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MRI-guided in-bore biopsy for prostate cancer: what does the evidence say? A case series of 554 patients and a review of the current literature

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Abstract

Purpose

To review our experience with MRI-guided in-bore prostate biopsy (MRGB) and present a review of the literature on MRGB.

Methods

A retrospective review of patients presenting for MRGB between 2013 and 2018. Diagnostic and biopsy MRI scans were reviewed to collect data on scan dates, procedure times, characteristics of MRI targets (PI-RADS™ score, target size, ADC value and location). A review of the literature on MRGB for the period 2013–2018 was performed.

Results

607 targets in 554 men were biopsied. Overall and significant cancer detection rate were 80% and 55% at a patient level, and 76 and 59% at the target level, respectively. Prostate cancer (CaP) detection in men with prior negative biopsy was 60% while 50% of men on active surveillance were upgraded to clinically significant disease (CSD). Lesion location did not predict for presence of CaP or CSD. PI-RADS™ score, age and PSAD were predictors of CSD at biopsy on multivariate analysis. Literature review identified 23 reports reporting on MRGB cohorts (~ 4000 patients). Overall cancer detection ranged from 23 to 74% and CSD in 63% overall. CaP detection in PI-RADS™ 3 targets was substantially lower in our series and the literature than for PI-RADS™ 4–5 targets.

Conclusions

MRGB in PI-RADS™ 3–5 targets yields high rates of cancer diagnosis. High detection rates are also seen in men with prior negative biopsy and AS cohorts. PI-RADS™ score, age and PSAD can reliably predict CSD detection. The number of published series is small and the role of MRGB in PI-RADS™ 3 targets needs further study.

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Abbreviations

ADC:

Apparent diffusion co-efficient

AS:

Active surveillance

CaP:

Prostate cancer

CCL:

Cancer core length

CSD:

Clinically significant disease

DICOM:

Digital imaging and communications in medicine

IQR:

Inter-quartile range

ISUP:

International Society of Urological Pathology

mpMRI:

Multiparametric magnetic resonance imaging

MRGB:

In-bore MRI-guided biopsy

MRI:

Magnetic resonance imaging

PI-RADS™:

Prostate Imaging-Reporting and Data System

PZ:

Peripheral zone

TRUS:

Transrectal ultrasound (guided)

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. The Wesley Hospital Urology Department, Brisbane, Australia

    Morgan Pokorny, Boon Kua, Rachel Esler, John Yaxley, Nigel Dunglison, Troy Gianduzzo, Geoff Coughlin & Les Thompson

  2. Wesley Medical Imaging, The Wesley Hospital, Brisbane, Australia

    Ross Holt, Barbara Laing, Darren Ault, Nicholas Brown & Rob Parkinson

  3. Aquesta Uropathology, Brisbane, Australia

    Hemamali Samaratunga

  4. School of Medicine, University of Queensland, Brisbane, Australia

    John Yaxley

Authors
  1. Morgan Pokorny
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  2. Boon Kua
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  3. Rachel Esler
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  4. John Yaxley
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  5. Hemamali Samaratunga
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  6. Nigel Dunglison
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  7. Troy Gianduzzo
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  8. Geoff Coughlin
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  9. Ross Holt
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  10. Barbara Laing
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  12. Nicholas Brown
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  13. Rob Parkinson
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  14. Les Thompson
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Contributions

MP: project development, data collection, data management, data analysis, manuscript writing and editing. BK: data collection, manuscript editing. RE: data collection, manuscript editing. JY: data analysis, manuscript editing. HS: data collection, manuscript editing. ND: manuscript editing. TG: manuscript editing. GC: manuscript editing. RH: data collection, data management, manuscript editing. BL: manuscript editing. DA: manuscript editing. NB: manuscript editing. RP: data analysis, data collection, manuscript editing. LT: data collection, manuscript editing.

Corresponding author

Correspondence to Morgan Pokorny.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional ethics committee approval was obtained from Uniting Care Health’s Human Research Ethics Committee for the conduct of this study.

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Pokorny, M., Kua, B., Esler, R. et al. MRI-guided in-bore biopsy for prostate cancer: what does the evidence say? A case series of 554 patients and a review of the current literature. World J Urol 37, 1263–1279 (2019). https://doi.org/10.1007/s00345-018-2497-y

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