Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation

Authors

  • Derek W. Cool University of Western Ontario London, ON http://orcid.org/0000-0003-1095-3553
  • Cesare Romagnoli Department of Medical Imaging (Radiology) University of Western Ontario London, ON
  • Jonathan I. Izawa Department of Surgery, Division of Urology University of Western Ontario London, ON
  • Joseph Chin Department of Surgery, Division of Urology University of Western Ontario London, ON
  • Lori Gardi Robarts Research Institute University of Western Ontario London, ON
  • David Tessier Robarts Research Institute University of Western Ontario London, ON
  • Ashley Mercado Department of Medical Imaging University of Western Ontario London, ON
  • Jonathan Mandel Department of Medical Imaging University of Western Ontario London, ON
  • Aaron D. Ward Department of Biophysics University of Western Ontario London, ON
  • Aaron Fenster Robarts Research Institute University of Western Ontario London, ON

DOI:

https://doi.org/10.5489/cuaj.3831

Abstract

Introduction: This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsy
patients with prior atypical small acinar proliferation (ASAP).

Methods: 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the prebiopsy
MP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches.

Results: Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months.

Conclusions: MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx.

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Author Biographies

Derek W. Cool, University of Western Ontario London, ON

Department of Medical Imaging (Radiology)

Resident (PGY-5)

Cesare Romagnoli, Department of Medical Imaging (Radiology) University of Western Ontario London, ON

Department of Medical Imaging (Radiology)

Associate Professor

Jonathan I. Izawa, Department of Surgery, Division of Urology University of Western Ontario London, ON

Department of Surgery, Division of Urology

Associate Professor, Surgeon

Joseph Chin, Department of Surgery, Division of Urology University of Western Ontario London, ON

Department of Surgery, Division of Urology
Professor, surgeon

Lori Gardi, Robarts Research Institute University of Western Ontario London, ON

Robarts Research Institute

Software Programmer

David Tessier, Robarts Research Institute University of Western Ontario London, ON

Robarts Research Institute
Research Coordinator

Ashley Mercado, Department of Medical Imaging University of Western Ontario London, ON

Department of Medical Imaging

Assistant professor, radiologist

Jonathan Mandel, Department of Medical Imaging University of Western Ontario London, ON

Department of Medical Imaging
Radiologist

Aaron D. Ward, Department of Biophysics University of Western Ontario London, ON

Department of Biophysics

Assistant professor, Scientist

Aaron Fenster, Robarts Research Institute University of Western Ontario London, ON

Robarts Research Institute

Professor, Scientist

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Published

2016-10-13

How to Cite

Cool, D. W., Romagnoli, C., Izawa, J. I., Chin, J., Gardi, L., Tessier, D., Mercado, A., Mandel, J., Ward, A. D., & Fenster, A. (2016). Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation. Canadian Urological Association Journal, 10(9-10), 342–8. https://doi.org/10.5489/cuaj.3831

Issue

Vol. 10 No. 9-10 (2016): CUAJ October

Section

Original Research

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