Missing the Mark: Prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy

No AccessJournal of UrologyAdult Urology1 Feb 2017Missing the Mark: Prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy Akhil Muthigi, Arvin K. George, Abhinav Sidana, Michael Kongnyuy, Richard Simon, Vanessa Moreno, Maria J. Merino, Peter L. Choyke, Baris Turkbey, Bradford J. Wood, and Peter A. Pinto Akhil MuthigiAkhil Muthigi Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Arvin K. GeorgeArvin K. George Department of Urology, University of Michigan, Ann Arbor, Michigan , Abhinav SidanaAbhinav Sidana Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Michael KongnyuyMichael Kongnyuy Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Richard SimonRichard Simon Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Vanessa MorenoVanessa Moreno Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Maria J. MerinoMaria J. Merino Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Peter L. ChoykePeter L. Choyke Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Baris TurkbeyBaris Turkbey Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Bradford J. WoodBradford J. Wood Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland , and Peter A. PintoPeter A. Pinto Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland View All Author Informationhttps://doi.org/10.1016/j.juro.2016.08.097AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Multiparametric magnetic resonance imaging and fusion biopsy detect more high risk prostate cancer and less low risk prostate cancer than systematic biopsy. However, there remains a small subset of patients in whom systematic biopsy captures higher grade disease than fusion biopsy. We sought to identify potential mechanisms of the failure of fusion biopsy in the detection of clinically significant prostate cancer. Materials and Methods: We reviewed a prospectively maintained database of patients who underwent multiparametric magnetic resonance imaging followed by fusion biopsy and systematic biopsy from 2007 to 2014. In patients in whom disease was upgraded to clinically significant disease (Gleason 7 or greater) by systematic biopsy over fusion biopsy, independent re-review of magnetic resonance imaging, archived biopsy imaging and whole mount pathology as well as needle coordinate mapping were performed. Multivariate logistic regression analysis was done to determine predictors of upgrading by systematic biopsy. Results: Disease was upgraded based on systematic biopsy over fusion biopsy in 135 of 1,003 patients (13.5%), of whom only 62 (6.2%) were upgraded to intermediate (Gleason 7) and high risk (Gleason 8 or greater) prostate cancer (51 or 5.1% and 11 or 1.1%, respectively). On multivariate analysis lower prostate specific antigen (p <0.001), higher magnetic resonance imaging prostate volume (p <0.001) and a lower number of target cores (p = 0.001) were predictors of upgrading by systematic biopsy. Main mechanisms of under grading by fusion biopsy included multiparametric magnetic resonance imaging reader oversight, presence of magnetic resonance imaging invisible cancer, fusion biopsy technique error and intralesion Gleason heterogeneity. Conclusions: Magnetic resonance imaging and fusion biopsy rarely missed clinically significant prostate cancer as only 62 of 1,003 cases (6.2%) were upgraded to clinically significant disease by systematic biopsy. Imaging and biopsy techniques are continually refined. Further studies will help clarify mechanisms of fusion biopsy failure and the patient populations that benefit from systematic biopsy in addition to fusion biopsy. References 1 : A urologist's perspective on prostate cancer imaging: past, present and future. Abdom Radiol (NY)2016; 41: 805. Google Scholar 2 : Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla. BJU Int2012; 110: E694. Google Scholar 3 : Posterior subcapsular prostate cancer: identification with mpMRI and MRI/TRUS fusion-guided biopsy. Abdom Imaging2015; 40: 2557. Google Scholar 4 : Prebiopsy