Category: Clinical Oncology: Outcomes & Complications

MP18-1 - MRI Guided TRUS Fusion Prostate Biopsy: Upgrading in ISUP Grading System with Targeted Biopsies

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Transrectal ultrasound (TRUS) guided random sampling of the prostate remains the standard of practice. Recently, the common use of multiparametric prostate magnetic resonance imaging (mpMRI) has revolutionized the imaging of prostate cancer (PCa). Consequently, MRI guided biopsy techniques have become available. International Society of Urological Pathology (ISUP) has recommended a new grade group classification instead of classical Gleason grading with an aim of better prediction of prognosis. We evaluate our MRI Guided TRUS biopsy results with the purpose of comparing systematical and targeted biopsy results regarding new ISUP group grading system.


Methods : Patients with a clinical suspicion of prostate cancer and had an abnormal area on MRI underwent MR-TRUS fusion biopsy using the Artemis (Eigen, CA, USA) platform. 3-5 cores were obtained from each target and biopsies were performed under sedation. Twelve core systematic biopsies were obtained in addition to lesion-targeted biopsies. Data was analyzed regarding cancer detection rates and ISUP grading groups.


Results :

MRI-TRUS fusion prostate biopsy was performed in 440 consecutive patients who has suspicious lesions detected with mpMRI. Mean age was 62.7 (±7.9) and mean PSA level was 7.7(±6.1) ng/ml. Overall cancer detection rate was 52.7% (232/440). Cancer detection rate for systematic biopsy vs. targeted biopsies were 48% and 44.7% (p < 0.05). Thirty-four patients had a higher ISUP grading group score when the targeted core results compared with systematical biopsy results. On the other hand, 24 patients had a lower ISUP grading group score with targeted biopsies when compared with their systematical biopsy results. Downgrading were from Group 4 to Group 3 in majority of these patients (15/ 24, 62%). Nineteen patients (19 / 232, 8%) had cancer diagnoses solely by targeted biopsies.


With sum of these two groups, 53 patients (23%) had reached unfavorable diagnosis with targeted biopsy, when compared with their systematical biopsy results regarding ISUP group grading system.


Conclusions :

Addition of MRI guided TRUS fusion biopsy to systematical sampling, allows additional cancer diagnosis with a high rate of ISUP group upgrading.

Tunkut Doganca

Urologist
Acibadem Taksim Hospital, Istanbul,Turkey
Istanbul, Istanbul, Turkey

T├╝nkut Do─čanca, MD, FEBU
Urologist
Acibadem Health Group
Acibadem Taksim Hospital

Mustafa Bilal Tuna

MD
Acibadem Maslak Hospital, Department of Urology
Is, Istanbul, Turkey

├ľmer Burak Argun

Assoc. Prof.
Acibadem Mehmet Ali Ayd─▒nlar University School of Medicine Urology Department
Istanbul, Istanbul, Turkey

─░lter T├╝fek

Assoc. Prof.
Acibadem Mehmet Ali Ayd─▒nlar University School of Medicine Urology Department
Istanbul, Istanbul, Turkey

Selcuk Keskin

MD
Acibadem Mehmet Ali Ayd─▒nlar University School of Medicine Urology Department
Istanbul, Istanbul, Turkey

Can ├ľbek

Prof.
Acibadem Taksim Hospital
Istanbul, Istanbul, Turkey

Ali R─▒za Kural

Prof.
Acibadem Mehmet Ali Ayd─▒nlar University School of Medicine Urology department
Istanbul, Istanbul, Turkey