RSNA 2016

Abstract Archives of the RSNA, 2016


RC607-10

In-Bore Magnetic Resonance-Guided Transrectal Biopsy for the Detection of Clinically Significant Prostate Cancer

Thursday, Dec. 1 11:15AM - 11:25AM Room: E450B



Ely R. Felker, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Stephanie A. Lee-Felker, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
John F. Feller, MD, Indian Wells, CA (Abstract Co-Author) Consultant, Koninklijke Philips NV; Consultant, Visualase, Inc ; Consultant, Hitachi, Ltd; Speaker, Hitachi, Ltd
Daniel J. Margolis, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
David S. Lu, MD, Los Angeles, CA (Abstract Co-Author) Consultant, Medtronic, Inc Speaker, Medtronic, Inc Consultant, Johnson & Johnson Research Grant, Johnson & Johnson Consultant, Bayer AG Research Grant, Bayer AG Speaker, Bayer AG
Robert A. Princenthal, MD, Thousand Oaks, CA (Abstract Co-Author) Employee, Koninklijke Philips NV
Stuart T. May Sr, MD, Indian Wells, CA (Abstract Co-Author) Nothing to Disclose
Martin I. Cohen, MD, Thousand Oaks, CA (Abstract Co-Author) Nothing to Disclose
Jiaoti Huang, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Bernadette M. Greenwood, BS, RT, Indian Wells, CA (Abstract Co-Author) Speakers Bureau, GenomeDx Biosciences Inc
Jeffrey Yoshida, Newport Beach, CA (Abstract Co-Author) Nothing to Disclose
Hyung J. Kim, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Steven S. Raman, MD, Santa Monica, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE

To determine the safety and efficacy of in-bore magnetic resonance-guided prostate biopsy (MRGB) for detection of clinically significant disease (CSD) in untreated men with known or suspected prostate cancer (PCa), and to compare MRGB results by Mp-MRI assessment grade.

METHOD AND MATERIALS

512 patients underwent multiparametric magnetic resonance imaging (Mp-MRI) followed by MRGB at one of three centers in this IRB-approved, HIPAA-compliant, retrospective study. Exclusion criteria were prior prostate cancer therapy and incomplete Mp-MRI (n = 51). Patients (n = 461) were analyzed in two subcohorts: no prior PCa (NP) (n = 381) and active surveillance (AS) (n = 80). Detection rates of PCa and CSD (Gleason Score at least 3 + 4) were calculated and compared among subcohorts and by Mp-MRI assessment grade (PI-RADS v1 or previously published modified PI-RADS score). Logistic regression was performed to identify predictors for detection of PCa and CSD.

RESULTS

Mean patient age was 66 years, median prostate-specific antigen (PSA) was 7.5 ng/mL, and median prostate volume was 54 cc. A mean of 1.7 targets was sampled per gland. Significant adverse events (urosepsis and hematuria with obstruction) occurred in 1% (5/461). Overall PCa detection rates were 51% per patient (233/461) and 37% per lesion (282/757). 65% (151/233) of men with detected PCa had CSD. Per patient PCa detection rates in the NP and AS subcohorts were: 47% (178/381) and 69% (55/80), respectively, significantly higher in the AS group (p < 0.001). CSD was detected in 10% (47/451), 43% (96/225) and 84% (68/81) of lesions with Mp-MRI assessment grades of 3, 4 and 5, respectively. Older age, higher PSA, and lower prostate volume predicted MRGB detection of CSD (OR=1.07 and p = 0.003, OR=1.1 and p=0.014, and OR=0.98 and p=0.032, respectively).

CONCLUSION

In-bore MRGB is safe and high-yield for detection of CSD among men with high and very high suspicion targets (grades 4 and 5).  The yield of MRGB for CSD among men with intermediate suspicion targets (grade 3) is lower, such that it may be reasonable to defer biopsy in select cases.

CLINICAL RELEVANCE/APPLICATION

MRGB is a safe and high-yield technique for detecting clinically significant PCa and may be useful in men with suspected PCa but no prior definitive diagnosis and those on AS.