SIU 2017: Outcomes of Cognitive MRI Targeted TRUS Biopsy of Prostate

Lisbon, Portugal (  Trans-rectal ultrasound guided biopsy of prostate (TRUS-BP) is the gold standard diagnostic investigation for patients presenting with an abnormal PSA and/or abnormal digital rectal examination. However, this procedure entails significant risks. Use of multiparametric MRI has been evolving over the past decade with various methods of performing targeted TRUS-BP. The simplest method is cognitive MRI targeting with visual registration of regions of interest.

The authors performed a retrospective analysis of cognitive MRI guided TRUS biopsies at a single center. 152 patients underwent cognitive MRI guided TRUS-BP between June 2014 and September 2015 performed by a single experienced consultant. Median age was 66.9. Thirteen patients were biopsied as part of active surveillance; 139 patients after presentation with a raised PSA and/ or abnormal DRE and had undergone at least one negative TRUS-BP previously. Median PSA in the active surveillance group was 6.2 and 9.6 in the negative biopsy group.

Of the 139 patients who had previous negative TRUS-BP, 33 had a cancer detected following cognitive MRI guided biopsy (23.7%). Nine patients had low risk prostate cancer detected, 19 intermediate risks, and 5 high risk. Of the 13 patients in the active surveillance group 5 patients had a negative targeted biopsy and continued on the active surveillance pathway. Of the 8 positive biopsies 4 had had an upgrade of their pathology.

Like similar studies, this study has shown that uses of cognitive MRI targeted biopsies has been shown to significantly increase the detection of prostate cancer in patients with a previous negative biopsy. In this population, cognitive MRI targeted biopsies detected prostate cancer in 23.7% of patients who had previous negative biopsies. Although the current literature suggests MRI-TRUS fusion biopsies have higher detection rates than cognitive-guided biopsies, it is important to remember the financial burden associated with the equipment needed for this procedure. Cognitive MRI targeted biopsies are a viable and less expensive alternative method to increase detection rate.

Presented by: Downey A
Affiliation: Royal Hallamshire Hospital, Sheffield, United Kingdom

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal