Editor's Commentary - MRI-guided prostate biopsy detects clinically significant cancer: Analysis of a cohort of 100 patients after previous negative TRUS biopsy

BERKELEY, CA (UroToday.com) - In the online edition of the World Journal of Urology, a group of German researchers report that MRI-guided prostate biopsy (MR-GB) has a high detection rate of clinically significant prostate cancer (CaP) in patients with a prior negative prostate biopsy.

The study was prompted due to the limitations of systematic, but non-targeted traditional prostate biopsies.

A total of 100 patients underwent MR-GB between 2005 and 2009. The study population was select, in that they all had at least one lesion suspicious for Cap in a previous MRI. The MR-GB was performed in a 1.5 Tesla machine with an endorectal coil. Lesion identification was augmented by the use of diffusion-weighted imaging (DWI), MR-spectroscopy, and dynamic contrast enhanced imaging (DCE). MRI-GB included at least 2 specimens obtained from the suspicious area. They defined clinically significant CaP as at least one of the following criteria; Gleason grade ≥4, final T stage >pT3a, and/or N1, and tumor volume >0.5cc.

Mean patient age was 64.6 years old, mean PSA level was 12.3ng/ml and average prostate volume was 46.7cc. The median number of previous biopsies patients had undergone was 2. MRI identified a mean of 1.16 suspicious areas resulting in a median of 4 biopsy cores per patient. CaP was detected in 52 patients (52%) with a median Gleason score of 7. CaP was localized in the peripheral zone in 63.4% (33 men) and in the transition zone in 34.6% (18 men). Among the 48 men without CaP detected, 14 had prostatitis and 9 had PIN or ASAP. Twenty-seven of the 52 men with CaP underwent radical prostatectomy. Pathology revealed non-organ confined disease in 15 and 20/27 had a Gleason grade of 4 or 5. Tumor volume was >0.05cc in 18 men. In total, 23 met the criteria for significant CaP. Among the patients not undergoing surgery, 19 met the criteria for clinically significant disease. Thus, 42 of 52 patients (80.8%) had clinically significant disease.

Roethke M, Anastasiadis AG, Lichy M, Werner M, Wagner P, Kruck S, Claussen CD, Stenzl A, Schlemmer HP, Schilling D


World J Urol. 2011 Apr 22. Epub ahead of print.

PubMed Abstract
PMID: 21512807

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