Yonsei Med J.  2016 May;57(3):565-571. 10.3349/ymj.2016.57.3.565.

Visually Estimated MRI Targeted Prostate Biopsy Could Improve the Detection of Significant Prostate Cancer in Patients with a PSA Level <10 ng/mL

• Lee DH
• Nam JK
• Park SW
• Lee SS
• Han JY
• Lee SD
• Lee JW
• Chung MK

• KMID: 2374073
• DOI: http://doi.org/10.3349/ymj.2016.57.3.565

Abstract

PURPOSE
To compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy (MRI-visual-Bx) for patients with prostate specific antigen (PSA) level less than 10 ng/mL.
MATERIALS AND METHODS
In total, 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospectively in 2014. In patients with abnormal lesions on mp-MRI, we performed additional MRI-visual-Bx. We compared pathologic results, including the rate of clinically significant prostate cancer cores (cancer length greater than 5 mm and/or any Gleason grade greater than 3 in the biopsy core).
RESULTS
The mean PSA was 6.43 ng/mL. In total, 48 of 76 (63.2%) patients had abnormal lesions on mp-MRI, and 116 targeted biopsy cores, an average of 2.42 per patient, were taken. The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 (34.2%) and 23/48 (47.9%), respectively. In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores, the positive rates were 8.4% (77 of 912 cores) and 46.6% (54 of 116 cores), respectively (p<0.001). Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5%, respectively, in TRUS-Bx and 6.3 mm and 45.4% in MRI-visual-Bx (p<0.001). In addition, Gleason score ≥7 was noted more frequently using MRI-visual-Bx (p=0.028). The detection rate of clinically significant prostate cancer was 27/77 (35.1%) and 40/54 (74.1%) for TRUS-Bx and MRI-visual-Bx, respectively (p<0.001).
CONCLUSION
MRI-visual-Bx showed better performance in the detection of clinically significant prostate cancer, compared to TRUS-Bx among patients with a PSA level less than 10 ng/mL.

Keyword

Prostate cancer; prostate biopsy; magnetic resonance imaging

MeSH Terms

Adenocarcinoma/blood/diagnosis/*pathology
Aged
Biopsy/*methods
Endoscopic Ultrasound-Guided Fine Needle Aspiration/*methods
Humans
Magnetic Resonance Imaging/methods
Magnetic Resonance Imaging, Interventional/methods
Male
Middle Aged
Neoplasm Grading
Prostate/diagnostic imaging/*pathology
Prostate-Specific Antigen/*blood
Prostatic Neoplasms/blood/diagnosis/*pathology
Ultrasonography, Interventional/methods
Prostate-Specific Antigen

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