MRI/US FUSION PROSTATE BIOPSY: OUR EXPERIENCE

Vito Lacetera1, Emanuele Cappa1, Bernardino Cervelli1, Matteo Cevenini1, Antonio Cicetti1, Giuliana Gabrielloni1, Michele Montesi1, Roberto Morcellini1, Gianni Parri1, Emilio Recanatini1, Valerio Beatrici1
  • 1 AO Ospedali Riuniti Marche Nord (Pesaro-Fano)

Objective

We present our experience with MRI/US fusion biopsy after the first 125 consecutive patients.

Materials and Methods

We prospectively evaluated the first consecutive 125 patients underwent to TRUS/US fusion biopsy. MRI images were obtained using a 1.5T scanner with a pelvic phased array coil, each suspicious area was further characterized according to the ESUR PI-RADS v.2 global score. All biopsy core specimens were examined by 2 urogenital pathologists and graded according to the 2005 International Society of Urological Pathology Modified Gleason Grading System
Characteristics of the patients: 80 patients with at least 1 negative biopsy (mean previous negative biopsies 1.2, CI 0-3), 32 biopsy-naïve patients, 13 patients on active surveillance. Mean age 66,1 years (CI 48-78), mean PSA= 8,1 ng/ml (CI 3.3- 21); mean Prostate Volume 57,7 ml ( CI 22-140), , DRE positive in 6/125, number of lesions dectected by MRI 1.4 ( 66 PIRADS 3, 54 PIRADS 4, 5 PIRADS 5) mean cores from each MRI target lesion 3 (CI 2-6), mean total cores 15 ( CI 12-19).

Results

55/125 positive for PCA (overall detection rate of 44.%). 14/66 positive for PCA in PIRADS 3 patients (detection rate of 21%), 37/54 positive for PCA in PIRADS 4 patients (detection rate of 68%), 4/5 positive for PCA in PIRADS 5 patients (detection rate of 80%).
In biopsy naive patients ( 32 of 125 pts) we obtained a detection rate of 59% (19/32 PCA): 55%(5/14) in pirads 3, 75% in PIRADS 4 (12/16), 100% ( 2/2) in PIRADS 5. Significant PCA in 10/32 ( 31%). 7 significant PCA was detected in target core e 3 in random core. in 8/32 PCA the random mapping was diagnostic ( target negative)
In re-biopsy patients ( 80 of 125 pts) we obtained a detection rate of 33% (27/80 PCA): 14%(7/51) in pirads 3, 69% in PIRADS 4 (18/26), 66% ( 2/3) in PIRADS 5. Significant PCA in 16/32 ( 50%), 14 in target core e 2 in mapping core. in 7/27 PCA the random mapping was diagnostic ( target negative)
In patients on active surveillance ( 13 of 125 pts) we obtained a positive biopsy in 9/13 pts ( 69%): in 5/13 fusion biopsy histology caused the switching to active treatment
The mean time of the procedure was 42 min (C.I. 22-55) in the first 20 patients , 32 min (C.I. 20-42) in the second 20 patients and than 20 min patients (C.I. 16-32)

Conclusion

Our overall detection rate was 44% ( Significant PCA in 31% of Naïve patient and 50% in repeated biopsy).These results are similar to current literature and promising for the future. We believe that using a platforms of co-registered MRI/US fusion biopsy we improved risk stratification and reduced underdiagnosis, understaging, undergrading in biopsy naïve patient, in patients with a previous negative biopsy and persistent suspicion of PCA and in patients on active surveillance. Fusion target biopsy is always associated with random mapping in our experience.

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