MRI-Ultrasound Fusion-Targeted Prostate Biopsy in a Consecutive Cohort of Men with No Previous Biopsy: Reduction of Over-Detection through Improved Risk Stratification.

MRI-ultrasound fusion-targeted prostate biopsy (MRF-TB) may improve detection of prostate cancer (PCa) in men presenting for prostate biopsy. We report clinical outcomes of 12-core systematic biopsy (SB) and MRF-TB in men presenting for primary biopsy and further describe pathological characteristics of cancers detected by SB and not by MRF-TB.

Clinical outcomes of 435 consecutive men who underwent pre-biopsy mpMRI followed by MRF-TB and SB at our institution between June 2012 and March 2015 were captured in an IRB-approved database Clinical characteristics, biopsy results and MRI suspicion scores (mSS) were queried from the database.

Among 370 men (mean age 64±8. 5 years; mean PSA 6. 8, SEM 0. 3 ng/mL) who met inclusion criteria, PCa was detected in 200 (54. 1%) cases. Cancer detection rates for SB and MRF-TB were 47. 3% and 43. 5%, respectively (p = 0. 104). MRF-TB detected more Gleason score ≥7 cancers than SB (114/128 (89. 1%) vs 95/128 (74. 2%), respectively, p = 0. 008). Of 39 cancers detected by SB, but not by MRF-TB, 32/39 (82. 1%) demonstrated Gleason 6 disease, and 24/39 (61. 5%) and 32/39 (82. 1%) were clinically insignificant by Epstein and UCSF CAPRA (score ≤ 2) criteria, respectively.

In men presenting for primary prostate biopsy, MRF-TB detects more high grade cancers than SB. Most cancers detected by SB, and not by MRF-TB, are clinically low-risk. Pre-biopsy MRI followed by MRF-TB reduces detection of low-risk cancers while significantly improving detection and risk-stratification of high-grade disease.

The Journal of urology. 2015 Jun 19 [Epub ahead of print]

Neil Mendhiratta, Andrew B Rosenkrantz, Xiaosong Meng, James S Wysock, Michael Fenstermaker, Richard Huang, Fang Ming Deng, Jonathan Melamed, Ming Zhou, William C Huang, Herbert Lepor, Samir S Taneja

School of Medicine, NYU Langone Medical Center, New York, NY. , Department of Radiology, NYU Langone Medical Center, New York, NY. , Department of Surgery, NYU Langone Medical Center, New York, NY. , Department of Urology, New York Hospital Queens, Flushing, NY. , School of Medicine, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , Department of Pathology, NYU Langone Medical Center, New York, NY. , Department of Pathology, NYU Langone Medical Center, New York, NY. , Department of Pathology, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , Department of Urology, Department of Radiology, NYU Langone Medical Center, New York, NY. Electronic address: samir. taneja@nyumc. org.

PubMed