Introduction

Assess the feasibility and the accuracy of targeted prostate biopsy with standard (systematic 12-core) biopsies after fusion imaging of choline-PET/CT (choline-PET) and multiparametric MRI (mpMRI) with 3D-transrectal ultrasound (TRUS) to detect prostate cancer. The Fusion of the two modality with echography 3d was try to compare the diagnostic performance for localization of primary PCa with (mpMRI) and last generation of PET/CT (Biograph mCT Flow, Siemens).

Methods

Within a prospective single-center study, from December 2014 to October 2016, 31 patients with a rising PSA ? 10ng/ml or with an history of a negative prostate biopsies were included, and performed a choline-PET and a mpMRI. PET and T2-weighted MR volumes of the prostate were spatially registered using commercially available software. Biopsy targets were selected on both modalities._x000D_ TRUS biopsy using the real-time 3D TRUS-tracking system (Urostation Touch®, Koelis, France), which enabled US-guided and/or MR/US fusion targeted biopsies. _x000D_ The biopsy procedure was performed after registration of real-time TRUS with mpMRI and choline-PET by the same operator, using 3D TRUS-tracking system. At the time of biopsy, volume data of the mpMRI and PET 18-ch was elastically fused with TRUS. Each target was biopsied twice. Histologic results were determined from standard and targeted biopsy cores_x000D_

Results

Mean PSA was 13.01 ng/ml (5.32-73). Mean number of biopsy was 16 (13-21) and mean prostate volume was 63.41 cc (25-169). The cancer detection rate was 69%. The cancer detection rate with standard biopsies off target was 42% and with prostate targeted biopsy was 50% using PET, 65% using mpMRI with a sensibility of 72%, 94%, 100% respectively for PET, mpMRI or both . The average number of positive cores was respectively 1.77 (1-7) ,2.74 (3-11) for PET and mpMRI.

Conclusions

We demonstrated the feasibility and accuracy of multimodal image registration for targeted prostate biopsies with echography 3D to define localization of prostate cancer, compared to standard biopsies. It was very interesting to observe sometimes a great difference in the distribution of PET choline targets and mpMRI targets in the prostate. mpMRI was probably better than PET to detected prostate cancer but it could be complementary. A new study with a novel ligands targeting prostate specific membrane antigen (PSMA) could improve our clinical results.

Funding

none