Purpose:In this study we evaluated the role of multiparametric magnetic resonance imaging (mp-MRI) for targeted biopsy of early stage prostate cancer.
Methods:A total 32 consecutive patients with slow rising prostate specific antigen greater than 2ng/ml and less than 15 ng/ml, prior negative biopsy, or positive biopsy with low-risk features being treated with active surveillance were selected to undergo mp-MRI 3 Tesla with endorectal coil. In first group, we used the MRI-suggested targeted biopsy when we performed mpMRI first and then biopsied the suspicious lesions in usual setting using TRUS-guided biopsy. In second group we tested a fusion MRI-TRUS-guided biopsy. In both groups we also used random biopsy of non-suspicious (by mp-MRI) areas of prostate. A third group included patients with focal lesions revealed on screening biopsy or consequently elevated PSA level who underwent a MRI-guided biopsy of these lesions only, (without random biopsy).
Results:The tumor detection rate of MRI-suggested TRUS-guided biopsy (Group 1) was 33.3% (3 of 10 patients), while for fusion MRI-TRUS-guided biopsy (Group 2) it was significantly higher as of 46.2%. The sensitivity and specificity for the first group was 45.5% and 33.3%, versus 61.9% and 20.8% in second group respectively. In third group the cancer detection rate was much higher, (80%), than in the second group, (p=0.005), although majority of these patients, (7 of 10), had a previously diagnosed prostate cancer on TRUS-guided 12 core biopsy.
Conclusion: Our preliminary experience of mp-MRI suggests an increase in the early detection of early stage prostate cancer with low-risk features as potential candidates for focal targeted therapy. The MRI-TRUS fusion system increases diagnostic yield compared to MRI-suggested TRUS-guided biopsy. The MRI-guided biopsy can be reserved to distinguish focal lesion/s.
Written by:
Mouraviev V, Pugnale M, Kalyanaraman B, Verma S, Zhai QJ, Gaitonde K, Donovan JF. Are you the author?
University of Cincinnati, Urology/Surgery, Cinicnnati, Ohio, United States.
Reference: J Endourol. 2012 Sep 11. Epub ahead of print.
doi: 10.1089/end.2012.0215
PubMed Abstract
PMID: 22966987
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