Presentation Authors: Annika Herlemann*, Matthew R. Cooperberg, Maya R. Overland, Janet E. Cowan, Samuel L. Washington III, Peter R. Carroll, Hao G. Nguyen, Katsuto Shinohara, San Francisco, CA
Introduction: There is growing evidence that magnetic resonance imaging (MRI)-targeted biopsy is superior to standard transrectal ultrasound (TRUS)-guided biopsy in men at risk for prostate cancer (PCa). We performed a three-way comparison of TRUS-targeted (TBx) vs. MRI-targeted (MBx) vs. systematic (SBx) prostate biopsy for PCa detection.
Methods: A prospective, single-center cohort study was conducted on patients with PCa suspicion or with low-risk PCa on active surveillance. All patients underwent pre-biopsy multiparametric MRI of the prostate. TBx, MBx and SBx were performed during the same clinical encounter. Three experienced surgeons performed the biopsies. All were blinded to the MRI results prior to SBx and TBx. MBx was performed at the end. Descriptive statistics were generated to report demographic, clinical and pathologic characteristics of the cohort.
Results: 201 patients were included in our study. 69 (34%) of these patients were biopsy-naive men, 36 (18%) had a prior negative SBx, and 96 (48%) were on active surveillance. Median patient age was 66 years (IQR 62-71). Median PSA at diagnosis was 7.2 ng/mL (IQR 5.0-10.0). Suspicious lesions were reported on both TRUS (hypoechoic lesion (HEL)) and MRI (â‰¥PI-RADS v2 score 3) in 69% of patients. More lesions per patient were found on MRI compared to TRUS (1.49 vs. 1.03, p < 0.01). PI-RADS 3, 4, and 5 MRI lesions were seen as HEL on TRUS in 51%, 69%, and 85% of patients, respectively. PCa and clinically significant PCa were detected in 84% and 5% of PI-RADS 3 lesions, 80% and 49% of PI-RADS 4 lesions, and 93% and 79% of PI-RADS 5 lesions, respectively. SBx detected the highest overall Gleason score or was equivalent to MBx/TBx in 135 patients (67%). The highest overall Gleason score was detected in 17 patients (8%) by TBx, and in 13 patients (6%) by MBx. In 36 patients (18%) no PCa was found by any biopsy method.
Conclusions: In the setting of high expertise and experience with TRUS and TBx, MRI and MBx do identify some additional high-grade cases, but this is not common, and the incremental value of MBx over SBx and TBx is relatively modest. SBx should not be omitted routinely from biopsy protocols, and urologists should not abandon TRUS as an important diagnostic imaging modality.