MADRID, SPAIN (UroToday.com) - In this study, the group compared MRI/ultrasound-fusion biopsy (fusion-PBx) with systemic prostate biopsy (TRUS-PBx) and correlated findings on the final histopathology of radical prostatectomy specimen (PrS).
Two hundred sixty-three patients with suspicion for prostate cancer were investigated (repeat biopsy = 195 patients; first biopsy = 68 patients). All patients underwent 3-Tesla multiparametric prostate MRI imaging. All patients underwent transperineal fusion-PBx (mean 9 cores) combined with standard TRUS-PBx (mean 12 cores). In patients proven to have PCa who underwent radical prostatectomy, MRI and whole-mount prostatectomy specimen was compared by a uro-radiologist and uro-pathologist. Prostate cancer detection rate and concordance of histopathological results in fusion-PBx, TRUS-PBx, and PrS were evaluated.
Prostate cancer detection rate was 52% overall. Fusion PBx detected more than TRUS-PBx ( 44% vs 35%, p = 0.0023). 74% of biopsy-proven PCA had Gleason Score (GS) ≥ 7. In fusion-PBx, the distribution of GS was 28% GS 6, 72% GS 7 or above. In TRUS-PBx, 26% of tumors were GS 6 and 74% GS ≥ 7. 55% more tumors with GS ≥ 7were detected by additional fusion-PBx compared to TRUS-PBx alone. Conversely, 21% more tumors with GS ≥ 7 were found by TRUS-BX additionally to fusion PBx.
Sixty-five patients underwent radical prostatectomy. Concordance of GS between biopsy and PrS was 51%, 48%, and 65% after fusion-Bx alone, TRUS-PBx alone, and combination of fusion PBX and TRUS-PBx, respectively. Upgrading of biopsy GS in PrS occurred in 40%, 48%, and 23% after fusion-PBx alone, TRUS-PBx alone, and combination of both.
The group concluded that while fusion-PBx alone is associated with more tumor upgrading and higher concordance of GS with final prostatectomy specimen, a combination of both modalities delivers the lowest upgrading and highest concordance. As such, TRUS-PBx should still be performed in addition to fusion-PBx.
Presented by Borkowetz A.,1 Zastrow S.,1 Platzek I.,2 Toma M.,3 Koch R.,4 Fröhner M.,1 and Wirth M.1 at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain
1TU Dresden, Dept. of Urology, Dresden, 2TU Dresden, Dept. of Radiology, Dresden, 3TU Dresden, Dept. of Pathology, Dresden, 4TU Dresden, Dept. of medical statistics and Epidemiology, Dresden
Reported by Mohammed Haseebuddin, MD, medical writer for UroToday.com