OBJECTIVES: To study the management impact that MRI-guided targeted prostate biopsies could provide relative to using only non-targeted systematic biopsies in men with clinically-localized prostate cancer (CaP).
SUBJECTS/PATIENTS AND METHODS: A consecutive series of untreated men undergoing Artemis (MRI-ultrasound fusion) biopsies between March 2010 and June 2013 was evaluated in this retrospective, IRB-approved study. Fusion biopsy included MRI targeted and systematic sampling at the same session. 3-Tesla multiparametric MRI was performed at a median of 2 weeks prior to biopsy. Patients were included if > 1 systematic core revealed CaP. The impact of the information obtained from targeted versus systematic biopsies was studied on the following: Gleason Score (GS), NCCN risk reclassification, cancer core length, percent of core positive for tumor involvement, and percent positive biopsy cores.
RESULTS: The study sample included 215 men (mean age=66 +/-8 years). Median PSA was 6.0 (range = 0.7-181 ng/ml). The mean number of total biopsy samples was 18 (12 systematic and 6 targeted samples). 34/215 men (16%) had a higher GS on targeted vs. systematic biopsy. 21/183 men (12%) were stratified into a higher NCCN risk group when incorporating targeted biopsy GS results. 18/101 men (18%) were upgraded to intermediate- or high-risk from the low-risk group. Among the 34 men whose cancer severity was upgraded, increases in cancer core length, percent involvement, and percent of cores involved were all statistically significant (p < 0.01).
CONCLUSION: Targeted prostate biopsy provided information about GS, NCCN risk, and tumor volume beyond that obtained in systematic biopsies, specifically increasing the proportions of intermediate- and high-risk men. Such patients may be recommended for additional treatments (pelvic nodal irradiation or hormonal therapy). The appropriateness of changing treatment because of targeted biopsy results is still unclear.
Kamrava M, Hegde JV, Abgaryan N, Chang E, Le JD, Wang J, Kupelian P, Marks LS. Are you the author?
Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
Reference: BJU Int. 2015 Feb 13. Epub ahead of print.