OP3-04 DETECTION AND UPGRADING OF PROSTATE CANCER BY MRI/ULTRASOUND FUSION GUIDED BIOPSY ACROSS PSA-BASED CUTOFFS (2014)

You have accessJournal of UrologyOutstanding Posters: Oncology1 Apr 2014OP3-04 DETECTION AND UPGRADING OF PROSTATE CANCER BY MRI/ULTRASOUND FUSION GUIDED BIOPSY ACROSS PSA-BASED CUTOFFS Nabeel Shakir, Jason Rothwax, Arvin George, 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 , Jason RothwaxJason Rothwax More articles by this author , Arvin GeorgeArvin George 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.2014.02.2325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The sensitivity of prostate specific antigen (PSA) increases with lower threshold values but with a corresponding decline in specificity. Magnetic resonance imaging/ultrasound (MR/US) fusion-guided biopsy has been shown to detect prostate cancer (PCa) more efficiently and of higher grade than standard 12-core transrectal ultrasound (TRUS) biopsy, but the optimal population for its use is not well defined. We aimed to evaluate the performance of MR/US fusion-guided vs. 12-core biopsy within established PSA cutoffs. METHODS A review of all patients enrolled in a prospective trial undergoing 12-core TRUS and MR/US-fusion-guided biopsies from August 2007 through June 2013 was performed. Patients were stratified into one of four groups by PSA: 0-2.5, 2.5-4, 4-10, and >10ng/mL, groups A, B, C and D respectively. The highest Gleason score from either biopsy method was compared within and across groups. Clinically significant (CS) PCa was defined as Gleason ≥4+3=7. Uni- and multivariate analyses were conducted with the JMP statistical package (version 11, SAS Institute, Inc.) RESULTS A total of 885 targeted and 12-core TRUS biopsies were performed, of which 493 diagnosed PCa for a detection rate of 55.7%. Targeted biopsy led to Gleason upgrading in 161 patients (33%), and significantly more upgraded to CS disease as compared to 12-core biopsy (24% vs. 11%, p<0.0001.) When stratified by PSA cutoffs, a greater proportion of patients in groups C and D were upgraded to CS PCa by targeted vs. 12-core biopsy (Figure 1.) Conversely, a greater proportion of patients were upgraded to clinically insignificant disease by 12-core vs. targeted biopsy (17% vs. 9%, p<0.0001.) This effect was significant in group B (27% vs. 11%, p=0.04) but not for patients in groups C or D. These differences persisted when controlling for age and MRI prostate volume in multivariate analysis. CONCLUSIONS Gleason score upgrading to clinically significant PCa occurred by targeted biopsy significantly more frequently at PSA levels of 4-10 and >10ng/mL. At lower PSA thresholds, targeted biopsy detects less clinically insignificant PCa. PSA-based cutoffs may identify populations who would benefit most from MR/US fusion-guided biopsy to optimize the screening and diagnosis of clinically significant PCa. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e852 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nabeel Shakir More articles by this author Jason Rothwax More articles by this author Arvin George 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 ...