This is an outdated version published on 2021-02-12. Read the most recent version.

Assessment of magnetic resonance imaging (MRI)-fusion prostate biopsy with concurrent standard systematic ultrasound-guided biopsy among men requiring repeat biopsy

Authors

  • Ryan Sun University of Manitoba
  • Andrew Fast University of Manitoba
  • Iain Kirkpatrick University of Manitoba
  • Patrick Cho
  • Jeffery Saranchuk Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba

DOI:

https://doi.org/10.5489/cuaj.6991

Keywords:

Prostate cancer, MRI, fusion biopsy, systematic biopsy

Abstract

Introduction: The role of magnetic resonance imaging (MRI)-fusion biopsy (FB) remains unclear in men with prior negative prostate biopsies. This study aimed to compare the diagnostic accuracy of FB with concurrent systematic biopsy (SB) in patients requiring repeat prostate biopsies.

Methods: Patients with previous negative prostate biopsies requiring repeat biopsies were included. Those without suspicious lesions (≥Prostate Imaging Reporting and Data System [PI-RADS] 3) on MRI were excluded. All patients underwent FB followed by SB. The primary outcome was the sensitivity for clinically significant prostate cancer (Gleason score ≥7). The secondary objective was identification of potential predictive factors of biopsy performance.

Results: A total of 53 patients were included; 41 (77%) patients were found to have clinically significant prostate cancer. FB had a higher detection rate of significant cancer compared to SB (85% vs. 76%, respectively, p=0.20) and lower diagnosis of indolent (Gleason score 3+3=6) cancer (10% vs. 27%, respectively, p=0.05). FB alone missed six (15%) clinically significant cancers, compared to 10 (24%) with SB. SB performance was significantly impaired in patients with anterior lesions and high prostate volumes (p<0.05). There was high degree of pathological discordance between the two approaches, with concordance seen in only 34% of patients.

Conclusions: In patients with prior negative biopsies and ongoing suspicion for prostate cancer, a combined approach of FB with SB is needed for optimal detection and risk classification of clinically significant disease. Anterior tumors and large prostates were significant predictors of poor SB performance and an MRI-fusion alone approach in these settings could be considered.

Downloads

Download data is not yet available.

Downloads

Published

2021-02-12

Versions

How to Cite

Sun, R., Fast, A., Kirkpatrick, I. ., Cho, P., & Saranchuk, J. (2021). Assessment of magnetic resonance imaging (MRI)-fusion prostate biopsy with concurrent standard systematic ultrasound-guided biopsy among men requiring repeat biopsy. Canadian Urological Association Journal, 15(9). https://doi.org/10.5489/cuaj.6991

Issue

Section

Original Research