2053 multiparametric magnetic resonance imaging and ultrasound fusion biopsy detects prostate cancer in patients with prior negative trus biopsies

You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 20122053 MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING AND ULTRASOUND FUSION BIOPSY DETECTS PROSTATE CANCER IN PATIENTS WITH PRIOR NEGATIVE TRUS BIOPSIES Nitin Yerram, Dmitry Volkin, Jeffery Nix, Srinivas Vourganti, An Hoang, Faisal Ahmed, Gopal Gupta, Art Rastinehad, Jochen Kruecker, Sameul Kadoury, Julie Locklin, Stacey Gates, Sheng Xu, Maria Merino, W. Marston Linehan, Ismail Baris Turkbey, Peter L. Choyke, Bradford J. Wood, and Peter A. Pinto Nitin YerramNitin Yerram Bethesda, MD More articles by this author , Dmitry VolkinDmitry Volkin Bethesda, MD More articles by this author , Jeffery NixJeffery Nix Bethesda, MD More articles by this author , Srinivas VourgantiSrinivas Vourganti Bethesda, MD More articles by this author , An HoangAn Hoang Bethesda, MD More articles by this author , Faisal AhmedFaisal Ahmed Bethesda, MD More articles by this author , Gopal GuptaGopal Gupta Bethesda, MD More articles by this author , Art RastinehadArt Rastinehad Bethesda, MD More articles by this author , Jochen KrueckerJochen Kruecker Briarcliff Manor, NY More articles by this author , Sameul KadourySameul Kadoury Briarcliff Manor, NY More articles by this author , Julie LocklinJulie Locklin Bethesda, MD More articles by this author , Stacey GatesStacey Gates Bethesda, MD More articles by this author , Sheng XuSheng Xu Briarcliff Manor, NY More articles by this author , Maria MerinoMaria Merino Bethesda, MD More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , Ismail Baris TurkbeyIsmail Baris Turkbey Bethesda, MD More articles by this author , Peter L. ChoykePeter L. Choyke Bethesda, MD More articles by this author , Bradford J. WoodBradford J. Wood Bethesda, MD More articles by this author , and Peter A. PintoPeter A. Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2218AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with prior negative transrectal ultrasound (TRUS) biopsies, an elevated prostate specific antigen (PSA), and high clinical suspicion for prostate cancer create a diagnostic dilemma. The ability of multiparametric MRI and ultrasound (MRI/US) fusion biopsy to detect distinct lesions within the prostate and its increased sensitivity as compared with TRUS biopsy alone may make it an effective tool in this challenging group of patients. METHODS A retrospective review was performed on all pts undergoing MRI/US fusion biopsy from March 2007 to November 2011. All pts with one or more previous negative biopsies prior to presentation at our institution were included. Patients underwent 3 Tesla MRI of the prostate with endorectal coil and had a 12 core TRUS biopsy as well as targeted MRI/US fusion biopsy of any concerning lesions. RESULTS We identified 206 pts with previous negative biopsies. Mean age at biopsy was 61.7 yrs (37–80), mean number of previous biopsy sessions was 2.2 (1–9), mean PSA was 14.0 ng/mL (0.3–103), and mean prostate volume was 68.0mL (21–210). Of the 206 pts, 76 (37%) were found to have cancer using both modalities at our institution. MRI/US fusion biopsy detected cancer in 62 pts (82%) while TRUS biopsy detected cancer in 55 pts (72%). High risk cancer (GS 8 and above) was found in 22 of the 206 pts (10%). All 22 pts (100%) were detected on MRI/US fusion biopsy while TRUS biopsy missed 12 of these high risk cancers (55%). PSA, prostate volume, and PSA density were significant predictors of cancer detection on univariable analysis while age, race, and number of prior biopsies were not. Only PSA density remained significant on multivariable analysis. No high risk cancers were found in pts with PSA density less than 0.18 ng/mL/mL. Using this cutoff, we can increase our yield of detecting high risk cancers to 21% while maintaining 100% sensitivity. CONCLUSIONS Multiparametric MRI in conjunction with a MR/US fusion biopsy platform is a novel diagnostic tool for detecting prostate cancer and may be ideally suited for pts with previously negative TRUS biopsies in the face of a persistent clinical suspicion for cancer. We found a sizeable percentage of these pts harbor aggressive disease which would have gone undetected without the addition of fusion biopsy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e828 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nitin Yerram Bethesda, MD More articles by this author Dmitry Volkin Bethesda, MD More articles by this author Jeffery Nix Bethesda, MD More articles by this author Srinivas Vourganti Bethesda, MD More articles by this author An Hoang Bethesda, MD More articles by this author Faisal Ahmed Bethesda, MD More articles by this author Gopal Gupta Bethesda, MD More articles by this author Art Rastinehad Bethesda, MD More articles by this author Jochen Kruecker Briarcliff Manor, NY More articles by this author Sameul Kadoury Briarcliff Manor, NY More articles by this author Julie Locklin Bethesda, MD More articles by this author Stacey Gates Bethesda, MD More articles by this author Sheng Xu Briarcliff Manor, NY More articles by this author Maria Merino Bethesda, MD More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Ismail Baris Turkbey Bethesda, MD More articles by this author Peter L. Choyke Bethesda, MD More articles by this author Bradford J. Wood Bethesda, MD More articles by this author Peter A. Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...