Login to Access Video or Poster Abstract: MP18-02
Sources of Funding: none

Introduction

Multiparametric magnet resonance imaging (mpMRI) of the prostate plays an increasingly important role during active surveillance (AS) protocols in patients with low-risk prostate cancer (PCa). We evaluated transperineal MRI/ultrasound-fusion biopsy (fusPbx) in combination with transrectal sysPbx in patients undergoing control biopsy in AS protocols.

Methods

81 patients fulfilling the following criteria for low-risk PCa (Gleason Score (GS) ≤6, ≤2 positive cores, ≤50% PCa/core, cT1 or cT2a; PSA ≤10ng/mL) undergoing control-biopsy were investigated. Before biopsy, mpMRI was performed in all patients and tumour-suspicious lesions were evaluated according PI-RADS. All patients underwent a transperineal fusPbx (mean 4 cores/lesion) and, additionally, a transrectal sysPbx (mean 12 cores) during the same session. Cancer detection rate and the rate of tumour progression defined as evidence of GS≥7(3+4) were evaluated in both biopsy modalities.

Results

Median age was 68yrs, median PSA-level was 6.8 ng/mL, median prostate volume was 43mL._x000D_ In total, 154 lesions were detected whereas 117 (76%) were classified according PI-RADS. In the mean, 1.9 lesions were detected per patient. The overall cancer detection rate was 77% (62/81). 41 patients (51%) showed a tumour progression to GS ≥7 (3+4). The detection rate was 57% (46/81) in fusPbx and 62% (50/81) in sysPbx (p=0.57); the detection rate of GS≥7 (3+4) was 42% (34/81) in fusPbx and 37% (30/81) in sysPbx (p=0.65). FusPbx alone would have missed 20% (8/41) of GS≥7(3+4) and sysPbx alone would have missed 27% (11/41) of GS ≥7(3+4). Regarding the detection rate of GS≥7(3+4), the combination of both biopsy modalities was superior to fusPbx (p=0.016) and sysPbx (p=0.013) alone. The detection of GS≥7(3+4) in lesions with PI-RADS 2/3/4/5 was 24% (5/21), 37% (13/35), 35% (12/34) and 56% (15/27), respectively. Lesions classified as PI-RADS≥4 showed significantly more PCa with a GS≥7 (3+4) than lesions classified as PI-RADS≤3 (38% vs. 14%; p<0.005)._x000D_

Conclusions

FusPbx is associated with a higher detection rate of PCa with GS ≥7(3+4). Especially the combination of both biopsy modalities outperforms fusPbx and sysPbx alone. Therefore, mpMRI with consecutive targeted biopsy in combination with sysPbx should be recommended for control biopsy in patients with low-risk PCa undergoing control-biopsy for AS protocols.

Funding

none