MP7-14 MULTIPARAMETRIC MRI CHARACTERISTICS OF PATIENTS UPGRADED BY MRI/ULTRASOUND FUSION GUIDED BIOPSY ACROSS PSA-BASED CUTOFFS (2014)

You have accessJournal of UrologyImaging/Radiology II1 Apr 2014MP7-14 MULTIPARAMETRIC MRI CHARACTERISTICS OF PATIENTS UPGRADED BY MRI/ULTRASOUND FUSION GUIDED BIOPSY ACROSS PSA-BASED CUTOFFS Nabeel Shakir, Arvin George, Jason Rothwax, Minhaj Siddiqui, Soroush Rais-Bahrami, Lambros Stamatakis, Daniel Su, Annerleim Walton-Diaz, Chinonyerem Okoro, Dima Raskolnikov, Baris Turkbey, Peter Choyke, Maria Merino, Bradford Wood, and Peter Pinto Nabeel ShakirNabeel Shakir More articles by this author , Arvin GeorgeArvin George More articles by this author , Jason RothwaxJason Rothwax More articles by this author , Minhaj SiddiquiMinhaj Siddiqui More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author , Lambros StamatakisLambros Stamatakis More articles by this author , Daniel SuDaniel Su More articles by this author , Annerleim Walton-DiazAnnerleim Walton-Diaz More articles by this author , Chinonyerem OkoroChinonyerem Okoro More articles by this author , Dima RaskolnikovDima Raskolnikov More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter ChoykePeter Choyke More articles by this author , Maria MerinoMaria Merino More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.337AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric prostate magnetic resonance imaging (MP-MRI) and MRI/ultrasound fusion-guided biopsy show promise in the evaluation of prostate cancer (PCa.) It is unclear, however, which populations are at risk of upgrading by fusion-guided biopsy. We aimed to characterize MP-MRI findings of patients stratified across prostate specific antigen (PSA) cutoffs. METHODS We reviewed patients enrolled in a prospective trial undergoing MP-MRI followed by 12-core TRUS and MR/US-fusion-guided biopsies from August 2007 through June 2013. Patients were divided into four groups by PSA: 0-2.5, 2.5-4, 4-10, and >10ng/mL, A, B, C and D respectively, and assigned an MP-MRI suspicion score according to the previously validated NIH scoring system. Suspicion score, number of prostatic lesions, and highest Gleason score from each biopsy method were compared. Clinically significant (CS) PCa was defined as Gleason ≥4+3=7. RESULTS 493 men were diagnosed with PCa by either 12-core or fusion biopsy, of whom 161 (33%) were upgraded by targeted biopsy. Patients with lower PSA had more low suspicion lesions than those at higher cutoffs (Table 1.) A greater proportion of patients in groups C and D with moderate/high suspicion lesions were upgraded to CS PCa by targeted vs. 12-core biopsy (p<0.001, Table 2.) More patients with low-suspicion lesions were upgraded by 12-core biopsy, but the majority of these were clinically insignificant disease (41% vs. 13%, p=0.003.) Number of lesions per patient was not associated with upgrading. These differences persisted when controlling for age and MRI prostate volume in multivariate analysis. CONCLUSIONS Patients with PSA of 4-10 or >10 ng/mL and moderate to high suspicion lesions on MP-MRI were upgraded to CS PCa more often by targeted than 12-core biopsy. Fusion biopsy detected significantly less low grade PCa in patients with PSA <4. Combining PSA-based cutoffs with MP-MRI suspicion score may enhance decision making in detecting clinically significant PCa. Table 1. Distribution of MP-MRI suspicion score vs. PSA cutoff. Cutpoint Low Suspicion Moderate Suspicion High Suspicion A: 0-2.5 17.9% 69.2% 12.8% B: 2.5-4 27.1% 64.3% 8.6% C: 4-10 11.1% 76.5% 12.5% D: >10 8.1% 56.1% 35.8% Total 13.3% 68.8% 17.9% Table 2. Patients upgrading to clinically significant PCa (≥4+3) via targeted vs. 12-core biopsy. MRI suspicion Low Low Moderate Moderate High High Cutpoint 12-core MR/US 12-core MR/US 12-core MR/US A: 0-2.5 0% 0% 11.1% 7.4% 0% 20.0% B: 2.5-4 5.3% 15.8% 20.0% 8.9% 0% 16.7% C: 4-10 25.9% 7.4% 11.3% 23.1%∗ 20.0% 26.7% D: >10 10.0% 10.0% 7.2% 47.8%∗ 0% 34.1%∗ All 14.3% 9.5% 11.6% 71.9%∗ 7.1% 29.4%∗ ∗ p<0.001 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e71 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nabeel Shakir More articles by this author Arvin George More articles by this author Jason Rothwax More articles by this author Minhaj Siddiqui More articles by this author Soroush Rais-Bahrami More articles by this author Lambros Stamatakis More articles by this author Daniel Su More articles by this author Annerleim Walton-Diaz More articles by this author Chinonyerem Okoro More articles by this author Dima Raskolnikov More articles by this author Baris Turkbey More articles by this author Peter Choyke More articles by this author Maria Merino More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...