Critical evaluation of MRI-targeted TRUS-guided transperineal fusion biopsy for detection of prostate cancer - Abstract

PURPOSE: Diagnosis and precise risk stratification of prostate cancer (PC) is essential for individualized treatment decisions.

MRI/TRUS fusion has shown encouraging results for detecting clinically significant prostate cancer. Here we critically evaluate MRI-targeted TRUS-guided transperineal fusion biopsy in routine clinical practice.

MATERIALS AND METHODS: 347 consecutive patients with suspicion of PC were prospectively included. The median age of patients was 65 years (range 42-84). Mean PSA level was 9.85ng/ml (0.5-104). 49% of men had previous negative TRUS-guided biopsies, 51% underwent primary biopsy. All patients underwent multiparametric (mp)-MRI at 3T and received systematic stereotactic prostate biopsies plus MRI-targeted TRUS-guided biopsies in case of MRI abnormalities. Imaging data and biopsy results were analyzed and a self-designed questionnaire was sent to all men regarding further clinical history and adverse effects of the biopsy.

RESULTS: 200 of 347 (58%) biopsy samples showed PC. 73.5% of biopsy proven PC was clinically relevant (NCCN criteria). On mp-MRI, 104 men were reported as highly suspicious for PC and, in these, the tumor detection rate was 82.6% (86/104) with 72% Gleason scores ≥7. Overall, targeted cores detected significantly more cancer than systematic biopsies (30% vs. 8.2%). In patients without cancer-suspicious MRI-lesions, 11.7% (11/94) were diagnosed with intermediate risk disease. Regarding adverse effects, 50.6% of patients (152/300) reported mild hematuria, 26% temporary erectile dysfunction and 2.6% needed short-term catheterization after biopsy. In three patients (1%) non-septic febrile urinary tract infection occurred.

CONCLUSIONS: MRI-targeted TRUS-guided transperineal fusion biopsy provides high detection rates of clinically significant tumors. mp-MRI still has some limitations, and therefore systematic biopsies should currently not be omitted. The morbidity of the transperineal saturation approach is reasonable and mainly self-limiting.

Written by:
Kuru TH, Roethke MC, Seidenader J, Simpfendörfer T, Boxler S, Alammar K, Rieker P, Popeneciu VI, Roth W, Pahernik S, Schlemmer HP, Hohenfellner M, Hadaschik BA.   Are you the author?
Department of Urology, UniversityHospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Reference: J Urol. 2013 Apr 19. pii: S0022-5347(13)04093-7.
doi: 10.1016/j.juro.2013.04.043

PubMed Abstract
PMID: 23608676 Prostate Cancer Section