MRI and MRI-ultrasound fusion-targeted prostate biopsy in men with previous negative biopsies: impact on repeat biopsy strategies. Urology2015; 86: 1192. Google Scholar 5 : Improved detection of anterior fibromuscular stroma and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion guidance. Prostate Cancer Prostatic Dis2015; 18: 288. Google Scholar 6 : Detection of clinically significant prostate cancer using magnetic resonance imaging-ultrasound fusion targeted biopsy: a systematic review. Eur Urol2015; 68: 8. Google Scholar 7 : Improving detection of clinically significant prostate cancer: magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy. J Urol2014; 191: 1749. Link, Google Scholar 8 : Reproducibility of multiparametric MRI and fusion-guided prostate biopsy: multi-institutional external validation by a propensity score matched cohort. J Urol2016; 195: 1737. Link, Google Scholar 9 : Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA2015; 313: 390. Google Scholar 10 : In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12-core biopsy still necessary in addition to a targeted biopsy?. BJU Int2015; 115: 562. Google Scholar 11 : Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. J Urol2015; 193: 87. Link, Google Scholar 12 : Efficiency of prostate cancer diagnosis by MR/ultrasound fusion-guided biopsy vs standard extended-sextant biopsy for MR-visible lesions. J Natl Cancer Inst2016; 108: djw039. Google Scholar 13 : Comparison of magnetic resonance imaging and ultrasound (MRI-US) fusion-guided prostate biopsies obtained from axial and sagittal approaches. BJU Int2015; 115: 772. Google Scholar 14 : Documenting the location of prostate biopsies with image fusion. BJU Int2011; 107: 53. Google Scholar 15 : Multiparametric MRI in the PSA screening era. Biomed Res Int2014; 2014: 465816. Google Scholar 16 : Optimizing patient population for MP-MRI and fusion biopsy for prostate cancer detection. Curr Urol Rep2015; 16: 50. Google Scholar 17 : Gleason 6 prostate cancer: translating biology into population health. J Urol2015; 194: 626. Link, Google Scholar 18 : Identification of threshold prostate specific antigen levels to optimize the detection of clinically significant prostate cancer by magnetic resonance imaging/ultrasound fusion guided biopsy. J Urol2014; 192: 1642. Link, Google Scholar 19 : Can magnetic resonance-ultrasound fusion biopsy improve cancer detection in enlarged prostates?. J Urol2013; 190: 2020. Link, Google Scholar 20 : Prostate cancer detection on transrectal ultrasonography-guided random biopsy despite negative real-time magnetic resonance imaging/ultrasonography fusion-guided targeted biopsy: reasons for targeted biopsy failure. BJU Int2016; 118: 35. Google Scholar 21 : Clinical application of a 3D ultrasound-guided prostate biopsy system. Urol Oncol2011; 29: 334. Google Scholar 22 : Prostate cancer diagnosis on repeat MRI-TRUS fusion biopsy of benign lesions: recommendations for repeat sampling. J Urol2016; 196: 62. Link, Google Scholar 23 : The role of image guided biopsy targeting in patients with atypical small acinar proliferation. J Urol2015; 193: 473. Link, Google Scholar 24 : Prostate cancer risk stratification with magnetic resonance imaging. Urol Oncol2016; 34: 311. Google Scholar 25 : Predictive value of negative 3T multiparametric prostate MRI on 12 core biopsy results. BJU Int2016; 118: 515. Google Scholar 26 : Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls. Expert Rev Anticancer Ther2016; 16: 303. Google Scholar 27 : Heterogeneity of prostate cancer in radical prostatectomy specimens. Urology1994; 43: 60. Crossref, Medline, Google Scholar 28 : Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol1996; 180: 295. Google Scholar 29 : Heterogeneity of Gleason grade in multifocal adenocarcinoma of the prostate. Cancer2004; 100: 2362. Google Scholar 30 : Real-time MRI-TRUS fusion for guidance of targeted prostate biopsies. Comput Aided Surg2008; 13: 255. