Category: Imaging & Image Guided Therapy: New Therapies

MP4-3 - Transperineal electromagnetically-guided MR/US fusion guided biopsy demonstrates comparable prostate cancer detection rates to transrectal fusion guided biopsy when utilizing the same platform

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Transperineal (TP) fusion guided biopsy (FG-Bx) has a theoretically lower infection rate than transrectal (TR) FG-Bx. However, there are not enough studies demonstrating that TP FG-Bx and TR FG-Bx have similar cancer detection rates (CDR) for clinically significant prostate cancer (CS-PCa). We herein compare CDRs for CS-PCa for these two techniques while using the same electromagnetically (EM)-tracked FG-Bx platform.


Methods :

84 patients underwent TP FG-Bx using the UroNav™ MR/US fusion biopsy platform (Invivo, Gainesville, FL) from July 2015 to November 2017. 312 patients had TR FG-Bxs using the same platform at a different institution from June 2012 to September 2014. Both TR and TP patients subsequently underwent systematic biopsies (Sys-Bx). All procedures were performed by the same physician.  Patients with previous positive biopsies were excluded. CS-PCa was defined as Gleason Score (GS) ≥ 7 or volume ≥ 0.5 cc on both FG-Bx and Sys-Bx.  


Results :

The overall CS-PCa CDR for TR and TP FG-Bx with subsequent Sys-Bx were 50% and 62% respectively. (p = 0.29) In the TR group, FG-Bx alone missed 46 cancers, 13 of which were CS (31%), while Sys-Bx alone missed 42 cancers, 31 of which were CS (74%). In the TP group, FG-Bx alone missed 4 cancers, 0  of which were CS and Sys-Bx alone missed 12 cancers, 6 of which were CS (50%). Age, pre-biopsy PSA, race, family history of PCa, and prior negative biopsies did not differ amongst the groups. Overall PiRADs v2 suspicion and number with positive digital rectal exam were significantly higher in the TP group. (p < 0.01) (Table 1)


 


Conclusions :

In this study, we present preliminary CS-PCa CDRs for TP and TR FG-Bx.  We demonstrate that CDRs for TP FG-Bx are comparable to those of TR FG-Bx. Validation of TP FG-Bx is important because it may benefit patients with history of post-biopsy infection or those planning to undergo PCa focal therapy.

Saikrishnaraya Doppalapudi

Medical Student
Rutgers - New Jersey Medical School
Plainsboro, New Jersey

Harry Anastos

The Icahn School of Medicine at Mount Sinai, Department of Urology
New York, New York

Jared Winoker

Resident Physician
The Icahn School of Medicine at Mount Sinai, Department of Urology
New York, New York

Pratik Shukla

The Icahn School of Medicine at Mount Sinai, Department of Radiology
New York, New York

Shivaram Cumarasamy

Icahn School of Medicine at Mount Sinai
New York, New York

John Sfakianos

Assistant Professor of Urology
Icahn School of Medicine at Mount Sinai
New York, New York

Michael R. Carrick

The Icahn School of Medicine at Mount Sinai, Department of Radiology
New York, New York

Cynthia J. Knauer

The Icahn School of Medicine at Mount Sinai, Department of Urology
New York, New York

Bachir Taouli

Professor of Radiology
Icahn School of Medicine at Mount Sinai
New York, New York

Sara C. Lewis

Assistant Professor of Radiology
Icahn School of Medicine at Mount Sinai
New York, New York

Jon A. Schwartz

The Icahn School of Medicine at Mount Sinai, Department of Radiology
New York, New York

Art Rastinehad

The Icahn School of Medicine at Mount Sinai, Department of Urology
New York, New York