OBJECTIVE: To evaluate the accuracy of combined multi-parametric magnetic resonance imaging (mp-MRI) and transperineal template-guided mapping biopsy (TTMB) for identifying lobes with significant prostate cancer (PCa) for the application of hemi-ablative focal therapy (FT).
PATIENTS AND METHODS: From January 2012-January 2014, 89 consecutive patients aged ≥40 with PSA ≤ 15 underwent in sequential order: mp-MRI, TTMB and radical prostatectomy (RP) at a single centre. Analysis was performed on 50 patients that met consensus guidelines for FT. Lobes were stratified into lobes with significant cancer (LSC), insignificant cancer (LIC) and no cancer (LNC). Using histopathology at RP, the predictive performance of combined mp-MRI+TTMB in identifying LSC was evaluated.
RESULTS: The sensitivity, specificity and positive predictive value (PPV) for mp-MRI+TTMB for LSC was 97%, 61% and 83% respectively. The negative predictive value (NPV), the primary parameter of interest, for mp-MRI+TTMB for LSC was 91%. Of the 50 patients, 21 had significant unilateral disease on mp-MRI+TTMB. Two of these 21 patients had significant bilateral disease on RP not identified on mp-MRI+TTMB.
CONCLUSIONS: In candidates for FT, mp-MRI and TTMB provides a high NPV in the detection of lobes with significant cancer.
Tran M, Thompson J, Böhm M, Pulbrook M, Moses D, Shnier R, Brenner P, Delprado W, Haynes AM, Savdie R, Stricker PD. Are you the author?
St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; School of Medicine, University of Sydney, NSW, Australia.
Reference: BJU Int. 2015 Feb 14. Epub ahead of print.