OBJECTIVES: To assess the accuracy of magnetic-resonance imaging (MRI)/ trans-rectal ultrasound (TRUS) fusion biopsies to diagnose prostate cancer (PCa) according to gland size.
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PATIENTS AND METHODS: A prospective study was conducted on 232 men with a first-round biopsy, a multiparametric MRI with a lesion and a Likert score ≥2, and prostate-specific antigen < 10 ng/mL. All men underwent a 12-cores protocol (STD) plus a protocol of 2 or 3 targeted cores (TAR). Significant PCa was defined as at least one core with a Gleason score of 7 (3 + 4) or 6 with a >4-mm maximal cancer-core length.
RESULTS: The patients' mean age was 64±6.4 years, mean prostate-specific antigens were 6.65±1.8 ng/mL, and mean prostate volume was 40±24.3 mL. Overall detection rate of clinically significant PCa was 44%. Detection of clinically significant PCa with a MRI-TRUS fusion-guided biopsy was 77% for prostate glands < 30 cm3, and 61%, 47%, and 34% for glands 30-38.5, 38.5-55, and 55-160 cm3, respectively (p=0.001). Differences in PCa detection rates between STD and TAR protocols were not significant (p = 0.8) for patients with prostate volumes ≤ 40 cm3. Conversely, twelve patients with prostate volumes >40 cm3 had clinically significant PCa using TAR but not STD, and 3 patients had PCa detected with STD but not with the TAR (p = 0.04).
CONCLUSIONS: MRI/TRUS fusion biopsies increased the yields of first-round prostate biopsy in patients with prostate volumes > 40 cm3.
de Gorski A, Rouprêt M, Peyronnet B, Le Cossec C, Granger B, Comperat E, Cussenot O, Renard-Penna R, Mozer P. Are you the author?
AP-HP, Hopital Pitié-Salpétrière, Academic Department of Urology, Paris, F-75013, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, F-75005, Paris, France; AP-HP, Hopital Pitié-Salpétrière, Academic Department of Biostatistics, Paris, F-75013, France; AP-HP, Hopital Pitié-Salpétrière, Academic Department of Pathology, Paris, F-75013, France; AP-HP, Hopital Pitié-Salpétrière, Academic Department of Radiology, Paris, F-75013, France; UPMC Univ Paris 06, ISIR, F-75005, Paris, France.
Reference: J Urol. 2015 Mar 14. pii: S0022-5347(15)03317-0.