Presentation Authors: Nicolas von Landenberg*, Joachim Noldus, Julian Hanske, Sebastian Berg, Marko Brock, Herne, Germany
Introduction: The risk of occult prostate carcinoma (PCa) after negative MRI-TRUS fusion biopsy (F-Bx) is unknown till today. To determine the false-negative predictive value, a cohort was examined for later tumor detection. Furthermore, as part of the follow-up (FU), biopsy-specific complications were collected.
Methods: Between 12/12 and 11/16, 491 patients with suspected PCa and suspicious MRI findings underwent transrectal F-Bx at our institution. Each biopsy contained 12 systematic and a set of 2 targeted cores out of suspicious MRI lesions. Patients with benign pathologically results (n = 191) were eligible for our follow-up survey. Patient characteristics (PSA, prostate volume, number of pre-biopsies, age, PI-RADS score) were correlated to subsequent findings of newly detected PCa of further examinations. Complications were classified according to Clavien Dindo Classification (CDC). Statistical analyses were conducted (chi2, Kruskal-Wallis, Mann-Whitney U test).
Results: A complete FU was available for 176 (92.2%) of 191 patients with negative F-Bx (10.2% first biopsy, 89.8% re-biopsy). Median FU range was 31 (IQR: 17-39) months. At the time of F-Bx median age was 63 (IQR: 58-69) years, median PSA was 9.1 (IQR: 6.9-12.7) ng/ml and median prostate volume was 45 (IQR: 38.5-51.8) ml for patients with newly detected PCa. MRI lesions were divided into PI-RADS score of =8 in 50%, 42.9% and 7.1%, respectively. Significant risk-factors for secondary PCa were PSA density and prostate volume (p < 0.05).Main complications were e.g. hematuria (34.9%, CDC1), hematospermia (29.6%, CDC1) or urosepsis (1.1%, CDC3a).
Conclusions: Despite negative MRI-TRUS fusion biopsy, patients should continue to be monitored as there is still a 8% risk of developing PCa over the time.Concerning the low transrectal biopsy complications, every patient should be informed in detail about the risks, even though it is a safe method.