Abstract
The MRI targeted biopsy (MRI-TBx) may increase the detection rate of clinically significant cancer (csPCa) in candidates for re-biopsy. However, there will be several patients in whom MRI is contraindicated. In this retrospective study we assessed the ability of combination of PDS guided biopsies (PDS-TBx) and modified SBx to substitute MRI-TBx. 154 men with persistently elevated PSA were referred for re-biopsy. Our protocol included a combination of MRI-TBx, DPS-TBx and modified SBx with additional biopsies from anterior lateral horns and anterior aspects of apex. MRI findings were defined as suspicious lesions (MRI-SL) and highly suspicious lesions (MRI-HL), based on PIRADS scale. In 40 patients csPCa was detected. While, MRI diagnosed csPCa in 36 patients (23%, n-36/154): 25% and 92% of biopsies targeted to the MRI- SL and MRI-HSL confirmed csPCa. Thirty-eight PDS hypervascular areas were found, while csPCa was diagnosed in 84% of these lesions, or in 28 patients (18%, n-28/154). SBx detected csPCa in 34 cores or in 21 patients (13%, n – 21/154). SBx missed cancers in the in the anterior aspect of middle gland. Combination of PDS-TBx + SBx detected csPCa in 35 (88% of csPCa) patients. Strongest predictors for the csPCa presence were MRI-HSL, PDS’ lesions and biopsies from anterior aspect that included apex, mid gland and anterior lateral horns (p < 0.001 and p-0.008, respectively). The combination of PDS-TBx + SBx may miss 15% of csPCa detected by MRI. However, it can detect additional 10% of csPCa that were missed by MRI. To improve the accuracy of this combination, the anterior aspect of middle gland should be also included in the modified SBx. These changes in combination can make it helpful in candidates for re-biopsy who cannot undergo MRI.
Similar content being viewed by others
References
Welch HG, Fisher ES, Gottlieb DJ, Barry MJ (2007) Detection of prostate cancer via biopsy in the Medicare–SEER population during the PSA era. J Natl Cancer Inst 99:1395–1400
Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L, Taneja SS, Emberton M (2013) Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 63:125–140
Sonn GA, Chang E, Natarajan S et al (2014) Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol 65:809–815
Wysock JS, Rosenkrantz AB, Huang WC et al (2013) 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
Salami SS, Ben-Levi E, Yaskiv O, Ryniker L, Turkbey B, Kavoussi LR, Villani R, Rastinehad AR (2015) In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12-core biopsy still necessary in addition to a targeted biopsy? BJU Int 115:562–570
Schoots IG, Roobol MJ, Nieboer D, Chris H, Bangma CH, Steyerberg EW, Hunink MG (2015) Magnetic resonance imaging–targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 68:438–450
Le JD, Stephenson S, Brugger M et al (2014) MRI-ultrasound fusion biopsy for prediction of final prostate pathology. J Urol 192:1367–1373
Mathur S, O'Malley ME, Ghai S, Jhaveri K, Sreeharsha B, Margolis M, Zhong L, Maan H, Toi A (2019) Correlation of 3T multiparametric prostate MRI using prostate imaging reporting and data system (PIRADS) version 2 with biopsy as reference standard. Abdom Radiol (NY) 44(1):252–258
Puech P, Rouviere O, Renard-Penna R et al (2013) Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy-prospective multicenter study. Radiology 268:461–469
Dewey M, Schink T, Dewey CF (2007) Frequency of referral of patients with safety-related contraindications to magnetic resonance imaging. Eur J Radiol 63(1):124–127
Chow GV, Nazarian S (2014) MRI for patients with cardiac implantable electrical devices. Cardiol Clin 32:299–304
Bastide C, Lechevallier E, Eghazarian C, Ortega JC, Coulange C (2003) Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate: risk factors. Prostate Cancer Prostatic Dis 6:239–241
Kravchick S, Yoffe B, Cytron S (2007) Modified perianal/pericapsular anesthesia for transrectal biopsy of prostate in patients with anal rectal problems. Urology 69(1):139–141
Gold SA, Hale GR, Bloom JB, Smith CP, Rayn KN, Valera V, Wood BJ, Choyke PL, Turkbey B, Pinto PA (2019) Follow-up of negative MRI-targeted prostate biopsies: when are we missing cancer? World J Urol 37(2):235–241
Takahashi S, Yamada Y, Homma Y, Horie S, Hosaka Y, Kitamura T (2002) Power Doppler ultrasonography-directed prostate biopsy in men with elevated serum PSA levels: an evaluation of the clinical utility and limitations. Urology. 60(2):248–252
Eisenberg ML, Cowan JE, Carroll PR, Shinohara K (2010) The adjunctive use of power Doppler imaging in the preoperative assessment of prostate cancer. BJU Int 105:1237–1241
Remzi M, Dobrovits M, Reissigl A, Ravery V, Waldert M, Wiunig C, Fong YK, Djavan B, European Society for Oncological Urology (ESOU) (2004) Can power Doppler enhanced transrectal ultrasound guided biopsy improve prostate cancer detection on first and repeat prostate biopsy? Eur Urol 46(4):451–456
Wright JL, Ellis WJ (2006) Improved prostate cancer detection with anterior apical prostate biopsies. Urol Oncol 24:492–495
DjavanB ZAR, Remzi M, Ghawidel K, Basharkhah A, Schulman CC et al (2000) Optimal predictors of prostate cancer in repeat prostate biopsy: a prospective study of 1051 men. J Urol 163:1144–1148
Kim M, Choi SK, Park M, Shim M, Song C, Jeong IG, Hong JH, Kim CS, Ahn H (2016) Characteristics of anterior located prostate cancer and usefulness of multiparametric magnetic resonance imaging for diagnosis. J Urol 196(2):367–373
Takashima R, Egawa S, Kuwao S, Baba S (2002) Anterior distribution of Stage T1c nonpalpable tumors in radical prostatectomy specimens. Urology 59(5):692–697
Author information
Authors and Affiliations
Author notes
Dr Ronit Peled has passed away.
- Ronit Peled
Corresponding author
Ethics declarations
Conflict of Interest
We state that there is no conflict of interest to any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kravchick, S., Cherniavsky, E., Peled, R. et al. Power Doppler Sonography (PDS) and Modified TRUS Systematic Biopsies – Can this Combination Adequately Replace Multiparametric Prostate Magnetic Resonance Imaging (mp-MRI) in Candidates for Re Biopsies Who cannot Undergo mp-MRI. Pathol. Oncol. Res. 26, 2357–2361 (2020). https://doi.org/10.1007/s12253-020-00824-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12253-020-00824-0