Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion–targeted Prostate Biopsy Outcomes
Menée à partir de données portant sur 601 patients avec suspicion de cancer de la prostate, cette étude évalue, par rapport à une biopsie systématique à 12 carottes, l'efficacité d'une biopsie ciblée à l'aide de fusions d'images échographiques et d'IRM pour le diagnostic de la maladie, puis analyse la relation entre les résultats de l'IRM pratiquée avant la biopsie et les résultats du prélèvement
Background : Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion–targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB).
Objective : To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI.
Design, setting, and participants : Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included.
Interventions : All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB.
Outcomes : Detection rates for all PCa and high-grade PCa (Gleason score [GS] ≥7) were compared using the McNemar test.
Results and limitations : MRF-TB detected fewer GS 6 PCas (75 vs 121; p < 0.001) and more GS ≥7 PCas (158 vs 117; p < 0.001) than SB. Higher mSS was associated with higher detection of GS ≥7 PCa (p < 0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS ≥7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS ≥7 PCas in men with no prior biopsy (88 vs 72; p = 0.012), in men with a prior negative biopsy (28 vs 16; p = 0.010), and in men with a prior cancer diagnosis (42 vs 29; p = 0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p < 0.001) and men with prior cancer (30 vs 46; p = 0.034). Limitations include the retrospective design and the potential for selection bias given a referral population.
Conclusions : MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted.
Patient summary : We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.
European Urology , résumé, 2014