https://doi.org/10.4081/aiua.2021.1.88

MRI/US fusion prostate biopsy in men on active surveillance: Our experience

Vol. 93 No. 1 (2021)
Published: March 22, 2021
Fusion Biopsy; MRI-US guided Fusion Biopsy; Prostate Cancer; Active Surveillance
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Authors

Vito Lacetera
vlacetera@gmail.com
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Angelo Antezza
Università Politecnica delle Marche-Azienda Ospedaliera Ospedali Riuniti Torrette di Ancona, Italy.
Alessio Papaveri
Università Politecnica delle Marche-Azienda Ospedaliera Ospedali Riuniti Torrette di Ancona, Italy.
Emanuele Cappa
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Bernardino Cervelli
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Giuliana Gabrielloni
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Michele Montesi
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Roberto Morcellini
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Gianni Parri
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Emilio Recanatini
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.
Valerio Beatrici
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro, Italy.

Aim: The upgrading or staging in men with prostate cancer (PCA) undergoing active surveillance (AS), defined as Gleason score (GS) ≥ 3+4 or more than 2 area with cancer, was investigated in our experience using the software-based fusion biopsy (FB).
Methods: We selected from our database, composed of 620 biopsies, only men on AS according to criteria of John Hopkins Protocol (T1c, < 3 positive cores, GS = 3+3 = 6). Monitoring consisted of PSA measurement every 3 months, a clinical examination every 6 months, confirmatory FB within 6 months and then annual FB in all men. The suspicious MRI lesions were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) classification version 2. FB were performed with a transrectal elastic free-hand fusion platform. The overall and clinically significant cancer detection rate was reported. Secondary, the diagnostic role of systematic biopsies was evaluated.
Results: We selected 56 patients on AS with mean age 67.4 years, mean PSA 6.7 ng/ml and at least one follow-up MRI-US fusion biopsy (10 had 2 or 3 follow-up biopsies). Lesions detected by MRI were: PIRADS-2 in 5, PIRADS-3 in 28, PIRADS-4 in 18 pts and PIRADS-5 in 5 patients. In each MRI lesion, FB with 2.1 ± 1.1 cores were taken with a mean total cores of 13 ± 2.4 including the systematic cores. The overall cancer detection rate was 71% (40/56): 62% (25/40) in target core and 28% (15/40) in systematic core. The overall significant cancer detection rate was 46% (26/56): 69% (18/26) in target vs 31% (8/26) in random cores.
Conclusions: The incidence of clinical significant cancer was 46% in men starting active surveillance, but it was more than doubled using MRI/US Target Biopsy 69% (18/26) rather than random cores (31%, 8/26). However, 1/3 of disease upgrades would have been missed if only the targeted biopsies were performed. Based on our experience, MRI/US fusion target biopsy must be associated to systematic biopsies to improve detection of significant cancer, reducing the risks of misclassification.

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How to Cite

Lacetera, V. ., Antezza, A. ., Papaveri, A. ., Cappa, E. ., Cervelli, B. ., Gabrielloni, G. ., Montesi, M. ., Morcellini, R. ., Parri, G. ., Recanatini, E. ., & Beatrici, V. . (2021). MRI/US fusion prostate biopsy in men on active surveillance: Our experience. Archivio Italiano Di Urologia E Andrologia, 93(1), 88–91. https://doi.org/10.4081/aiua.2021.1.88

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