Multiparametric magnetic resonance imaging-transrectal ultrasoundguided cognitive fusion biopsy of the prostate: Clinically significant cancer detection rates stratified by the Prostate Imaging and Data Reporting System version 2 assessment categories

  • Susan John The Ottawa Hospital - University of Ottawa
  • Steven Cooper The Ottawa Hospital - University of Ottawa
  • Rodney H. Breau The Ottawa Hospital - University of Ottawa
  • Trevor A. Flood The Ottawa Hospital - University of Ottawa
  • Ilias Cagiannos The Ottawa Hospital - University of Ottawa
  • Luke T. Lavallée The Ottawa Hospital - University of Ottawa
  • Christopher Morash The Ottawa Hospital - University of Ottawa
  • Joseph O’Sullivan The Ottawa Hospital - University of Ottawa
  • Nicola Schieda The Ottawa Hospital - University of Ottawa

Abstract

Introduction: We aimed to report the clinically significant prostate cancer (PCa) detection rate in men undergoing magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-cognitive fusion (CF) targeted biopsies stratified by the Prostate Imaging and Data Reporting System (PI-RADS) version 2 (v2) scores.

Methods: With a quality assurance waiver from the institutional review board, we identified a cohort of men who underwent MRITRUS- CF and synchronous template biopsy from 2015–2017. MRI (PI-RADS v2 score, lesion size, lesion location [peripheral or transition zone (PZ/TZ)]), and CF-TRUS biopsy (operator experience, TRUS visibility, and number of biopsies) features were extracted. The primary outcome was diagnosis of clinically significant (Gleason score ≥3+4=7 or International Society of Urological Pathology [ISUP] grade group ≥2) PCa.

Results: During the study period, 131 men (with 142 PI-RADS v2 score ≥3 lesions) met inclusion criteria; 98 men had previously negative template biopsy and 33 were on active surveillance for previously detected low-grade PCa. In total, 41.9% (55/131) men had clinically significant PCa — 17.6% (23/131) detected on targeted biopsy only, 8.4% (11/131) on template biopsy only, and 16.0% (21/131) on both targeted and template biopsy. Clinically significant PCa detection stratified by PI-RADS v2 scores were: 11.1% (3/27) for score 3 (indeterminate), 42.9% (24/56) for score 4 (significant cancer likely), and 35.6% (21/59) for score 5 (significant cancer very likely). Clinically significant PCa detection rates in targeted biopsies were better among PZ (41.8% [33/79]) compared to TZ (23.8% [15/63]) lesions (p=0.025) in TRUS-visible lesions (p=0.033) and in the most experienced radiologists (p=0.05), with no difference by lesion size or number of additional core biopsies performed (all p>0.05).

Conclusions: CF-MRI-TRUS-guided targeted biopsy yielded substantially lower rates of clinically significant cancer in PI-RADS v2 score 4 and 5 lesions when compared to published results using in-bore MR-guided or automated MRI-TRUS fusion guidance systems. Cancer detection was worst for TZ lesions.

Published
2018-06-19
How to Cite
John, S., Cooper, S., Breau, R. H., Flood, T. A., Cagiannos, I., Lavallée, L. T., Morash, C., O’Sullivan, J., & Schieda, N. (2018). Multiparametric magnetic resonance imaging-transrectal ultrasoundguided cognitive fusion biopsy of the prostate: Clinically significant cancer detection rates stratified by the Prostate Imaging and Data Reporting System version 2 assessment categories. Canadian Urological Association Journal, 12(12). https://doi.org/10.5489/cuaj.5254
Section
Original Research