@article{John_Cooper_Breau_Flood_Cagiannos_Lavallée_Morash_O’Sullivan_Schieda_2018, title={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}, volume={12}, url={https://cuaj.ca/index.php/journal/article/view/5254}, DOI={10.5489/cuaj.5254}, abstractNote={<p><strong>Introduction:</strong> 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.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results:</strong> 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).</p> <p><strong>Conclusions:</strong> 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.</p>}, number={12}, journal={Canadian Urological Association Journal}, author={John, Susan and Cooper, Steven and Breau, Rodney H. and Flood, Trevor A. and Cagiannos, Ilias and Lavallée, Luke T. and Morash, Christopher and O’Sullivan, Joseph and Schieda, Nicola}, year={2018}, month={Jun.} }