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Del Monte M, Leonardo C, Salvo V, Grompone MD, Pecoraro M, Stanzione A, Campa R, Vullo F, Sciarra A, Catalano C, Panebianco V. MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer. Radiol Med 2017; 123:227-234. [PMID: 29075977 DOI: 10.1007/s11547-017-0825-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/09/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE 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). MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Maurizio Del Monte
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Vincenzo Salvo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Marcello Domenico Grompone
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Martina Pecoraro
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Riccardo Campa
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Francesco Vullo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Carlo Catalano
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Valeria Panebianco
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy.
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Kesch C, Radtke JP, Distler F, Boxler S, Klein T, Hüttenbrink C, Hees K, Roth W, Roethke M, Schlemmer HP, Hohenfellner M, Hadaschik BA. [Multiparametric MRI and MRI-TRUS fusion biopsy in patients with prior negative prostate biopsy]. Urologe A 2017; 55:1071-7. [PMID: 27168038 DOI: 10.1007/s00120-016-0093-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multiparametric MRI (mpMRI) plays an increasingly important role in prostate cancer (PCa) diagnostics and is recommended in men with previously negative TRUS biopsy. The optimal biopsy method after mpMRI is under discussion. OBJECTIVE Prospective, PIRADS- and START-conform analysis of the relevance of mpMRI and MRI-TRUS fusion biopsy in patients with prior negative TRUS biopsy and comparison of the detection rates of fusion-targeted biopsies (tB) and systematic transperineal saturation biopsies (sB). MATERIALS AND METHODS Between 10/2012 and 09/2015, 287 patients with prior negative TRUS biopsy underwent mpMRI and software-assisted, rigid MRI-TRUS fusion biopsy. In addition to and strictly separated from sB (median cores n = 24), tB (median cores per patient n = 4, per lesion n = 3) were performed in case of suspicious MRI lesions (PIRADS ≥ 2). Both biopsy methods were compared by using McNemar's test. RESULTS Of the 287 patients, 148 (52 %) had positive biopsies. Of these, 108/287 (38 %) had significant PCa (Gleason Score [GS] = 3 + 3 and PSA ≥ 10 ng/ml or GS ≥ 3 + 4) and again 43/287 (15 %) had a GS ≥ 4 + 3 PCa. sB failed to diagnose 8/148 PCa (5.4 %) and 6/108 significant PCa (5.5 %), whereas tB failed to diagnose 48 (32.4 %) PCa (p < 0.0001) and 22 (20.4 %) significant PCa (p = 0.0046). Of the PCa missed by tB, 11 had a GS ≥ 3 + 4 and 5 of these a GS = 4 + 3. On a per patient basis, MRI failed to detect 5 significant PCa, whereby 17 of the significant PCa were missed by fusion-targeted cores alone. CONCLUSIONS In men with unsuspicious MRI (PIRADS < 3), there is a 11 % risk of significant PCa. In case of suspicious MRI lesions, the combination of both biopsy approaches offers maximum tumor detection.
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Affiliation(s)
- C Kesch
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - J P Radtke
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.,Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - F Distler
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Boxler
- Universitätsklinik für Urologie, Universität Bern, Bern, Schweiz
| | - T Klein
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - C Hüttenbrink
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - K Hees
- Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - W Roth
- Pathologisches Institut der Universität Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - M Roethke
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - H P Schlemmer
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - M Hohenfellner
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - B A Hadaschik
- Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Nörenberg D, Solyanik O, Schlenker B, Magistro G, Ertl-Wagner B, Clevert DA, Stief C, Reiser MF, D'Anastasi M. [MRI of the prostate]. Urologe A 2017; 56:665-677. [PMID: 28424829 DOI: 10.1007/s00120-017-0378-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
New clinical and technological advances in the field of magnetic resonance imaging (MRI) and targeted image-guided biopsy techniques have significantly improved the detection, localization and staging as well as active surveillance of prostate cancer in recent years. Multiparametric MRI (mpMRI) is currently the main imaging technique for the detection, characterization and diagnostics of metastasizing prostate cancer and is of high diagnostic importance for local staging within the framework of the detection of prostate cancer.
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Affiliation(s)
- D Nörenberg
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland.
| | - O Solyanik
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - B Schlenker
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - G Magistro
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - B Ertl-Wagner
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - D A Clevert
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - C Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - M F Reiser
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
| | - M D'Anastasi
- Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistrasse 15, 81377, München, Deutschland
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Abstract
CLINICAL ISSUE Prostate cancer is the most common form of cancer in men in Germany; however, there is a distinct difference between incidence and mortality. STANDARD TREATMENT The detection of prostate cancer is based on clinical and laboratory testing using serum prostate-specific antigen (PSA) levels and transrectal ultrasound with randomized biopsy. DIAGNOSTIC WORK-UP Multiparametric MR imaging of the prostate can provide valuable diagnostic information for detection of prostate cancer, especially after negative results of a biopsy prior to repeat biopsy. PERFORMANCE In addition the use of MR ultrasound fusion-guided biopsy has gained in diagnostic importance and has increased the prostate cancer detection rate. ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS The prostate imaging reporting and data system (PI-RADS) classification has standardized the reporting of prostate MRI which has positively influenced the acceptance by urologists.
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