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byZattoni F, Marra G, Kasivisvanathan V, Grummet J, Nandurkar R, Ploussard G, Olivier J, Chiu P, Valerio M, Gontero P, Guo H, Zhuang J, Barletta F, Leni R, Frydenberg M, Moon D, Hanegbi U, Landaumailto A, Snow R, Apfelbeck M, Kretschmer A, van den Bergh R, Novara G, Briganti A, Dal Moro F and Gandaglia G (2022) The Detection of Prostate Cancer with Magnetic Resonance Imaging-Targeted Prostate Biopsies is Superior with the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-Institutional StudyJournal of Urology, VOL. 208, NO. 4, (830-837), Online publication date: 1-Oct-2022.Lee A, Chen K and Tay K (2021) Can We Avoid a Systematic Biopsy in Men with PI-RADS® 5? Letter.Journal of Urology, VOL. 207, NO. 1, (240-241), Online publication date: 1-Jan-2022.Williams C, Ahdoot M, Daneshvar M, Hague C, Wilbur A, Gomella P, Shih J, Khondakar N, Yerram N, Mehralivand S, Gurram S, Siddiqui M, Pinsky P, Parnes H, Merino M, Wood B, Turkbey B and Pinto P (2021) Why Does Magnetic Resonance Imaging-Targeted Biopsy Miss Clinically Significant Cancer?Journal of Urology, VOL. 207, NO. 1, (95-107), Online publication date: 1-Jan-2022.Taneja S (2020) Re: MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer DiagnosisJournal of Urology, VOL. 204, NO. 6, (1382-1383), Online publication date: 1-Dec-2020.Dimitroulis P, Rabenalt R, Nini A, Hiester A, Esposito I, Schimmöller L, Antoch G, Albers P and Arsov C (2018) Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy—Are 2 Biopsy Cores per Magnetic Resonance Imaging Lesion Required?Journal of Urology, VOL. 200, NO. 5, (1030-1034), Online publication date: 1-Nov-2018.Prendeville S, Gertner M, Maganti M, Pintilie M, Perlis N, Toi A, Evans A, Finelli A, van der Kwast T and Ghai S (2018) Role of Magnetic Resonance Imaging Targeted Biopsy in Detection of Prostate Cancer Harboring Adverse Pathological Features of Intraductal Carcinoma and Invasive Cribriform CarcinomaJournal of Urology, VOL. 200, NO. 1, (104-113), Online publication date: 1-Jul-2018.Calio B, Sidana A, Sugano D, Gaur S, Maruf M, Jain A, Merino M, Choyke P, Wood B, Pinto P and Turkbey B (2017) Risk of Upgrading from Prostate Biopsy to Radical Prostatectomy Pathology—Does Saturation Biopsy of Index Lesion during Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy Help?Journal of Urology, VOL. 199, NO. 4, (976-982), Online publication date: 1-Apr-2018.Ristau B, Chen D, Ellis J, Malhotra A, DeMora L, Parsons R, Milestone B, Brody M, Viterbo R, Greenberg R, Smaldone M, Uzzo R, Anaokar J and Kutikov A (2017) Defining Novel and Practical Metrics to Assess the Deliverables of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate BiopsyJournal of Urology, VOL. 199, NO. 4, (969-975), Online publication date: 1-Apr-2018.Smith J (2016) This Month in Adult UrologyJournal of Urology, VOL. 197, NO. 2, (273-274), Online publication date: 1-Feb-2017. Volume 197Issue 2February 2017Page: 327-334 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsriskdiagnostic imagingimage-guided biopsymagnetic resonance imagingprostatic neoplasmsMetricsAuthor Information Akhil Muthigi Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland Equal study contribution. More articles by this author Arvin K. George Department of Urology, University of Michigan, Ann Arbor, Michigan Equal study contribution. More articles by this author Abhinav Sidana Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Michael Kongnyuy Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Richard Simon Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Vanessa Moreno Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Maria J. Merino Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Peter L. Choyke Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Baris Turkbey Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Bradford J. Wood Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland Financial interest and/or other relationship with Philips and InVivo. More articles by this author Peter A. Pinto Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...