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

  • 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.

Abstract

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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Published
2021-03-22
Info
Issue
Section
SIEUN Congress 2020: Original Papers, Reviews and Case Reports
Keywords:
Fusion Biopsy; MRI-US guided Fusion Biopsy; Prostate Cancer; Active Surveillance
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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