Skip to main content
SpringerLink
Log in

Outcomes of magnetic resonance imaging fusion-targeted biopsy of prostate imaging reporting and data system 3 lesions

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the characteristics and histological outcomes in patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions undergoing magnetic resonance imaging-guided fusion-targeted biopsy (MRIFTB).

Methods

We retrospectively reviewed 138 patients with PI-RADS category 3 lesions classified using multiparametric MRI who underwent MRIFTB between May 2016 and March 2018. The study population included biopsy-naïve and patients with prior negative biopsy. Univariate and multivariate analyzes were performed to determine significant predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The definition of csPCa was set at Gleason score ≥ 3 + 4.

Results

Overall, 114 (82.6%) biopsied lesions were benign and 24 (17.4%) were identified as prostate cancer. Of these 24 lesions, 14 (58.3%) harbored csPCa. Peripheral zone (PZ) lesions were more likely to be associated with malignant disease than transition zone lesions (13.7 vs. 6.2%). Multivariate logistic analysis revealed that age, PZ location, and prostate-specific antigen (PSA) density (P < 0.05) were independent predictors of both PCa and csPCa.

Conclusions

A non-negligible number of PI-RADS 3 patients harbor csPCa. Moreover, age, lesion location, and PSA density could be potential clinical predictors of PCa and csPCa. Physicians should be aware of the cancer prevalence of PI-RADS 3 lesions, as the use of the aforementioned factors can help in the decision-making process for these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Center MM, Jemal A, Lortet-Tieulent J et al (2012) International variation in prostate cancer incidence and mortality rates. Eur Urol 61:1079–1092

    PubMed  Google Scholar 

  2. Trabulsi EJ, Halpern EJ, Gomella LG (2011) Ultrasonography and biopsy of the prostate. In: Wein AJ (ed) Campbell–Walsh urology, 10th edn. Saunders, Philadelphia, pp 2735–2747

    Google Scholar 

  3. Pinkhasov GI, Lin Y-K, Palmerola R et al (2012) Complications following prostate needle biopsy requiring hospital admission or emergency department visits—experience from 1000 consecutive cases. BJU Int 110:369–374

    Article  PubMed  Google Scholar 

  4. Zaytoun OM, Anil T, Moussa AS, Jianbo L, Fareed K, Jones JS (2011) Morbidity of prostate biopsy after simplified versus complex preparation protocols: assessment of risk factors. Urology 77:910–914

    Article  PubMed  Google Scholar 

  5. Bjurlin MA, Meng X, Le Nobin J, Wysock JS, Lepor H et al (2014) Optimization of prostate biopsy: the role of magnetic resonance imaging targeted biopsy in detection, localization and risk assessment. J Urol 192:648–658

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hassanzadeh E, Glazer DI, Dunne RM, Fennessy FM, Harisinghani MG et al (2016) Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review. Abdom Radiol (NY) 42:278–289

    Article  Google Scholar 

  7. Hamoen EH, de Rooij M, Witjes JA, Barentsz JO, Rovers MM (2015) Use of the prostate imaging reporting and data system (PI-RADS) for prostate cancer detection with multiparametric magnetic resonance imaging: a diagnostic meta-analysis. Eur Urol 67:1112–1121

    Article  PubMed  Google Scholar 

  8. AdMetech Foundation (2015) PI‑RADSv2: prostate imaging and reporting and data system. https://www.acr.org/‑/media/ACR/Files/RADS/Pi‑RADS/PIRADS‑V2.pdf. Accessed 30 Jan 2018.

  9. Tewes S, Mokov N, Hartung D, Schick V, Peters I et al (2016) Standardized reporting of prostate MRI: comparison of the prostate imaging reporting and data system (PI-RADS) version 1 and version 2. PLoS One 11:e0162879

    Article  PubMed  PubMed Central  Google Scholar 

  10. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA et al (2016) PI-RADS prostate imaging-reporting and data system: 2015, version 2. Eur Urol 69:16–40

    Article  PubMed  Google Scholar 

  11. Schieda N, Quon JS, Lim C, El-Khodary M, Shabana W et al (2015) Evaluation of the European Society of Urogenital Radiology (ESUR) PI-RADS scoring system for assessment of extra-prostatic extension in prostatic carcinoma. Eur J Radiol 84:1843–1848

    Article  PubMed  Google Scholar 

  12. Mertan FV, Greer MD, Shih JH, George AK, Kongnyuy M et al (2016) Prospective evaluation of the prostate imaging reporting and data system version 2 for prostate cancer detection. J Urol 196:690–696

    Article  PubMed  Google Scholar 

  13. Vargas HA, Hotker AM, Goldman DA, Moskowitz CS, Gondo T et al (2016) Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 26:1606–1612

    Article  CAS  PubMed  Google Scholar 

  14. Alberts A, Roobol M, Drost FJ et al (2017) PSA-density based patient selection for MRI-targeted prostate biopsy could reduce unnecessary biopsy procedures in men on active surveillance for low-grade prostate cancer. Eur Urol Suppl 16:e856

