PURPOSE:To assess the value of MRI targeted biopsies (TB) alone over prostatic random biopsies (RB), and compare the accuracy of visual (Visual-TB) versus computerized TRUS-MRI image registration using a non deformable (Esaote®-TB) or a deformable (Koelis®-TB) approach.
PATIENTS AND METHODS:391 consecutive patients with suspected localized prostate cancer were prospectively included. All patients underwent prostate MRI followed by prostate 10-12 cores RB. In case of MRI-detected suspicious findings, TB was performed: Visual-TB were performed in the first 127 patients, Esaote®-TB in the next 131 patients and Koelis®-TB in the last 133 patients. The comparison of cancer detection rates was assessed by conditional logistic regression. TB alone and RB were further compared for the amount of tissue sampled and microfocal cancer (MFC) detection. MFC was defined as one single core with ≤ 5 mm of Gleason 6 cancer.
RESULTS:Patients' characteristics and RB detection rates were similar between groups. MRI detected at least one suspicious area in 54 (42%), 78 (59%), and 82 (62%) patients in groups 1, 2 and 3. Cancer detection rates of Esaote®-TB and Koelis®-TB were significantly higher than that of RB (p=0.0065 and p=0.0016, respectively). Visual-TB did not perform better than RB (p=0.66). Esaote®-TB and Koelis®-TB allowed decreasing the number of cores and the detection of MFC, while increasing the detection of high grade cancers.
CONCLUSIONS: TB alone, when performed with computerized MRI-TRUS image registration, improved cancer detection over RB, decreased the detection rate of MFC and increased that of Gleason score >6 cancers.
Delongchamps NB, Peyromaure M, Schull A, Beuvon F, Bouazza N, Flam T, Zerbib M, Muradyan N, Legman P, Cornud F. Are you the author?
Department of Urology, AP-HP, Cochin hospital, Paris Descartes University, France.
Reference: J Urol. 2012 Sep 13. pii: S0022-5347(12)04875-6.