Magnetic resonance imaging-guided prostate biopsy: present and future

Cognitive-Targeted versus Magnetic Resonance Imaging-Guided Prostate Biopsy in Prostate Cancer Detection

Introduction

Purpose of this study is to evaluate the detection rates of prostate cancer (PCa) for cognitive-targeted biopsy (CTB) in comparison with magnetic resonance imaging (MRI)-guided biopsy (MRGB) related to prostate imaging reporting and data system (PI-RADS) score, lesion location and lesion volume. Furthermore, the addition of systematic transrectal ultrasound-guided biopsy (TRUS-GB) to CTB is evaluated.

Materials and Methods

We included all patients with cancer-suspicious lesions on 3-Tesla multiparametric MRI who underwent either CTB and additional TRUS-GB or only MRGB (in-bore) in Haga Teaching Hospital between January 2013 and January 2015.

Results

In total 219 patients were included: 64 CTB + TRUS-GB and 155 MRGB. In 32 (50%) men with CTB was positive for PCa. PI-RADS 3-, 4- and 5-lesions were in 17, 69 and 95% positive, respectively. In 100 men (65%) with MRGB was positive for PCa. Detection rates for PI-RADS 3-, 4- and 5-lesions were 10, 77 and 89%, respectively. CTB missed 4 (11%) low-grade tumors detected by TRUS-GB. In lesions between 0-1.5 ml PCa were significantly more often detected with MRGB than with CTB (69 vs. 39%).

Conclusion

CTB has a high detection rate of PCa in men with cancer-suspicious lesions on MRI. Correction for lesion volume shows that in lesions < 1.5 ml MRGB is more accurate than CTB. The addition of TRUS-GB to CTB can safely be avoided without missing any high grade PCa.

Transrectal real-time tissue elastography targeted biopsy coupled with peak strain index improves the detection of clinically important prostate cancer

The focus of the present study was to evaluate transrectal real-time tissue elastography (RTE)-targeted two-core biopsy coupled with peak strain index for the detection of prostate cancer (PCa) and to compare this method with 10-core systematic biopsy. A total of 141 patients were enrolled for evaluation. The diagnostic value of peak strain index was assessed using a receiver operating characteristic curve. The cancer detection rates of the two approaches and corresponding positive cores and Gleason score were compared. The cancer detection rate per core in the RTE-targeted biopsy (44%) was higher compared with that in systematic biopsy (30%). The peak strain index value of PCa was higher compared with that of the benign lesion. PCa was detected with the highest sensitivity (87.5%) and specificity (85.5%) using the threshold value of a peak strain index of ≥5.97 with an area under the curve value of 0.95. When the Gleason score was ≥7, RTE-targeted biopsy coupled with peak strain index detected 95.6% of PCa cases, but 84.4% were detected using systematic biopsy. Peak strain index as a quantitative parameter may improve the differentiation of PCa from benign lesions in the prostate peripheral zone. Transrectal RTE-targeted biopsy coupled with peak strain index may enhance the detection of clinically significant PCa, particularly when combined with systematic biopsy.