Prostate Cancer Diagnosis on Repeat Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy of Benign Lesions: Recommendations for Repeat Sampling

• Published in: The Journal of urology Vol. 196; no. 1; pp. 62 - 67
• Main Authors: Chelluri, Raju, Kilchevsky, Amichai, George, Arvin K, Sidana, Abhinav, Frye, Thomas P, Su, Daniel, Fascelli, Michele, Ho, Richard, Abboud, Steven F, Turkbey, Baris, Merino, Maria J, Choyke, Peter L, Wood, Bradford J, Pinto, Peter A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Adult; Aged; high-intensity focused; Humans; image-guided biopsy; Image-Guided Biopsy - methods; magnetic resonance imaging; Magnetic Resonance Imaging, Interventional - methods; Male; Middle Aged; Prostate - diagnostic imaging; Prostate - pathology; prostatic neoplasms; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retrospective Studies; transrectal; Ultrasonography, Interventional - methods; ultrasound; Urology; watchful waiting; transrectal; Gleason score; multiparametric MRI; transrectal ultrasound; magnetic resonance imaging; image guided fusion biopsy; MRI; image-guided biopsy; prostate specific antigen; GS; ultrasound; PCa; AS; prostate cancer; high-intensity focused; mpMRI; prostatic neoplasms; TRUS; FB; watchful waiting; active surveillance; PSA
• ISSN: 0022-5347; 1527-3792; 1527-3792
• DOI: 10.1016/j.juro.2016.02.066

Purpose Urologists face a dilemma when a lesion identified on multiparametric magnetic resonance imaging is benign on image guided fusion biopsy. We investigated the detection rate of prostate cancer on repeat fusion biopsy in multiparametric magnetic resonance imaging lesions initially found to be pathologically benign on fusion biopsy. Materials and Methods We reviewed the records of all patients from 2007 to 2014 who underwent multiparametric magnetic resonance imaging and image guided fusion biopsy. We identified men who underwent rebiopsy of the same discrete lesion after initial fusion biopsy results were benign. Data were documented on a per lesion basis. We manually reviewed UroNav system (Invivo, Gainesville, Florida) needle tracking to verify accurate image registration. Multivariate analysis was used to identify clinical and imaging factors predictive of prostate cancer detection at repeat fusion biopsy. Results A total of 131 unique lesions were rebiopsied in 90 patients. Of these 131 resampled lesions 21 (16%) showed prostate cancer, which in 13 (61.9%) was Gleason 3 + 3. On multivariate analysis only lesion growth on repeat multiparametric magnetic resonance imaging was significantly associated with prostate cancer detection at repeat biopsy (HR 3.274, 95% CI 1.205–8.896, p = 0.02). Conclusions Pathologically benign multiparametric magnetic resonance imaging lesions on initial image guided fusion biopsy are rarely found to harbor clinically significant prostate cancer on repeat biopsy. When prostate cancer was identified, most disease was low risk. An increase in lesion diameter was an independent predictor of prostate cancer detection. While these data are retrospective, they may provide some confidence in the reliability of negative initial image guided fusion biopsies despite a positive multiparametric magnetic resonance imaging finding.