    Article  Google Scholar 

  15. Rosenkrantz AB, Babb JS, Taneja SS, Ream JM (2017) Proposed adjustments to PI-RADS version 2 decision rules: impact on prostate cancer detection. Radiology 283:119e29

    Article  Google Scholar 

  16. Hoeks CMA, Hambrock T, Yakar D, Hulsbergen-van CA, de Kaa T, Feuth JA Witjes et al (2013) Transition zone prostate cancer: detection and localization with 3-T multiparametric MR imaging. Radiology 266(1):207–217

    Article  PubMed  Google Scholar 

  17. Yoshizako T, Wada A, Hayashi T, Uchida K, Sumura M, Uchida N et al (2008) Usefulness of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in the diagnosis of prostate transition zone cancer. Acta Radiol 49(1207):1213

    Google Scholar 

  18. Veneziano S, Pavlica P, Compagnone G, Martorana G (2005) Usefulness of the (F/T)/PSA density ratio to detect prostate cancer. Urol Int 74:13–18

    Article  CAS  PubMed  Google Scholar 

  19. De Castro HAS, Iared W, Shigueoka DC, Mourão JE, Ajzen S (2011) Contribution of PSA density in the prediction of prostate cancer in patients with PSA values between 2.6 and 10.0 ng/ml. Radiol Bras 44 205:209

    Google Scholar 

  20. Kundu SD, Roehl KA, Yu X, Antenor JAV, Suarez BK, Catalona WJ (2007) Prostate specific antigen density correlates with features of prostate cancer aggressiveness. J Urol 177:505–509

    Article  CAS  PubMed  Google Scholar 

  21. Bastian PJ, Mangold LA, Epstein JI, Partin AW (2004) Characteristics of insignificant clinical T1c prostate tumors—a contemporary analysis. Cancer 101:2001–2005

    Article  PubMed  Google Scholar 

  22. Kosaka T, Mizuno R, Shinojima T et al (2014) The implications of prostate specific antigen density to predict clinically significant prostate cancer in men ≤ 50 years. Am J Clin Exp Urol 2:332–336

    PubMed  PubMed Central  Google Scholar 

  23. Cash H, Maxeiner A, Stephan C, Fischer T, Durmus T et al (2016) The detection of significant prostate cancer is correlated with the prostate imaging reporting and data system (PI-RADS) in MRI/transrectal ultrasound fusion biopsy. World J Urol 34:525–532

    Article  PubMed  Google Scholar 

  24. Hansen N, Patruno G, Wadhwa K et al (2016) Magnetic resonance and ultrasound image fusion supported transperineal prostate biopsy using the ginsburg protocol: technique, learning points, and biopsy results. Eur Urol 70:332–340

    Article  PubMed  Google Scholar 

  25. Schoots IG, Osses DF, Drost FH et al (2018) Safe reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSA-density, with different thresholds for significant disease. Transl Androl Urol. https://doi.org/10.21037/tau.2017.12.29

    Article  PubMed  PubMed Central  Google Scholar 

  26. Delongchamps NB, Peyromaure M, Schull A et al (2013) Prebiopsy magnetic resonance imaging and prostate cancer detection: comparison of random and targeted biopsies. J Urol 189:493–499

    Article  PubMed  Google Scholar 

  27. Park BK, Park JW, Park SY et al (2011) Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy. AJR Am J Roentgenol 197:W876–W881

    Article  PubMed  Google Scholar 

  28. Wysock JS, Rosenkrantz AB, Huang WC et al (2014) A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS Trial. Eur Urol 66:343–351

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Tae Jin Kim, Min Seung Lee & Sung Kyu Hong

  2. Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Sung Il Hwang & Hak Jong Lee

  3. Department of Urology, Seoul National University College of Medicine, Seoul, South Korea

    Sung Kyu Hong

Authors
  1. Tae Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min Seung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung Il Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hak Jong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sung Kyu Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TJK and SKH contributed to protocol/project development; MSL, SIH, and HJL were involved in data collection or management; TJK, MSL, and SKH analyzed the data; TJK and SKH contributed to manuscript writing/editing; TJK, HJL, and SKH were involved in critical review; SKH supervised the study.

Corresponding author

Correspondence to Sung Kyu Hong.

Ethics declarations

Conflict of interest

There are no conflicts of interest, including specific financial interests, relationships, and affiliations relevant to the subject materials described in this manuscript.

Ethical statements

All study protocols were in accordance with the principles of the Helsinki Declaration. We removed personal identifiers and anonymized all data, which exempted the study from the need to obtain informed consent from patients.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, T.J., Lee, M.S., Hwang, S.I. et al. Outcomes of magnetic resonance imaging fusion-targeted biopsy of prostate imaging reporting and data system 3 lesions. World J Urol 37, 1581–1586 (2019). https://doi.org/10.1007/s00345-018-2565-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-018-2565-3

Keywords

Search

Navigation