Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies.
Author(s): Pokorny MR, de Rooij M, Duncan E, Schröder FH, Parkinson R, Barentsz JO, Thompson LC
Publication: Eur Urol, 2014, Vol. 66, Page 22-9
PubMed ID: 24666839 PubMed Review Paper? No
Purpose of Paper
The purpose of this paper was to compare the efficacy of multiparametric magnetic resonance imaging- guided biopsy (mpMRIGB) and transrectal ultrasound-guided biopsy (TRUSGB) methods for the identification of high/intermediate- and low-risk prostate cancer.
Conclusion of Paper
Cancer was detected by TRUSGB in 56.5% of patients (126/223), and by mpMRIGB in 69.7% of patients (99/142). A greater percentage of patients were diagnosed with intermediate/high risk cancer with the mpMRIGB method compared to the TRUSGB method (93.9% vs 62.7%, respectively), while a lower percentage of patients were diagnosed with low risk cancer (6.1% vs 37.3%, respectively). The percentage of cores that contained cancer was significantly higher (p<0.001) when obtained by the mpMRIGB method than the TRUSGB method (56.4% versus 15%, respectively). Further, the negative predictive value for intermediate/high risk cancer with the mpMRIGB method was greater than the TRUSGB method (96.9 % vs 71.9%). A subset of 75 patients underwent mpMRIGB, TRUSGB, and a subsequent prostatectomy. Of these, a greater number of patients were correctly diagnosed using mpMRIGB than TRUSGB (60 vs 53 patients, respectively), and cancer was missed by mpMRIGB in fewer patients than TRUSGB(11 vs 18 patients, respectively), while the number of patients treated for insignificant tumors were identical. The authors conclude that MRGB improved overall detection of intermediate/high risk cancers, while also reducing the detection of low-risk cancers.
Studies
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Study Purpose
The purpose of this study was to compare the efficacy of mpMRIGB and TRUSGB methods for the identification of high/intermediate- and low-risk prostate cancer. Patients identified as having intermediate/high risk lesions by multiparametric magnetic resonance imaging (mpMRI) guidance underwent mpMRIGB by one physician, after which TRUSGB were procured by a different physician. When the mpMRI scan was normal, patients only underwent TRUSB. A total of 12 TRUSGB cores, and a mean of 2-3 MRIGB cores were obtained from each patient by a urologist that was blinded to mpMMRI results. Case-matched biopsies were procured from 1003 patients, 170 of which later underwent a radical prostatectomy. Tumors were classified as low-risk when a low-volume Gleason score of 3+3 or very low-volume Gleason score of 3+4. TRUSGB specimens were obtaining from 223 patients, and mpMRIGB specimens were also obtained from 142 of those patients.
Summary of Findings:
Of the 223 patients evaluated, 63.7% (142 patients) were diagnosed as having prostate cancer. Cancer was detected by TRUSGB in 56.5% of patients (126/223), and by mpMRIGB in 69.7% of patients (99/142). Of the patients diagnosed with cancer by TRUSGB, the cancer was intermediate/high risk for 62.7% (79/142) of patients, and low risk for 37.3% (47/142). Conversely, of the patients diagnosed with cancer by mpMRIGB, the cancer was intermediate/high risk for 93.9% (93/99) of patients, and low risk for 6.1% (6/99). The percentage of cores that contained cancer was significantly higher (p<0.001) for the MRGB method than the TRUSGB method, 56.4% (235/ 417 cores) versus (15%) 401/2672 cores, respectively. Further, the negative predictive value for intermediate/high risk cancer with the mpMRIGB method was greater than the TRUSGB method (96.9 % versus 71.9%). A subset of patients (75) underwent mpMRIGB, TRUSGB, and a subsequent prostatectomy. Of these, 60 patients were correctly diagnosed based on mpMRIGB results compared to the results of the prostatectomy, while 4 patients were treated for what turned out to be insignificant tumors, and cancer was missed in 11 patients based on mpMRIGB specimens Based on findings in TRUSGB specimens, 53 patients were correctly diagnosed, 4 patients were treated for insignificant tumors, and cancer was missed in 18 patients. The authors conclude that mpMRIGB improved overall detection of intermediate/high risk cancers, while also reducing the detection of low-risk cancers.
Biospecimens
Preservative Types
- Formalin
Diagnoses:
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform Morphology H-and-E microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition Magnetic resonance imaging-guided biopsy
Ultrasound-guided biopsy
Surgical resection