PURPOSE: Men diagnosed with atypical small acinar proliferation (ASAP) are counseled to undergo early re-biopsy, as their risk of prostate cancer (PCa) is high.
However, random re-biopsies may not re-sample areas of concern. Magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion-guided biopsy offers an opportunity to accurately target, and later re-target, specific areas within the prostate. The purpose of this study is to describe the ability of MRI/TRUS fusion-guided prostate biopsy to detect PCa in areas with an initial diagnosis of ASAP.
MATERIALS AND METHODS: From March 2007 to February 2014, 1,028 patients underwent MP-MRI of the prostate and MRI/TRUS fusion-guided biopsy. Twenty patients met the following stringent inclusion criteria: no history of PCa; index biopsy demonstrating at least one core of ASAP and benign glands in all remaining cores; fusion targeted re-biopsy with at least one targeted core directly re-sampling an area of the prostate which previously contained ASAP.
RESULTS: At index biopsy, the 20 patients had a median age of 60 years (IQR 57-64) and median PSA of 5.92ng/ml (IQR 3.34-7.48). At fusion targeted re-biopsy in a median 11.6 months, 5/20 (25%, 95% CI 6.02-43.98) patients were diagnosed with PCa, all of which was primary Gleason grade 3, low-volume disease. On fusion re-biopsy, cores which directly re-targeted areas of previous ASAP detected the highest tumor burden.
CONCLUSIONS: When MRI/TRUS fusion-guided biopsy detects isolated ASAP on index biopsy, early re-biopsy is unlikely to detect clinically significant PCa. Cores which re-target areas of previous ASAP are more effective than random re-biopsy cores.
Raskolnikov D, Rais-Bahrami S, George AK, Turkbey B, Shakir NA, Okoro C, Rothwax JT, Walton-Diaz A, Siddiqui MM, Su D, Stamatakis L, Yan P, Kruecker J, Xu S, Merino MJ, Choyke PL, Wood BJ, Pinto PA. Are you the author?
1Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Philips Research North America, Briarcliff Manor, New York; Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland; Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Reference: J Urol. 2014 Aug 20. pii: S0022-5347(14)04256-6.