Cancer Diagnosis Program | Biorepositories and Biospecimen Research Branch

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Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy.

Author(s): Siddiqui MM, Rais-Bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, Hoang AN, Walton-Diaz A, Shuch B, Weintraub M, Kruecker J, Amalou H, Turkbey B, Merino MJ, Choyke PL, Wood BJ, Pinto PA

Publication: Eur Urol, 2013, Vol. 64, Page 713-9

PubMed ID: 23787357 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared prostate cancer diagnosis rates among MP-MRI /US-targeted and TRUS-guided biopsies and determined the influence of clinical parameters on upgrading patient diagnosis after consideration of both biopsies. Case-matched MP-MRI/US-targeted (mean 5.7 biospies/patient) and TRUS -guided biopsies (12 cores/patient) were obtained from 582 patients during the same biopsy session. For each guidance method, the highest Gleason score was assigned to the case independently. Specimens were characterized as clinically significant high grade (Gleason score of ≥4 + 3), clinically insignificant low grade (Gleason score ≤3 + 4), or normal/no cancer. After determination of diagnosis for each biopsy independently, the diagnosis for the case was determined based on both biopsies.

   Summary of Findings:

   A mean of 17.7 biopsies were obtained from each patient. A prostate cancer diagnosis was assigned to 315 of the 582 patients (54%), of which 255 (81%) were diagnosed based on TRUS-guided biopsy and 253 (80%) by MP-MRI/US-targeted biopsy. Of the 57 cases diagnosed with a clinically significant disease based on TRUS-guided biopsy, an identical diagnosis was assigned in 50 cases based on results of the MP-MRI/US-targeted biopsy, while 5 were diagnosed with a clinically insignificant disease and 2 were diagnosed as normal based on results obtained from the MP-MRI/US- targeted biopsy. Conversely, diagnoses assigned using TRUS-guided biopsies were upgraded based on results of MP-MRI/US targeted biopsies from clinically insignificant to clinically significant in 21 cases, and from normal to clinically significant in 17 cases. Gleason scores were higher in the MP-MRI/US-targeted biopsy than the TRUS-guided biopsy in 81 cases (43 cases were upgraded to clinically insignificant and 38 to clinically significant); however higher Gleason scores were observed among TRUS-guided biopsies in 67 cases (60 cases upgraded to clinically insignificant and 7 to clinically significant). Specimens that displayed discordant Gleason scores among biopsy methods that resulted in a diagnosis upgrade were associated with lower prostate volume (OR=0.84, P=0.0005), higher PSA level (OR=1.03, P=0.004), more lesions (OR=1.4, P=0.004), and higher MRI suspicion level (OR=1.7, P=0.04); but the association with number of lesions was not significant (P=0.6). 

   Biospecimens

   • Tissue - Prostate

   Preservative Types

   • Formalin

   Diagnoses:

   • Normal
   • Neoplastic - Carcinoma

   Platform:

   Analyte	Technology Platform
   Morphology	H-and-E microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Preaquisition	Biomarker level	9.9 ± 13.1 ng/mL PSA
   Biospecimen Acquisition	Method of tissue acquisition	Magnetic resonance imaging-guided biopsy Ultrasound-guided biopsy
   Preaquisition	Prognostic factor	Prostate volume of 56.4 ± 31.2 An average of 2.6 ±1.3 lesions

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