Should Biopsy-Naive Patients Be Offered Up-Front Multi-Parametric Mri (Mpmri) Scan And Trans-Perineal Mri-Fusion Targeted And Saturation Biopsies?

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP20)1 Apr 2020MP20-09 SHOULD BIOPSY-NAIVE PATIENTS BE OFFERED UP-FRONT MULTI-PARAMETRIC MRI (MPMRI) SCAN AND TRANS-PERINEAL MRI-FUSION TARGETED AND SATURATION BIOPSIES? Woon Tsang*, Yu Fei Qiao, Karthik Thandapani, Qing Hui Wu, Bertrand Ang, Wynne Chua, Yee Liang Thian, Lincoln Tan, and Edmund Chiong Woon Tsang*Woon Tsang* More articles by this author , Yu Fei QiaoYu Fei Qiao More articles by this author , Karthik ThandapaniKarthik Thandapani More articles by this author , Qing Hui WuQing Hui Wu More articles by this author , Bertrand AngBertrand Ang More articles by this author , Wynne ChuaWynne Chua More articles by this author , Yee Liang ThianYee Liang Thian More articles by this author , Lincoln TanLincoln Tan More articles by this author , and Edmund ChiongEdmund Chiong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000853.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: EAU guidelines recommended mpMRI scan for prior negative biopsy and was expanded to include biopsy-naïve and AS patients. Strength of recommendation was weak for biopsy-naïve patients. Our aims were to determine clinically significant prostate cancer (CSPC, any GS≥7) rate for biopsy-naïve patients using Trans-perineal MRI-Fusion targeted and saturation biopsy(TP-Fusion-BX)compared to systemic biopsies with trans-rectal(TRUS-BX) and trans-perineal(TP-BX) US-guided biopsies and their complications. METHODS: Between September 2015 to September 2019, 241 patients with an elevated PSA and mpMRI scan were recruited into a prospective study for TP MRI-fusion targeted and saturation biopsies using a robotic-assisted iSR’obot Mona LisaTMbiopsy platform. MRI lesions were classified according to PIRADv2. PIRAD≥3 lesions were targeted. RESULTS: For 241 TP-Fusion-BX patients, 116(48%) were biopsy-naïve, 73(30%) prior negative biopsy and 52(22%) AS:mean age 65years; median PSA 7.32ng/dL; mean target cores 7.44±4.83; mean saturation cores 29.80±10.78 (IQR 12-56 cores). For 178 TRUS-BX patients, median PSA 10.76ng/dL(IQR 0.93–4679), mean cores 11.14±2.92(IQR 2-18 cores). For 117 TP-BX patients, median PSA 12.51ng/dL(IQR 0.30–1000), mean cores 12.99±3.68(IQR 12–18 cores). For biopsy-naïve patients who had TP-Fusion-BX, 55% had prostate cancer and 42% CSPC. 53% prior negative biopsy had cancer, 37% CSPC. For AS 93% had cancer, 56% CSPC. 306 PIRAD lesions ≥3 were targeted and cancer rate was summarised in Table 1. Cancer rate for 3 different biopsy platforms was summarised in Table 2. Using TP-Fusion-BX for biopsy-naïve patients, CSPC was significantly higher compared to TRUS-BX and TP-BX for PSA<10 (p=0.0019). Comparing TRUS-BX with TP-Fusion-BX, PSA<10 (p<0.004) and PSA 10-20 (p=0.0378) were significant. Post biopsy sepsis was low:1.7%TP-Fusion-BX; 0.9%TP-BX and 4.4%TRUS-BX. CONCLUSIONS: CSPC was higher for biopsy-naïve patients for PSA<20 using TP MRI-Fusion biopsy. Thus, an up-front mpMRI scan prior to prostate biopsy be offered to these patients and not restricted to patients with prior negative biopsy. TP MRI-Fusion biopsy with target and saturation biopsies, CSPC was higher compared to non-targeted biopsy and morbidity was less. Source of Funding: NONE © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e310-e310 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Woon Tsang* More articles by this author Yu Fei Qiao More articles by this author Karthik Thandapani More articles by this author Qing Hui Wu More articles by this author Bertrand Ang More articles by this author Wynne Chua More articles by this author Yee Liang Thian More articles by this author Lincoln Tan More articles by this author Edmund Chiong More articles by this author Expand All Advertisement PDF downloadLoading ...