“In-bore” MRI prostate biopsy is a safe preoperative clinical tool to exclude significant prostate cancer in symptomatic patients with benign prostatic obstruction before transurethral laser enucleation

  • Angelo Porreca Department of Urology, Abano Terme Hospital, Padua, Italy.
  • Daniele D'Agostino Department of Urology, Abano Terme Hospital, Padua, Italy.
  • Mario Vigo Department of Radiology, Abano Terme Hospital, Padua, Italy.
  • Paolo Corsi Department of Urology, Abano Terme Hospital, Padua, Italy.
  • Daniele Romagnoli Department of Urology, Abano Terme Hospital, Padua, Italy.
  • Alessandro Del Rosso Department of Urology, Abano Terme Hospital, Padua, Italy.
  • Riccardo Schiavina Department of Urology, University of Bologna, Bologna, Italy.
  • Eugenio Brunocilla Department of Urology, University of Bologna, Bologna, Italy.
  • Walter Artibani Department of Urology, Abano Terme Hospital, Padua, Italy.
  • Marco Giampaoli | mgiampaoli@casacura.it Department of Urology, Abano Terme Hospital, Padua, Italy.

Abstract

Introduction: Purpose of our study was to investigate the role of a negative in-bore MRI-guided biopsy (MRI-GB) in comparison to a negative multiparametric prostate MRI (mpMRI) and a contextual negative transrectal ultrasound guided biopsy of the prostate with regard to incidental prostate cancer findings in the surgical specimen of men who underwent to Holmium Laser enucleation of prostate (HoLEP) with a preoperative suspicion of prostate cancer.
Materials and methods: Data of 117 of symptomatic patients for bladder outflow obstruction who subsequently underwent to HoLEP was retrospectively analyzed form a multicentric database. All patients had a raised serum PSA and/or an abnormal digital rectal examination (DRE) with a pre-interventional mpMRI. Prostate cancer was excluded either with an en-bore MRI-GB (group "IN-BORE MRI-GB" n = 57) in case of a suspect area at the mpMRI or with a standard biopsy (group "mpMRI + TRUS-GB" n = 60) in case of a negative mpMRI. Preoperative characteristic surgical and histological outcomes were analyzed. Univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa).
Results: Both groups presented moderate to severe lower tract urinary symptoms: median IPSS was 19 (IQR: 17.0-22.0) in the IN-BORE MRI-GB group and 20 (IQR: 17.5-22.0) in the mpMRI + TRUS-GB (p = 0.71). No statistically significant difference was found between the two groups besides total prostate volume with 68 cc (IQR: 58.0-97.0) in the IN-BORE MRI-GB group and 84 cc (IQR: 70.0-115.0) in the mpMRI + TRU-GB group (p = 0.01) No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. No different rates (p = 0.50) of iPCa were found in the IN-BORE MRI-GB group (14%) in comparison with mpMRI + TRUS-GB group (10 %); pT stage and ISUP Grade Group in iPCa stratification were comparable between the two groups. In multivariate analysis a statistically significant correlation with age as an independent predictive factor of iPCa was found (OR 1.14; 95% CI: 1.02-1.27; p = 0.02) while no correlations were revealed with PSA (OR 1.12; 95% CI: 0.99-1.28; p = 0.08) and a negative in-bore MRI-GB (OR 1.72; 95% CI: 0.51-5.77; p = 0.37).
Conclusions: Including a mpMRI and an eventual in-bore MRIGB represents a novel clinical approach before surgery in patients with symptomatic obstruction with a concomitant suspicion of PCa, leading to low rate of iPCa and avoiding unnecessary standard TRUS-GB biopsies

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Published
2020-01-14
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Section
Original Papers - Prostate
Keywords:
magnetic resonance imaging, Holmium laser enucleation of the prostate, prostate biopsy, prostatic enlargement, prostate cancer
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How to Cite
Porreca, A., D’Agostino, D., Vigo, M., Corsi, P., Romagnoli, D., Del Rosso, A., Schiavina, R., Brunocilla, E., Artibani, W., & Giampaoli, M. (2020). “In-bore” MRI prostate biopsy is a safe preoperative clinical tool to exclude significant prostate cancer in symptomatic patients with benign prostatic obstruction before transurethral laser enucleation. Archivio Italiano Di Urologia E Andrologia, 91(4), 224-229. https://doi.org/10.4081/aiua.2019.4.224

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