PURPOSE: Multiparametric-MRI (mp-MRI) and MRI-targeted biopsy may improve detection of clinically significant prostate cancer (PCa).
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However, standardized prospective evaluation is limited.
MATERIAL AND METHODS: 294 consecutive men with suspicion of PCa (186 primary, 108 repeat-biopsies) enrolled in 2013 underwent 3T mp-MRI (T2w,DWI,DCE) without endorectal-coil and systematic transperineal cores (SB, median 24) independently of MRI-suspicion and MRI-targeted cores with software-registration (TB, median 4). The highest Gleason score (GS) from each biopsy-method was compared. McNemar's-tests were used to evaluate detection-rates. Predictors of GS≥7 disease were assessed using logistic regression.
RESULTS: Overall 150 cancers and 86 GS≥7 cancers were diagnosed. SB missed 18 GS≥7 tumors (20.9%), while TB did not detect 11 (12.8%). TB of PIRADS 2-5 alone overlooked 43.8% of GS6 tumors. McNemar's-tests for detection of GS≥7 cancers in both modalities were not statistically significant, but showed a trend of superiority for targeted primary biopsies (p=0.08). Sampling-efficiency was in favor of MRI-targeted prostate biopsy: 46.0% TB vs. 7.5% SB-cores detected GS≥7 cancers. To diagnose one GS≥7 cancer 3.4 targeted and 7.4 systematic biopsies were needed, respectively. Limiting biopsy to men with PIRADS 3-5 would have missed 17 GS≥7 tumors (19.8%), demonstrating limited MRI-sensitivity. PIRADS-scores, DRE-findings and PSA-levels>20ng/ml were predictors for GS≥7.
CONCLUSIONS: Compared to SB as reference-test, MRI-targeted biopsy alone detected as many GS≥7 tumors while simultaneously mitigating detection of lower-grade disease. The gold standard for cancer-detection in primary biopsy is a combination of systematic and targeted cores.
Radtke JP, Kuru TH, Boxler S, Alt CD, Popeneciu IV, Huettenbrink C, Klein T, Steinemann S, Bergstraesser C, Roethke M, Roth W, 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; Department of Urology, UniversityHospital Heidelberg, Heidelberg, Germany; Department of Urology, University Hospital Bern, Bern, Switzerland; Department of Diagnostic and Interventional Radiology, UniversityHospital Heidelberg, Heidelberg, Germany; Department of Pathology, UniversityHospital Heidelberg, Heidelberg, Germany.
Reference: J Urol. 2014 Jul 28. pii: S0022-5347(14)04049-X.