Value of Targeted Prostate Biopsy Using Magnetic Resonance–Ultrasound Fusion in Men with Prior Negative Biopsy and Elevated Prostate-specific Antigen

• Published in: European urology Vol. 65; no. 4; pp. 809 - 815
• Main Authors: Sonn, Geoffrey A., Chang, Edward, Natarajan, Shyam, Margolis, Daniel J., Macairan, Malu, Lieu, Patricia, Huang, Jiaoti, Dorey, Frederick J., Reiter, Robert E., Marks, Leonard S.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.04.2014; Elsevier
• Subjects: Aged; Biological and medical sciences; Biopsy, Needle - methods; False Negative Reactions; Gynecology. Andrology. Obstetrics; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Male; Male genital diseases; Medical sciences; Middle Aged; Multimodal Imaging; Nephrology. Urinary tract diseases; Prospective Studies; Prostate - pathology; Prostate biopsy; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - diagnostic imaging; Tumors; Tumors of the urinary system; Ultrasonography; Ultrasound; Urinary tract. Prostate gland; Urology; Magnetic resonance imaging; Prostate biopsy; Prostate cancer; Ultrasound; Human; Nephrology; Urinary system disease; Prostate disease; Targeting; Magnetic resonance; Male; Tumoral marker; Malignant tumor; Nuclear magnetic resonance imaging; Urology; Prostate specific antigen; Anatomic pathology; Biopsy; Medical imagery; Adult; Urogenital system; Male genital diseases; Prostate; Cancer
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2013.03.025

Conventional biopsy fails to detect the presence of some prostate cancers (PCas). Men with a prior negative biopsy but persistently elevated prostate-specific antigen (PSA) pose a diagnostic dilemma, as some harbor elusive cancer. To determine whether use of magnetic resonance–ultrasound (MR-US) fusion biopsy results in improved detection of PCa compared to repeat conventional biopsy. In a consecutive-case series, 105 subjects with prior negative biopsy and elevated PSA values underwent multiparametric magnetic resonance imaging (MRI) and fusion biopsy in an outpatient setting. Suspicious areas on multiparametric MRI were delineated and graded by a radiologist; MR–US fusion biopsy was performed by a urologist using the Artemis device; targeted and systematic biopsies were obtained regardless of MRI result. Detection rates of all PCa and clinically significant PCa (Gleason ≥3+4 or Gleason 6 with maximal cancer core length ≥4mm) were determined. The yield of targeted biopsy was compared to systematic biopsy. The ability of an MRI grading system to predict clinically significant cancer was investigated. Stepwise multivariate logistic regression analysis was performed to determine predictors of significant cancer on biopsy. Fusion biopsy revealed PCa in 36 of 105 men (34%; 95% confidence interval [CI], 25–45). Seventy-two percent of men with PCa had clinically significant disease; 21 of 23 men (91%) with PCa on targeted biopsy had significant cancer compared to 15 of 28 (54%) with systematic biopsy. Degree of suspicion on MRI was the most powerful predictor of significant cancer on multivariate analysis. Twelve of 14 (86%) subjects with a highly suspicious MRI target were diagnosed with clinically significant cancer. MR–US fusion biopsy provides improved detection of PCa in men with prior negative biopsies and elevated PSA values. Most cancers found were clinically significant. Targeted prostate biopsy via magnetic resonance–ultrasound fusion results in improved detection of prostate cancer in men with prior negative biopsies and elevated prostate-specific antigen levels when compared with conventional biopsy. Targeted biopsies identify more clinically significant and fewer insignificant cancers than systematic biopsy.