Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Sep-Oct;10(9-10):342-348.
doi: 10.5489/cuaj.3831.

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

Derek W Cool  1 , Cesare Romagnoli  1 , Jonathan I Izawa  2 , Joseph Chin  2 , Lori Gardi  3 , David Tessier  3 , Ashley Mercado  1 , Jonathan Mandel  1 , Aaron D Ward  4 , Aaron Fenster  3
Affiliations

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

Derek W Cool et al. Can Urol Assoc J. 2016 Sep-Oct.

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).

Materials: 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 pre-biopsy 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.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Example of magnetic resonance imaging-transrectal ultrasound fusion of (MRI-TRUS) (A) a lesion identified on multiparametric -MRI in medial left mid-gland (arrow). Single slice of the 3D-TRUS image after only rigid registration of the MRI shows (B) poor correspondence of the MRI prostate boundary (dashed outline) and suspicious lesion (dotted outline) with the TRUS prostate gland. (C) Improved correspondence is achieved following thin-plate spline non-rigid alignment of the MRI and TRUS prostate surfaces. MRI-TRUS fusion biopsy demonstrated Gleason score 3 + 4, >90% core involvement.
Fig. 2.
Fig. 2.
Comparison of the percentage of biopsy cores positive for prostate adenocarcinoma (CaP) for both standard, systematic, and magnetic resonance-targeted biopsy approaches.
Fig. 3.
Fig. 3.
Comparison of the percentage of biopsy cores positive for prostate adenocarcinoma (CaP) for both standard systematic and magnetic resonance-targeted biopsy approaches with first biopsy and atypical small acinar proliferation repeat biopsy patients separated.
Fig. 4.
Fig. 4.
Diagram illustrating the number clinically significant cancers detected in each prostate section as detected by magnetic resonance imaging-transrectal ultrasound fusion for first biopsy patients (top row) and atypical small acinar proliferation repeat biopsy patients (bottom row).
See this image and copyright information in PMC

References

    1. Delongchamps NB, Lefevre A, Bouazza N, et al. Detection of significant prostate cancer with magnetic resonance targeted biopsies — Should transrectal ultrasound-magnetic resonance imaging fusion-guided biopsies alone be a standard of care? J Urol. 2015;193:1198–204. doi: 10.1016/j.juro.2014.11.002. - DOI - PubMed
    1. Sonn GA, Chang E, Natarajan S, et al. Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol. 2014;65:809–15. doi: 10.1016/j.eururo.2013.03.025. - DOI - PMC - PubMed
    1. Pinto PA, Chung PH, Rastinehad AR, et al. Magnetic resonance imaging/ultrasound fusion-guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 2011;186:1281–5. doi: 10.1016/j.juro.2011.05.078. - DOI - PMC - PubMed
    1. Sonn GA, Natarajan S, Margolis DJ, et al. Targeted biopsy in the detection of prostate cancer using an office-based magnetic resonance ultrasound fusion device. J Urol. 2013;189:86–91. doi: 10.1016/j.juro.2012.08.095. - DOI - PMC - PubMed
    1. Delongchamps NB, Peyromaure M, Schull A, et al. Prebiopsy magnetic resonance imaging and prostate cancer detection: Comparison of random and targeted biopsies. J Urol. 2013;189:493–9. doi: 10.1016/j.juro.2012.08.195. - DOI - PubMed