Prostate Cancer Diagnosis on repeat MRI-TRUS Fusion Biopsy of Benign Lesions: Recommendations for Repeat Sampling

PURPOSE - Urologists face a dilemma when a lesion identified on multiparametric MRI (mpMRI) is benign on image-guided fusion biopsy (FB). We investigated the detection rate of prostate cancer (PCa) on repeat FB in mpMRI lesions initially found to be pathologically benign on FB.

MATERIALS AND METHODS - A review of all patients from 2007 to 2014 who underwent mpMRI and FB was conducted. Men who had a re-biopsy of the same discrete lesion after the initial FB was benign were identified. Data were documented on a per-lesion basis. Manual review of the UroNav system's needle tracking was conducted to verify accurate image registration. Multivariate analysis was used to identify both clinical and imaging factors that were predictive of PCa detection at repeat FB.

RESULTS - Ninety patients had repeat biopsy of 131 unique lesions. Of these re-sampled lesions, 16% (21/131) were found to have PCa; the majority (13/21, 61. 9%) were Gleason 3+3. On multivariate analysis, only lesion growth on repeat mpMRI was significantly associated with PCa detection at repeat biopsy (HR = 3. 274, 95% CI [1. 205, 8. 896], p=0. 02).

CONCLUSIONS - Pathologically benign mpMRI lesions on initial FB are rarely found to harbor clinically significant PCa on repeat biopsy. When PCa was identified, the majority were low-risk. Increase in lesion diameter was an independent predictor of PCa detection. While retrospective, this data may provide some confidence in the reliability of negative initial FBs despite a positive mpMRI finding.

The Journal of urology. 2016 Feb 12 [Epub ahead of print]

Raju Chelluri, Amichai Kilchevsky, Arvin K George, Abhinav Sidana, Thomas P Frye, Daniel Su, Michele Fascelli, Richard Ho, Steven F Abboud, Baris Turkbey, Maria J Merino, Peter L Choyke, Bradford J Wood, Peter A Pinto

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD. , Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. 

PubMed

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