Focal therapy eligibility determined by MRI/US fusion biopsy

To assess focal therapy (FT) eligibility among men receiving multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy, with correlation to whole mount histology after radical prostatectomy (RP).

Subjects were selected from among the 454 men (2010-2016) with targeted biopsy-proven prostate cancer (CaP) derived from regions of interest (ROI) on mpMRI. FT eligibility was limited to a maximum Gleason score (GS) of 4+3 within ROIs with or without other foci of low-risk CaP (GS 3+3, < 4 mm). Men who did not meet NCCN intermediate risk criteria were classified as ineligible for FT. 64 of the 454 men received RP, and biopsy findings were compared to final pathology.

38.5% (175/454) of men with a biopsy-proven ROI were eligible for FT. Fusion biopsy, which combined both targeted and template biopsy, had a sensitivity, specificity, and accuracy of 80.0% (12/15), 73.5% (36/49), and 75.0% (48/64) respectively for FT eligibility. Targeted cores alone yielded a sensitivity of 73.3% (11/15), a specificity of 47.9% (23/48), and an accuracy of 54.7% (35/64). Discordant cases between biopsy and whole mount histologies differed in GS (4/13) and extension across the midline (9/13).

Using intermediate-risk eligibility criteria, more than one-third of men with a targeted biopsy-proven lesion identified on mpMRI would have been eligible for FT. Eligibility determined by fusion biopsy was concordant with whole mount histology in 75% of cases. Improved selection criteria are needed to reliably determine FT eligibility.

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The Journal of urology. 2017 Aug 19 [Epub ahead of print]

Nima Nassiri, Edward Chang, Patricia Lieu, Alan M Priester, Daniel J A Margolis, Jiaoti Huang, Robert E Reiter, Frederick J Dorey, Leonard S Marks, Shyam Natarajan

Department of Urology, David Geffen School of Medicine, Los Angeles, CA, USA., Department of Bioengineering, University of California Los Angeles, CA, USA., Department of Radiology, Weill Cornell at New York Presbyterian, New York, NY, USA., Department of Pathology, Duke University School of Medicine, Durham, NC, USA., Department of Urology, David Geffen School of Medicine, Los Angeles, CA, USA; Department of Bioengineering, University of California Los Angeles, CA, USA. Electronic address: .