Anterior localization of prostate cancer suspicious MRI lesions in patients undergoing initial and repeat biopsy: Results from 1,161 patients undergoing MRI/ultrasound fusion-guided targeted biopsies

Based on findings from transrectal ultrasound guided (TRUS) biopsies series, standard sampling of the prostate targets the posterior/peripheral zone. However, a substantial proportion of PCa suspicious MRI PI-RADS ≥3 lesions is located in the anterior segment of the prostate, requiring a deeper placement and targeting of the biopsy needle.

Overall, 1,161 patients underwent MRI/ultrasound fusion-guided targeted biopsy. PCa suspicious MRI lesions were dichotomized into anterior vs. posterior prostate segments. Patients were stratified according to number of prior negative systematic biopsy (SB) sessions. Descriptive statistics included frequencies and proportions of mpMRI findings and corresponding histologic results.

Targeted biopsy was performed in 513 (44%) SB naïve patients, 396 (34%) patients with one prior negative SB and 252 (22%) patients ≥2 prior negative SB. The proportion of patients with exclusively anterior located MRI PI-RADS ≥3 lesions increased from 3.5 to 9.1% (p=0.006), when patients were stratified according to number of prior SB sessions. Unfavorable primary Gleason patterns 3+4 and ≥4+3 were more often identified in exclusively- anterior vs. posterior located lesions in 31 vs. 21% (each, p=0.016) in 448 patients with either exclusively- anterior (n=64) vs. posterior (n=384) located MRI PI-RADS ≥3 lesions. Multivariable logistic regression analyses confirmed these findings.

After multiple previous negative SB sessions, the proportion of anterior located MRI lesions increase. Such lesions harbor a higher amount of unfavorable PCa. Therefore, image-guidance for precise targeting should be considered especially after initial negative TRUS guided SB.

The Journal of urology. 2018 Jun 20 [Epub ahead of print]

Sami-Ramzi Leyh-Bannurah, Mykyta Kachanov, Dirk Beyersdorff, Felix Preisser, Derya Tilki, Margit Fisch, Markus Graefen, Lars Budäus

Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada., Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: .