 0.99-2.22). Conclusions: MRI/TRUS fusion TB may obtain similar csPCa DRs with less biopsy cores. But currently there was no enough evidence showing fusion TB can help significantly improve overall PCa or csPCa DRs compared with SB alone in biopsy-naïve men.

A review of optimal prostate biopsy: indications and techniques.

Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Patient selection for prostate biopsy is complex and is influenced by emerging use of prebiopsy imaging. The introduction of the magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion prostate biopsy has clear advantages over the historical standard of care. There are several biopsy techniques currently utilized with unique advantages and disadvantages. We review and summarize the current body of literature pertaining to when and how a prostate biopsy should be performed. We discuss current recommendations regarding patient selection for biopsy and discuss future directions regarding prebiopsy imaging. We offer a description of the MRI–TRUS fusion biopsy technique and a comparison of many of the currently available fusion software platforms. Articles pertaining to the title were obtained via PubMed index search with relevant keywords supplemented with personal collection of related publications. Prostate biopsy should be considered for patients with gross digital rectal exam (DRE) abnormality, patients with a prostate-specific antigen (PSA) greater than 4 ng/ml, and concomitant risk factors for prostate cancer or patients with lesions identified on multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System 2 (PI-RADS2) score of 4 or 5. MRI–TRUS fusion biopsy has demonstrated advantages in cancer detection when compared with TRUS-guided biopsy. There are currently several fusion software platforms available with a variety of biopsy approaches. Future efforts should detail the role of prebiopsy imaging as a triage tool for prostate biopsy. Consensus should be sought regarding the preferred modality of fusion biopsy. Additional data describing each fusion software platform would enable a more rigorous comparison of platform sensitivities.

Magnetic Resonance Imaging–guided In-bore and Magnetic Resonance Imaging-transrectal Ultrasound Fusion Targeted Prostate Biopsies: An Adjusted Comparison of Clinically Significant Prostate Cancer Detection Rate

BackgroundWith the increasing adoption of targeted prostate biopsies, it becomes important to understand the strengths and shortcomings of the techniques available for targeting suspicious lesions. ObjectiveTo compare clinically significant prostate cancer (csPCa) detection rate with magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion versus in-bore biopsy in men with abnormal multiparametric MRI (mpMRI). Design, setting, and participantsThis single-center, retrospective analysis of prospectively generated data included all men with abnormal mpMRI and fusion or in-bore biopsy between May 2017 and April 2018. Grade group (GG) 2–5 cancers were considered csPCa. Outcome measurements and statistical analysisDetection of csPCa was adjusted according to patient- and lesion-related characteristics using propensity score weighting. Secondary endpoints included the detection of clinically insignificant tumors and the rate of GG upgrade from biopsy to prostatectomy specimen. Analyses were performed at patient and lesion levels. Results and limitationsA total of 103 and 300 men were included in the in-bore and fusion cohorts, respectively. On a per-patient basis, in-bore biopsies detected a higher proportion of csPCa (61%, 63/103) than fusion plus systematic biopsies (47%, 141/300; adjusted odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.6–2.8, p<0.0001). In-bore biopsies also detected fewer (11%, 11/103) clinically insignificant cancers than fusion biopsies (18%, 53/300; OR: 0.5, 95% CI: 0.3–0.8, p=0.001). Of those who had radical prostatectomy, GG upgrade after surgery was seen in 17% (4/24) of the men in the in-bore cohort and in 27% (22/82) of the men in the fusion cohort (p=0.55). ConclusionsMRI-guided in-bore biopsies detected more clinically significant and fewer insignificant prostate cancers than MRI-TRUS fusion targeted biopsies. Further cost-utility and patient outcome analyses are needed. Patient summaryIn-bore biopsies (where the patient is on the magnetic resonance imaging [MRI] scanner itself) detected more aggressive cancers and fewer indolent cancers than fusion (where software blends MRI and ultrasound images) biopsies. These findings may help patients and physicians choose the best biopsy approach.

Multiparametric magnetic resonance imaging - Transrectal ultrasound-guided cognitive fusion biopsy of the prostate: Clinically significant cancer detection rates stratified by the Prostate Imaging and Data Reporting System version 2 assessment category.

