Abstract
Purpose
To investigate the role of transrectal MRI fusion biopsy to select patients for prostate cancer focal therapy.
Methods
Patients with suspected prostate cancer underwent transrectal MRI fusion biopsy with the Koelis trinity device. Two focal therapy eligibility criteria were subsequently defined: Group 1: PSA ≤ 15 ng/ml, unilateral csPCa, ISUP grade ≤ 2, no contralateral PIRADS 3–5 lesion; Group 2: same criteria but ISUP grade 3. These subgroups were correlated with histopathological post-prostatectomy parameters for stage pT2, unilateral csPCa, no ISUP upgrading. In addition, parameters of csPCa detection were analyzed for patients undergoing primary and re-biopsy.
Results
Four hundred fourteen consecutive patients were analyzed (314 for primary biopsy, 100 for re-biopsy). Post-prostatectomy whole mount section analysis was available from 155 patients. 39 and 62 of these patients met focal therapy inclusion criteria for group 1 and group 2, respectively. A correlation with final pathology parameters following radical prostatectomy (stage pT2, unilateral csPCa, no ISUP upgrading) revealed a positive predictive value of only 53.8% and 64.5% for Group 1 and 2, respectively. The overall csPCa detection rate was 73.7%. In the re-biopsy group 20% additional patients with csPCa were detected by targeted biopsy.
Conclusion
Despite high csPCa detection rates following MRI fusion biopsy our study demonstrated that, using final pathology to confirm locally advanced tumor stage, presence of bilateral csPCa and ISUP upgrading, between 35.5 and 46.2% of patients would have been incorrectly selected for focal therapy.
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References
Onik G, Miessau M, Bostwick DG (2009) Three-dimensional prostate mapping biopsy has a potentially significant impact on prostate cancer management. J Clin Oncol 27:4321–4326
Barentsz JO, Weinreb JC, Verma S et al (2016) Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol 69:41–49
Kasivisvanathan V, Dufour R, Moore CM et al (2013) Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer. J Urol 189:860–866
Tay KJ, Scheltema MJ, Ahmed HU et al (2017) Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project. Prostate Cancer Prostatic Dis 20:294–299
van den Bos W, Muller BG, Ahmed H et al (2014) Focal therapy in prostate cancer: international multidisciplinary consensus on trial design. Eur Urol 65:1078–1083
Ahmed HU, Freeman A, Kirkham A et al (2011) Focal therapy for localized prostate cancer: a phase I/II trial. J Urol 185:1246–1254
Schouten MG, van der Leest M, Pokorny M et al (2017) Why and where do we miss significant prostate cancer with multi-parametric magnetic resonance imaging followed by magnetic resonance-guided and transrectal ultrasound-guided biopsy in biopsy-naive men? Eur Urol 71:896–903
Ahmed HU, El-Shater Bosaily A, Brown LC et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822
Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777
Rouviere O, Puech P, Renard-Penna R et al (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 20:100–109
Barkovich EJ, Shankar PR, Westphalen AC (2019) A systematic review of the existing prostate imaging reporting and data system version 2 (PI-RADSv2) literature and subset meta-analysis of PI-RADSv2 categories stratified by gleason scores. AJR Am J Roentgenol 212:847–854
Bratan F, Niaf E, Melodelima C et al (2013) Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol 23:2019–2029
Priester A, Natarajan S, Khoshnoodi P et al (2017) Magnetic resonance imaging underestimation of prostate cancer geometry: use of patient specific molds to correlate images with whole mount pathology. J Urol 197:320–326
Drost FH, Osses DF, Nieboer D et al (2019) Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 4:CD012663
Valerio M, Ahmed HU, Emberton M et al (2014) The role of focal therapy in the management of localised prostate cancer: a systematic review. Eur Urol 66:732–751
Isbarn H, Karakiewicz PI, Vogel S et al (2010) Unilateral prostate cancer cannot be accurately predicted in low-risk patients. Int J Radiat Oncol Biol Phys 77:784–787
Ganzer R, Hadaschik B, Pahernik S et al (2018) Prospective multicenter phase II study on focal therapy (hemiablation) of the prostate with high intensity focused ultrasound. J Urol 199:983–989
Feijoo ER, Sivaraman A, Barret E et al (2016) Focal high-intensity focused ultrasound targeted hemiablation for unilateral prostate cancer: a prospective evaluation of oncologic and functional outcomes. Eur Urol 69:214–220
Nassiri N, Chang E, Lieu P et al (2018) Focal therapy eligibility determined by magnetic resonance imaging/ultrasound fusion biopsy. J Urol 199:453–458
Johnson DC, Yang JJ, Kwan L et al (2019) Do contemporary imaging and biopsy techniques reliably identify unilateral prostate cancer? Implications for hemiablation patient selection. Cancer 125:2955–2964
Choi YH, Yu JW, Kang MY et al (2019) Combination of multiparametric magnetic resonance imaging and transrectal ultrasound-guided prostate biopsies is not enough for identifying patients eligible for hemiablative focal therapy for prostate cancer. World J Urol 37:2129–2135
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RG: Protocol project development, Data collection and management, Data analysis, Manuscript writing and editing. AM: Protocol project development, Data collection and management, Data analysis, Manuscript writing and editing, Statistical analysis. FSS: Data collection and management. CB: Data collection and management, Histopathological processing and analysis. WB: Protocol project development, Data collection and management.
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The study protocol was evaluated by the local ethics committee and it was confirmed that the retrospective study does not need ethics approval according to §15 of professional regulations.
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Ganzer, R., Mangold, A., Siokou, F.S. et al. Value of magnetic resonance imaging/ultrasound fusion prostate biopsy to select patients for focal therapy. World J Urol 40, 2689–2694 (2022). https://doi.org/10.1007/s00345-022-04157-2
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DOI: https://doi.org/10.1007/s00345-022-04157-2