Presentation Authors: Christophe Mannaerts*, Marc Engelbrecht, Arnoud Postema, Olivia Lodeizen, Rob van Kollenburg, Amsterdam, Netherlands, Ruud Van Sloun, Rogier Wildeboer, Massimo Mischi, Eindhoven, Netherlands, Theo De Reijke, Hessel Wijkstra, Amsterdam, Netherlands
Introduction: Contrast-enhanced ultrasound (CEUS) with quantitative parametric imaging is currently not recommended for the detection of prostate cancer (PCa). Meanwhile, multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) has evolved as an alternative to systematic transrectal ultrasound (TRUS)-guided biopsy (SBx). However, mpMRI before first biopsy remains controversial. In this prospective trial, we compared clinically significant (cs)PCa detection rates for MRI-TBx and CEUS-TBx with standard SBx in biopsy-naive men.
Methods: This prospective trial included 150 biopsy-naive men. Men underwent imaging and biopsy and served as their own control. Prebiopsy mpMRI consisted of T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging while CEUS imaging consisted of 4 prostate plane recordings using an US contrast agent and dispersion quantification software. The mpMRI and CEUS with parametric maps were evaluated in blinded fashion by a radiologist and CEUS expert with PIRADSv2 and a 1 to 5 Likert Scale, respectively. A TRUS-guided 12-core SBx was performed by an operator blinded for imaging. A second operator performed a TBx from CEUS suspicious lesions and an MRI TRUS fusion-TBx. Detection rates of csPCa (Gleason score (GS)â‰¥7) and insignificant PCa (GS=6) were compared between the biopsy regimens. Negative (NPV) and positive predictive values (PPV) of mpMRI and CEUS for csPCa were determined.
Results: Data of 140 men was available for final analysis. Overall, GSâ‰¥7 PCa was found in 61 men (44%) and GS=6 PCa in 17 men (12%). As seen in Table 1, SBx detected more GSâ‰¥7 PCa and GS=6 PCa then a MRI-TBx or CEUS-TBx only approach (all p < 0.05) while a combination of MRI and CEUS-TBx had equal GSâ‰¥7 PCa detection (p=0.115). The NPV of MRI and CEUS for GSâ‰¥7 PCa was comparable (81% vs 83%) while the PPV of MRI was higher than CEUS (83% vs 48%). For the combination of MRI and CEUS, the NPV and PPV was 90% and 52%, respectively.
Conclusions: Despite avoidance of biopsy in men with GS=6 PCa, a MRI-TBx or CEUS-TBx only approach missed GSâ‰¥7 PCa as compared to SBx. A combination of MRI and CEUS-TBx demonstrated equal detection of GSâ‰¥7 PCa as compared to SBx. mpMRI and CEUS have comparable detection rates but mpMRI provided higher sampling efficiency than CEUS.
Source of Funding: This trial is funded by the Dutch Cancer Society (grant number: UVA 2013-5941). The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the abstract.