We aimed to report the clinically significant prostate cancer (PCa) detection rate in men undergoing magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-cognitive fusion (CF) targeted biopsies stratified by the Prostate Imaging and Data Reporting System (PI-RADS) version 2 (v2) scores. With a quality assurance waiver from the IRB, we identified a cohort of men who underwent MRI-TRUS-CF and synchronous template biopsy from 2015-2017. MRI (PI-RADS v2 score, lesion size, lesion location [peripheral or transition zone (PZ/TZ)]), and CF-TRUS biopsy (operator experience, TRUS visibility, and number of biopsies) features were extracted. The primary outcome was diagnosis of clinically significant (Gleason score ≥3+4=7 or International Society of Urological Pathology (ISUP) grade group ≥2) PCa. During the study period, 131 men (with 142 PIRADS v2 score ≥3 lesions) met inclusion criteria; 98 men had previously negative template biopsy and 33 were on active surveillance for previously detected low-grade PCa. In total, 41.9% (55/131) men had clinically significant PCa - 17.6% (23/131) detected on targeted biopsy only, 8.4% (11/131) on template biopsy only, and 16.0% (21/131) on both targeted and template biopsy. Clinically significant PCa detection stratified by PI-RADS v2 scores were: 11.1% (3/27) for score 3 (indeterminate), 42.9% (24/56) for score 4 (significant cancer likely), and 35.6% (21/59) for score 5 (significant cancer very likely). Clinically significant PCa detection rates in targeted biopsies were better among PZ (41.8% [33/79]) compared to TZ (23.8% [15/63]) lesions (p=0.025) in TRUS visible lesions (p=0.033) and in the most experienced radiologists (p=0.05), with no difference by lesion size or number of additional core biopsies performed (all p&gt;0.05). Cognitive fusion MRI-TRUS-guided targeted biopsy yielded substantially lower rates of clinically significant cancer in PI-RADS v2 score 4 and 5 lesions when compared to published results using in-bore MR-guided or automated MRI-TRUS fusion guidance systems. Cancer detection was worst for TZ lesions.

Impact of Lesion Visibility on Transrectal Ultrasound on the Prediction of Clinically Significant Prostate Cancer (Gleason Score 3 + 4 or Greater) with Transrectal Ultrasound-Magnetic Resonance Imaging Fusion Biopsy

The purpose of this study was to estimate the impact of lesion visibility with transrectal ultrasound on the prediction of clinically significant prostate cancer with transrectal ultrasound-magnetic resonance imaging fusion biopsy. This HIPAA (Health Insurance Portability and Accountability Act) compliant, institutional review board approved, retrospective study wasperformed in 178 men who were 64.7 years old with prostate specific antigen 8.9ng/ml. They underwent transrectal ultrasound-magnetic resonance imaging fusion biopsy from January 2013 to September 2016. Visible lesions on magnetic resonance imaging were assigned a PI-RADS™ (Prostate Imaging Reporting and Data System), version 2 score of 3 or greater. Transrectal ultrasound was positive when a hypoechoic lesion was identified. We used a 3-level, mixed effects logistic regression model to determine how transrectal ultrasound-magnetic resonance imaging concordance predicted the presence of clinically significant prostate cancer. The diagnostic performance of the 2 methods was estimated using ROC curves. A total of 1,331 sextants were targeted by transrectal ultrasound-magnetic resonance imaging fusion or systematic biopsies, of which 1,037 were negative, 183 were Gleason score 3 + 3 and 111 were Gleason score 3 + 4 or greater. Clinically significant prostate cancer was diagnosed by transrectal ultrasound and magnetic resonance imaging alone at 20.5% and 19.7% of these locations, respectively. Men with positive imaging had higher odds of clinically significant prostate cancer than men without visible lesions regardless of modality (transrectal ultrasound OR 14.75, 95% CI 5.22-41.69, magnetic resonance imaging OR 12.27, 95% CI 6.39-23.58 and the 2 modalities OR 28.68, 95% CI 14.45-56.89, all p <0.001). The ROC AUC to detect clinically significant prostate cancer using the 2 methods (0.85, 95% CI 0.81-0.89) was statistically greater than that of transrectal ultrasound alone (0.80, 95% CI 0.76-0.85, p = 0.001) and magnetic resonance imaging alone (0.83, 95% CI 0.79-0.87, p = 0.04). The sensitivity and specificity of transrectal ultrasound were 42.3% and 91.6%, and the sensitivity and specificity of magnetic resonance imaging were 62.2% and 84.1%, respectively. Lesion visibility on magnetic resonance imaging or transrectal ultrasound denotes a similar probability of clinically significant prostate cancer. This probability is greater when each examination is positive.

Multiparametric MRI/TRUS Fusion Prostate Biopsy: Advantages of a Transperineal Approach

To evaluate the detection rate for clinically-significant prostate cancer (PCa) of transperineal (TP) vs. transrectal (TR) multiparametric MRI/TRUS (magnetic resonance imaging/transrectal ultrasound) fusion targeted-biopsy. From January 2016 to December 2016, 150 men underwent repeat saturation transperineal prostate biopsy (SPBx; median 30 cores) combined with targeted mpMRI/TRUS TR and TP fusion biopsies (4 cores for each procedure) of suspicious MRI lesions (PI-RADS 3/5). Overall, in 55/150 (36.6%) men a clinically-significant PCa was found and in 49 (89.1%) of them mpMRI was positive. SPBx, mpMRI/TRUS TR and TP fusion targeted-biopsy diagnosed 52 (94.5%), 43 (78.1%) and 49 (89.1%) PCa, respectively; TR fusion biopsy missed 8 (53.3%) while TP missed 2 (13.3%) cancers of the anterior zone. Multiparametric MRI/TRUS TP in comparison to TR fusion biopsy detected a greater percentage of small but clinically significant PCa of the anterior zone (86.7% vs. 46.7%; p=0.0001).

