MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer

The aim of this study was to validate the role of MR/Ultrasound Fusion-Guided Targeted Biopsy as a first diagnostic modality in subjects with clinical suspicion of prostate cancer (PCa).

108 men (age range 46-78 years) with clinical suspicion for PCa (PSA > 4 ng/mL) underwent multiparametric MRI of the prostate (mpMRI) and, when suspicious lesion were found (according to the PIRADSv2 scoring system), targeted biopsy was performed. All patients without significant alteration patterns at mpMRI have been referred for follow-up at 1 year.

91/108 patients showed on the mpMRI highly suspicious lesions (PIRADS 4 and 5); the remaining 17/108 patients revealed no significant alteration consistent with PCa (PIRADS 3). Among the first group of patients, 58/91 proved to be positive for PCa on the pathology report: 24 patients had a Gleason Score (GS) 6 (3 + 3); 18 patients GS 7 of which 7 (3 + 4) and 11 (4 + 3); 14 patients GS 8 (4 + 4); two patients GS 9 (5 + 4); 33 proved to be negative. Overall cancer detection rate (CDR) was 63%. However, the CDR rises significantly, up to 77%, after the 53 initial consecutive biopsies that were performed (p < 0,05) and thus identified as part of the learning curve. Patients of the second group (17/108) have been followed with serial PSA assessments, clinical reevaluation, and follow-up mpMRI.

Performing exclusively targeted MR/Ultrasound Fusion-Guided biopsies for the diagnosis of PCa in patients with suspicious PSA levels (> 4 ng/mL) increases the detection rate of clinically significant cancer, changing both the therapeutic options and the prognosis.

La Radiologia medica. 2017 Oct 26 [Epub ahead of print]

Maurizio Del Monte, Leonardo Costantino, Vincenzo Salvo, Marcello Domenico Grompone, Martina Pecoraro, Arnaldo Stanzione, Riccardo Campa, Francesco Vullo, Alessandro Sciarra, Carlo Catalano, Valeria Panebianco

Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy., Department of Urology, Sapienza University, Rome, Italy., Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy., Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy. .