Should Hypoechoic Lesions on TRUS be Sampled during MRI-Targeted Prostate Biopsy?

To determine whether supplemental biopsy of hypoechoic ultrasound lesions (HUL) incidentally found during MRI-transrectal ultrasound (TRUS) fusion-targeted prostate biopsy results in improved prostate cancer (PCa) detection.

Patients underwent MRI-TRUS targeted biopsy as part of an ongoing prospective trial from August 2007 to February 2015. For men with HUL, the biopsy pathology of HUL and MRI lesions was classified according to the updated 2014 International Society of Urological Pathology (ISUP) grading system. The detection of PCa by MRI-targeted biopsy with and without HUL biopsy was compared.

Of 1260 men in the trial, 106 underwent biopsy of 119 HUL. PCa was diagnosed in 52/106 men (49%) by biopsy of either MRI lesions or HUL. Biopsy of HUL in addition to MRI lesions resulted in 4 additional diagnoses of high-grade (ISUP Grade 3-5) PCa vs biopsy of MRI lesions alone (20 vs 16 men, p=0.046). Three of these cases were upgraded from lower grade (ISUP Grade 1-2) PCa on MRI-guided biopsy alone, and only 1 case (1% of cohort) was diagnosed that would have been missed by MRI-guided biopsy alone. Supplemental biopsy of HUL did not change the PCa risk category in 96% (102/106) of men with HUL.

Supplemental biopsy of HUL yields a small increase in the detection of higher grade PCa as compared to biopsy of MRI lesions alone. As upgrading is rare, routinely screening for HUL during MRI-targeted biopsy remains controversial.

Urology. 2016 Nov 15 [Epub ahead of print]

Nabeel A Shakir, M Minhaj Siddiqui, Arvin K George, Michael Kongnyuy, Richard Ho, Michele Fascelli, Maria J Merino, Baris Turkbey, Peter L Choyke, Bradford J Wood, Peter A Pinto

Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland. Electronic address: ., Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

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