MP38-12 PROPENSITY SCORE ANALYSIS OF PATHOLOGICAL OUTCOME AT RADICAL PROSTATECTOMY FOR MAGNETIC RESONANCE IMAGING-TRANSRECTAL ULTRASOUND FUSION PROSTATE BIOPSY VERSUS UNTARGETED EXTENDED TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2017MP38-12 PROPENSITY SCORE ANALYSIS OF PATHOLOGICAL OUTCOME AT RADICAL PROSTATECTOMY FOR MAGNETIC RESONANCE IMAGING-TRANSRECTAL ULTRASOUND FUSION PROSTATE BIOPSY VERSUS UNTARGETED EXTENDED TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY Hans Arora, Ahmed Elshafei, Yaw Nyame, Daniel Sun, Helen Liang, Nitin Yerram, Daniel Greene, Dominic Grimberg, Karishma Gupta, Shree Agrawal, Sudhir Isharwal, Paurush Babbar, Andrew Sun, Khaled Fareed, Michael Gong, Ryan Berglund, Eric Klein, Andrew Stephenson, Andrei Purysko, and J. Stephen Jones Hans AroraHans Arora More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , Yaw NyameYaw Nyame More articles by this author , Daniel SunDaniel Sun More articles by this author , Helen LiangHelen Liang More articles by this author , Nitin YerramNitin Yerram More articles by this author , Daniel GreeneDaniel Greene More articles by this author , Dominic GrimbergDominic Grimberg More articles by this author , Karishma GuptaKarishma Gupta More articles by this author , Shree AgrawalShree Agrawal More articles by this author , Sudhir IsharwalSudhir Isharwal More articles by this author , Paurush BabbarPaurush Babbar More articles by this author , Andrew SunAndrew Sun More articles by this author , Khaled FareedKhaled Fareed More articles by this author , Michael GongMichael Gong More articles by this author , Ryan BerglundRyan Berglund More articles by this author , Eric KleinEric Klein More articles by this author , Andrew StephensonAndrew Stephenson More articles by this author , Andrei PuryskoAndrei Purysko More articles by this author , and J. Stephen JonesJ. Stephen Jones More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1165AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided prostate biopsy has been shown to increase the detection of clinically significant prostate cancer (PCa) by targeting specific lesions at biopsy. Our objective was to evaluate the accuracy of MRI-TRUS fusion biopsy to determine final pathology at radical prostatectomy (RP) as compared to untargeted extended template TRUS-guided prostate biopsy. METHODS From a single institution database, 2,201 patients were identified who underwent both prostate biopsy and RP between 2006 and 2016. Propensity score matching was performed with the nearest neighbor method using R-programming version 3.3.1 and a 4:1 match ratio. A total of 101 men were identified who underwent MRI-TRUS plus standard template biopsies were subsequently matched to 404 men who underwent untargeted extended template TRUS biopsy. Matched covariates included age at diagnosis, initial prostate specific antigen (PSA), race, clinical stage, total number of cores retrieved at time of biopsy, and history of prior TRUS biopsy. Continuous variables were compared using Wilcoxon rank-sum tests and categorical variables were assessed with χ2 test. The concordance of Gleason score from biopsy to RP was assessed. RESULTS After propensity score matching, median age was 64 years (IQR 59.5-68.5), median PSA was 5.4 ng/mL (IQR 4.0-8.1), median prostate size was 48 grams (IQR 38.5-60), and median number of cores retrieved at time of biopsy was 15 (IQR 12-20). Of patients who received MRI-TRUS plus standard template biopsy, 67 of 99 (67.7%) showed concordant Gleason grading between biopsy and RP pathology, whereas 204 of 397 (51.4%) of extended template TRUS biopsy patients were concordant (p<0.01). Fewer MRI-TRUS plus standard template biopsy patients were either upgraded (26.3% versus 32.2%) or downgraded (6.1% versus 15.4%) from biopsy to RP (p<0.01). CONCLUSIONS Of men undergoing TRUS biopsy for the diagnosis of PCa, MRI-TRUS fusion plus standard template techniques have a higher concordance with final pathology at RP. Additionally, MRI-TRUS techniques demonstrated better accuracy with lower rates of upgrading and downgrading prostatectomy when compared to untargeted extended template TRUS biopsy independent of total number of cores taken. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e488-e489 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Hans Arora More articles by this author Ahmed Elshafei More articles by this author Yaw Nyame More articles by this author Daniel Sun More articles by this author Helen Liang More articles by this author Nitin Yerram More articles by this author Daniel Greene More articles by this author Dominic Grimberg More articles by this author Karishma Gupta More articles by this author Shree Agrawal More articles by this author Sudhir Isharwal More articles by this author Paurush Babbar More articles by this author Andrew Sun More articles by this author Khaled Fareed More articles by this author Michael Gong More articles by this author Ryan Berglund More articles by this author Eric Klein More articles by this author Andrew Stephenson More articles by this author Andrei Purysko More articles by this author J. 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