In this presentation, we will discuss about imaging and clinical variables that may help achieve a better performance on MR-TRUS fusion-guided biopsies of the prostate.
•The routine diagnosis of prostate cancer (PCa) relies on standardized sextant biopsies (SB), usually performed with transrectal ultrasound (TRUS) guidance
•The low contrast between malignant and normal tissue on TRUS reduces the ability to identify PCa
•As a result, there is a propensity to detect slow growing indolent microfoci of cancer while potentially missing larger tumors that are outside of the usual biopsy sampling regions.
•It has been shown that the sextant biopsies miss 10–30 % of PCa and that more than two sextant biopsy sets are required in over 20 % of men to diagnose Pca.
•Multiparametric magnetic resonance imaging (MP-MRI) is now regarded as the mainstay in prostate cancer imaging.
•There is growing interest in utilizing MP-MRI for detection and staging of prostate cancer, especially after the development of biopsy systems capable of performing fusion of MRI and ultrasound (MR-TRUS) images.
•It has now been consistently demonstrated that MR-TRUS fusion biopsies improve the diagnosis of clinically significant PCa (csPCa), while reducing overdiagnosis of clinically insignificant PCa.
•However, up to 15% of PCa lesions may still be missed by the targeted approach, and for this reason a standard sextant-based set of cores is still usually acquired in combination with the targeted set.
•This increased number of cores resulting from the combination of the targeted and standard sets also increases the final cost of the procedure, and may potentially be associated to a higher complication rate.
•Therefore, in this presentation, we will discuss about imaging and clinical variables that may help achieve a better performance on MR-TRUS fusion-guided biopsies of the prostate.
References:
1- Weinreb JC, Barentsz JO, et al. PI-RADS Prostate Imaging – Reporting and Data System: 2015, Version 2. European Urology, Volume 69, Issue 1, 2016, Pages 16-40.
2- Costa DN, et al. MR Imaging–Transrectal US Fusion for Targeted Prostate Biopsies: Implications for Diagnosis and Clinical Management. RadioGraphics 2015 35:3, 696-708
3- Rosenkrantz AB, et al. Prostate Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Patients with a Prior Negative Biopsy: A Consensus Statement by AUA and SAR. The Journal of Urology, Volume 196, Issue 6, 2016, Pages 1613-1618
4- Purysko AS, et al. Accuracy and Interobserver Agreement for Prostate Imaging Reporting and Data System, Version 2, for the Characterization of Lesions Identified on Multiparametric MRI of the Prostate. American Journal of Roentgenology 2017 209:2, 339-349
5- Epstein JI, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. The American Journal of Surgical Pathology: February 2016 - Volume 40 - Issue 2 - p 244–252