Presentation Authors: Catherine Lovegrove*, Louise Brown, Saiful Miah, Ahmed El-Shater Bosaily, Richard Kaplan, Alex Freeman, Alex Kirkham, Mathias Winkler, London, United Kingdom, Raj Persad, Bristol, United Kingdom, Richard Hindley, London, United Kingdom, Robert Oldroyd, Nottingham, United Kingdom, Tim Dudderidge, Southampton, United Kingdom, Derek Rosario, Sheffield, United Kingdom, Nick Burns-Cox, Taunton, United Kingdom, Iqbal Shergill, Wrexham, United Kingdom, Simon Bott, Farnborough, United Kingdom, Alastair Henderson, Maidstone, United Kingdom, Christopher Parker, Sutton, United Kingdom, Mark Emberton, Hashim Ahmed, London, United Kingdom
Introduction: PROMIS provided level 1 evidence for pre-biopsy MP-MRI triage in diagnosing clinically significant prostate cancer (csPCa). We evaluated the performance of transrectal ultrasound-guided systematic (TRUS) biopsy compared to transperineal template mapping (TPM) with a 5mm sampling frame, stratified by MP-MRI score.
Methods: Biopsy-naive men due to undergo prostate biopsy for elevated PSA and/or abnormal DRE underwent MP-MRI, TPM and TRUS biopsies, conducted and reported blind to other test results. csPCa was primarily defined as Gleason >/=4+3 or maximum cancer core length (MCCL) >/=6mm of any grade, and secondarily Gleason >/=3+4 or MCCL >/=4mm of any grade.
Results: In 41 months, 740 men at 11 centres were recruited; 576 underwent all three tests. Of 150 with MRI score 1-2, 8 (5.3%) had any Gleason >/=3+4 disease. In 75 where TRUS-biopsy showed Gleason 3+3 of any MCCL, 61/75 (81%) had Gleason 3+4, 8/75 (11%) Gleason 4+3 and 0/75 (0%) Gleason >/=4+5._x000D_
For definition1 csPCa, TRUS-Biopsy sensitivity remained stable and low across Likert scores (35%-52%) (Table1). For definition2 csPCa and any cancer, sensitivity increased with higher MP-MRI score (Table2). NPV varied due to varying disease prevalence but for all cancer thresholds declined with increasing MP-MRI score (Tables1-3).
Conclusions: TRUS-biopsy in setting of MP-MRI scores 1-2 finds Gleason3+4 PCa in only 1 in 20 men. Further, for any csPCa definition, TRUS-biopsy had poor sensitivity and variable but low NPV across MP-MRI scores. Men undergoing TRUS-biopsy without targeting in the setting of MP-MRI score 3 to 5 should be advised to undergo a repeat (targeted) biopsy.