A total of 210 men underwent 3 Tesla multiparametric MR imaging (mpMRI) and fusion biopsy consecutively between 2015-2017. Only Patients with a PIRADS-score (Version 1.0 + 2.0) III - V were included in this study. The fusion biopsy was used to obtain targeted cores from the region of interest (ROI) (mean 6.7 Biopsies) followed by a systematic biopsy (mean 8.6 biopsy). Biopsy cores were sent to the pathologist without specification of the PIRADS score and no information was given of where the cores were taken from. Clinical significant PCa was defined by the Epstein criteria.
Among the 210 men 59 (28%) underwent first biopsy whereas 151 Patients (72%) underwent repeated biopsy. The median PSA level was 10.2 ng/ ml. The median prostate volume was 58 ml. The mean overall number of biopsies taken was 15.3. The median volume of the ROI was 2.9 ml. The overall cancer detection Rate was 52.9% (111 patients). When stratified according to PI-RADS score V, IV and III, the detection rate was 86.4%, 51.6% and 18.9% respectively. Combing target and systemic biopsy resulted in a higher detection of PCa than one method alone. Targeted-91% vs systematic 41% of cancers would have been missed by using the target biopsy only. Significant prostate cancer was found in 81% of the positive targeted biopsies and 30% of the positive systematic biopsies.
The Real time TRUS/MRI Fusion Biopsy system -Biojet demonstrated a reliable and reproducible higher detection rate than the systematic prostate biopsy alone, while taking fewer cores. Targeted and systematic biopsy in combination detected more PCa than either modality alone. Insignificant PCa was found only in 19% of the fusion biopsies. Due to the additional detection of PCa in the systemic biopsy it should be performed together with a target biopsy.
Presented by: Drerup M
Affiliation: University Clinic of Urology Salzburg, Salzburg, Austria
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