EAU 2018: The FUTURE trial: A Multicenter RCT on Three Techniques of MRI Targeted Prostate Biopsy

Copenhagen, Denmark (UroToday.com) Guidelines advise a multi-parametric MRI (mpMRI) in patients with prior negative prostate biopsies and a persisting suspicion of prostate cancer, enabling targeted biopsy of MRI lesions. At today’s EAU 2018 prostate cancer session, Dr. Wegelin and colleagues presented results of the FUTURE trial, assessing three techniques for MRI targeted biopsy. Although these three techniques for MRI targeted biopsy exist, there is no consensus on which is preferred. The objective of the multicenter randomized control FUTURE trial is to compare detection rates of (significant) prostate cancer for MRI targeted biopsy using cognitive TRUS, MR-TRUS fusion or in-bore MRI.

For this trial, 642 men were recruited between 2014 and 2017 with prior negative prostate biopsies and a suspicion on prostate cancer (based on PSA≥4 and/or abnormal DRE) who underwent an mpMRI. Imaging was centrally evaluated by an expert radiologist using PIRADS v2. If mpMRI demonstrated PIRADS ≥3 lesions, patients were randomized 1:1:1 for MRI-targeted biopsy using one of the three aforementioned approaches. Overall prostate cancer and significant prostate cancer (Gleason≥7) detection rates were compared using the Pearson Chi square test.

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There were 231 patients (36.0%) who had a PIRADS ≥3 lesion on mpMRI, and 223 underwent MRI-targeted biopsy. There were no significant differences in baseline characteristics, nor were PIRADS scores significantly different between the three groups (p=0.87).

Table: PIRADS scores stratified by MRI-targeted approach
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Using cognitive TRUS biopsy, prostate cancer was detected in 44.0% of cases, and significant prostate cancer in 33.3%. Using MR-TRUS fusion biopsy, prostate cancer was detected in 49.3%, and significant prostate cancer in 33.3%. Using in-bore MRI biopsy, prostate cancer was detected in 56.2%, and significant prostate cancer in 34.2%. The detection rates of the three MRI-targeted techniques were neither significantly different for overall prostate cancer detection (p=0.33) nor for significant prostate cancer (p=0.99).

The authors concluded that based on the results of this multicenter RCT, there does not seem to be a significant advantage of one specific MRI-targeted biopsy technique for the detection of (clinically significant) prostate cancer following prior negative prostate biopsies.

Speaker: Olivier Wegelin, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands

Co-Authors: Exterkate L, Somford D, Barentsz J, Leest Van Der M, Kummer A, Vreuls W, Bruin, De P, Bosch R, Melick, Van H

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark