Image fusion targeted prostate biopsy in 771 men at risk: a multi-centre evaluation showing low diagnostic yield of significant cancer in non-targeted biopsies


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Saiful Miah1,Feargus Hoskings-Jervis2,David Eldred-Evans2,Taimur Shah2,Mark Laniado3,Richard Hindley3,Alan Doherty3,Andrew Sinclair3,Daniel Burke3,Jeetesh Bhardwa3,Omer Karim3,Bruce Montgomery3,Simon Bott3,Neil Barber3,Raj Nigam3,Manit Arya4,Mathias Winkler1,Clare Allen4,Hashim Ahmed2
1Imperial College NHS Healthcare,2Imperial College London,3Nuada Urology London,4University College London Hospital

Abstract

Background

MRI image guided prostate biopsy is an increasingly utilized method of procuring tissue from men with suspected prostate cancer.  We sought to report the largest prospective series of image-fusion transperineal prostate biopsies and compare the diagnostic yield of clinically-significant prostate cancer (csPCa) between targeted and non-targeted biopsies.

Method

771 men had transperineal image-fusion targeted biopsy (MIM-Symphony-DXTM) (April 2014-June 2017) by 13 urologists.

Results

Mean age, median PSA and median prostate volume were 63.58 years, of 6.3ng/ml and 43.5cc respectively. Overall, 363 (47.08%) were diagnosed with csPCa (Gleason >/=4+3 or any grade >/=6mm) from the 771 men undergoing biopsy.  The csPCa detection rate from the target biopsies alone occurred in 341 men (44.23%).  Of those 409 men who underwent random biopsies, only 14 men (3.42%) were discovered to have csPCa exclusively in the non-targeted cores alone where the targeted cores demonstrated no evidence of disease.  None of these men harboured high-grade disease and 11 out of the 14 (78.57%) had primary pattern 3 disease.  The presence of clinically insignificant disease in the random targets occurred in 66 of the 409 (16.12%) men underdoing going this type of biopsy format. Insignificant cancer exclusively occurred in non-targeted prostate cores in 16 out of 409 men who underwent these random biopsies (3.91%) where there was no evidence of disease in the target cores.

Conclusion

In this large multi-centre series, the added benefit of non-targeted cores is low. An image-fusion targeted-biopsy only has high detection for csPCa and reduced over-detection of insignificant cancers.