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Prospective evaluation of magnetic resonance imaging guided in-bore prostate biopsy versus systematic transrectal ultrasound guided prostate biopsy in biopsy naïve men with elevated prostate specific antigen.

Author(s): Quentin M, Blondin D, Arsov C, Schimmöller L, Hiester A, Godehardt E, Albers P, Antoch G, Rabenalt R

Publication: J Urol, 2014, Vol. 192, Page 1374-9

PubMed ID: 24866597 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared prostate cancer detection rates in TRUS- and MRI-guided biopsies and investigated if patient age, prostate volume, or PSA levels differed between patients with or without prostate cancer. After multiparametric MRI, targeted MRI-guided in-bore biopsies of up to three lesions were obtained transrectally using an 18-gauge needle biopsy gun from 128 men with a PSA of >4 ng/mL. Following MRI-guided biopsy, standard 12-core TRUS biopsies were obtained using an automatic 18-gauge needle biopsy gun. Clinically significant cancer was defined as having a cancer length ≥ 5 mm or a Gleason pattern greater than 3. The method of preservation and analysis was not specified but assumed to be H&E microscopy of formalin-fixed specimens.

   Summary of Findings:

   Prostate cancer was detected in 78 of the 128 (60.9%) patients and considered to be clinically significant in 68 of the 78 cases. Interestingly, biopsies obtained by each guidance method identified cancer in 68 of the 78 patients with cancer, with each method missing 10 cases. Of the cases missed by MRI, five were considered to be clinically significant in the TRUS biopsy (Gleason score of 3+3=6 in 1 case, 3+4=7 in 3 cases and 4+4=8 in 1 case). Similarly, 6 of the cases missed by TRUS were considered clinically significant in the MRI-guided biopsy (Gleason score of 3+4=7 in 3 cases, 4+3=7 in 2 cases, and 4+4=8 in once case). Gleason score distributions were comparable between TRUS-guided and MRI-guided biopsies (mean of 7.1 for each, P=0.74). A higher percentage of MRI-guided biopsy cores than TRUS-guided biopsy cores were found to contain cancer (35.4% versus 14.4%, P<0.01) but the mean number of cores per patient was lower for MRI than TRUS-guided biopsies (5.3 versus 12). Although prostate volume was significantly lower in patients with prostate cancer than those without (45.9 mL vs 68.4 mL, P<0.01), patients with prostate cancer and those without had comparable average patient age (67 years versus 64.5 years, P=0.09) and PSA levels (9.6 versus 7.3, P=0.08). 

   Biospecimens

   • Tissue - Prostate

   Preservative Types

   • Formalin

   Diagnoses:

   • Neoplastic - Benign
   • Neoplastic - Carcinoma

   Platform:

   Analyte	Technology Platform
   Morphology	H-and-E microscopy
   Morphology	Light microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Preaquisition	Biomarker level	9.6 ng/mL PSA 7.3 ng/mL PSA
   Preaquisition	Patient age	64.5 years 67 years
   Biospecimen Acquisition	Method of tissue acquisition	Magnetic resonance imaging-guided biopsy Ultrasound-guided biopsy
   Preaquisition	Diagnosis/ patient condition	Clinically significant prostate cancer Clinically insignificant prostate cancer
   Preaquisition	Prognostic factor	45.9 mL prostate 68.4 mL prostate

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