PURPOSE: Multi-parametric magnetic resonance imaging (mpMRI) can be used to guide prostate biopsy by targeting biopsies to areas within the prostate at high risk of cancer.
We compared the detection of clinically significant and clinically insignificant cancer by transperineal MRI-targeted biopsy (MRI-TB) with transperineal template-guided prostate biopsy (TPB).
MATERIALS AND METHODS: One-hundred and eighty-two men who had a lesion suspicious for cancer on mpMRI underwent transperineal MRI-TB using a cognitive registration technique followed by systematic transperineal TPB. The primary outcome was detection rate of clinically significant prostate cancer. Clinical significance was defined using maximum cancer core length(MCCL)≥ 4mm and/or Gleason Grade(GG)≥ 3+4 (UCL definition 2). Other commonly used thresholds of clinically significant disease (MCCL≥6mm and/or GG≥4+3; MCCL≥3mm and/or GG≥3+4; MCCL≥2mm and/or GG≥3+4) were secondarily evaluated. Statistical comparison between strategies was carried out using McNemar's test.
RESULTS: Mean age was 63.3 years (SD±7.2) and median PSA was 6.7 ng/ml (interquartile range 4.7-10.0). Clinically significant cancer detection with MRI-TB and TPB was 57% (103/182) and 62% (113/182) respectively (p=0.174). Clinically insignificant cancer detection with MRI-TB and TPB was 9.3% (17/182) and 17.0% (31/182) respectively (p=0.024).
CONCLUSIONS: The use of prostate biopsies targeted to suspicious lesions on mpMRI has encouraging rates of detection of clinically significant cancer whilst also reducing the rate of detection of clinically insignificant cancer. It does this with fewer biopsy cores than systematic template guided biopsy. Further prospective multicentre comparative trials investigating the performance of targeting strategies are necessary to consider MRI-TB as an alternative to conventional systematic biopsy.
Kasivisvanathan V, Dufour R, Moore CM, Ahmed HU, Abd-Alazeez M, Charman SC, Freeman A, Allen C, Kirkham A, van der Meulen J, Emberton M. Are you the author?
Division of Surgery and Interventional Sciences, University College London, UK; Urology Department, Division of Surgery, University College London Hospitals Trust, London, UK.
Reference: J Urol. 2012 Oct 10. pii: S0022-5347(12)05188-9.