MR/US FUSION TARGETED BIOPSY FAILED TO DETECT PROSTATE CANCER: ROLE OF CONFIRMMDX (R) AS AN ADJUNCT

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (MP24)1 Apr 2019MP24-15 MR/US FUSION TARGETED BIOPSY FAILED TO DETECT PROSTATE CANCER: ROLE OF CONFIRMMDX® AS AN ADJUNCT Michael Witthaus, Matthew Truong*, Jacob Gantz, Thomas Frye, Ahmed Ghazi, Edward Messing, Jean Joseph, Hiroshi Miyamoto, and Hani Rashid Michael WitthausMichael Witthaus More articles by this author , Matthew Truong*Matthew Truong* More articles by this author , Jacob GantzJacob Gantz More articles by this author , Thomas FryeThomas Frye More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , Edward MessingEdward Messing More articles by this author , Jean JosephJean Joseph More articles by this author , Hiroshi MiyamotoHiroshi Miyamoto More articles by this author , and Hani RashidHani Rashid More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555640.83324.73AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Negative prostate biopsies occur in up to 40% of cases following MR/US fusion targeted biopsy (TB) with concurrent systematic biopsy (SB) for PIRADS score ≥3 after at least one prior negative 12-core SB. Was the inability to detect prostate cancer (PCa) due to targeting error, inadequate sampling, or did the radiologist overcall the MRI lesion as positive? This perplexing situation leads to clinical uncertainty as to whether repeating another MR/US fusion biopsy session would be beneficial. In this study, we sought to determine whether ConfirmMDx®, a validated DNA methylation field effect assay, would be clinically useful if applied to TB + SB cores with benign pathology. METHODS: In a retrospectively maintained database, we identified 142 consecutive patients who underwent MR/US fusion TB + SB for PIRADS ≥3 following at least one negative SB session. Multiparametric MRI was performed using a 3-Tesla scanner and scored using PI-RADS Version 2. Among the 142 patients who underwent biopsy, 65 patients had benign pathology and were offered subsequent ConfirmMDx® testing of the benign TB + SB cores. ConfirmMDx® was performed in a total 44 patients and alterations in GSTP1, APC, and RASSF1 correlated with abnormal regions of interest (ROI) on MRI based on corresponding sextant location. RESULTS: Among 44 patients who underwent ConfirmMDx®, 18/44 (40.9%) exhibited DNA hypermethylation of either GSTP1, APC, or RASSF1, while 6/44 (13.6%) exhibited hypermethylation of least two genes. DNA hypermethylation of GSTP1, APC, or RASSF1 within and outside the ROI was observed in 7/44 (15.9%) and 14/44 (31.8%) of patients, respectively. There was no correlation between PIRADS score and hypermethylation status (p > 0.05). CONCLUSIONS: Given that DNA hypermethylation of GSTP1, APC, and RASSF1 was uncommon in the benign tissue sampled from MRI-positive regions, repeating a TB will likely have low yield for detecting clinically significant PCa. In the future, sextant sampling of regions with field effects may be a more effective means of detecting occult PCa in this specific population of patients. Source of Funding: none Rochester, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e339-e340 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Witthaus More articles by this author Matthew Truong* More articles by this author Jacob Gantz More articles by this author Thomas Frye More articles by this author Ahmed Ghazi More articles by this author Edward Messing More articles by this author Jean Joseph More articles by this author Hiroshi Miyamoto More articles by this author Hani Rashid More articles by this author Expand All Advertisement PDF downloadLoading ...