Prostate cancer detection rate using MRI/ultrasound fusion-guided prostate biopsy in Siriraj Hospital

Authors

  • Supisara Boonseana Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Sittiporn Srinualnad Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Sunai Leewansangtong Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Ngoentra Tantranont Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Varat Woranisarakul Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.52786/isu.a.58

Keywords:

MRI/ultrasound fusion-guided biopsy, targeted biopsy, prostate cancer

Abstract

Objective: Systematic transrectal ultrasound (TRUS) guided biopsy has been considered a gold standard for prostate cancer diagnosis for many decades. The problem of this conventional method is the low detection rate especially in the case of repeat biopsy. This results from a limitation associated with ultrasound imaging inhibiting the visualization of cancerous lesions during the procedure. More recently, there has been increasing importance attributed to the use of multiparametric MRI for the identification of cancer inside the prostate gland. Targeted prostate biopsy, using multiparametric MRI/ultrasound (mpMRI/US) fusion-guided technology helps improve the detection of prostate cancer and has become a novel standard for tissue diagnosis. This study was conducted to investigate and report on the cancer detection rate of mpMRI/US fusion guided prostate biopsies at Siriraj Hospital.

Materials and Methods: Data pertinent to patients who underwent mpMRI/US fusion guided biopsy at Siriraj Hospital between September 2017 and December 2019 was retrospectively reviewed.

Results: A total of 499 men underwent mpMRI/US fusion guided biopsy, with the transperineal approach being used in the vast majority of cases (91.8%). Targeted biopsy provides a better cancer detection rate than systematic biopsy (55.3% vs 47.1%, p = 0.009). Combined targeted and systematic biopsies improved cancer detection rate compared to systematic biopsy alone (60.3% vs 47.1%, p < 0.001). A subgroup analysis of men with positive biopsies showed that detection of clinically significant cancer (Gleason grade group ≥ 2) was no different between targeted and random biopsies (87.2% vs 80.8%, p = 0.11). The common complications from transperineal approach were urinary retention (5.4%) and hematuria (5.2%) while complications of infection were rare (0.2%).

Conclusion: We found that targeted biopsy with mpMRI/US fusion guided technology provides a more effective option for prostate cancer diagnosis. A combination of targeted and systematic biopsy improve prostate cancer detection rate more effectively than systematic biopsy alone. The transperineal approach is a safe and effective technique with a rare incidence of infectious complications.

References

Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815-22.

Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. New Engl J of M 2018;378:1767-77.

Purysko AS, Rosenkrantz AB, Turkbey IB, Macura KJ. Radiographics update: PI-RADS version 2.1—a pictorial update. Radiographics 2020;40:E33-7.

Oon SF, Watson RW, O’Leary JJ, Fitzpatrick JM. Epstein criteria for insignificant prostate cancer. BJU Int 2011;108:518-25.

Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol 2016;40:244-52.

JLH van Leenders G, van der Kwast TH, Grignon DJ, Evans AJ, Kristiansen G, Kweldam CF, et al. The 2019 International Society of Urological Pathology (ISUP) Consensus Conference on Grading of Prostatic Carcinoma. Am J Surg Pathol 2020;44:e87-99.

Baco E, Rud E, Eri LM, Moen G, Vlatkovic L, Svin- dland A, et al. A Randomized Controlled Trial to Assess and Compare the Outcomes of Two-core Prostate Biopsy Guided by Fused Magnetic Res- onance and Transrectal Ultrasound Images and Traditional 12-core Systematic Biopsy. Eur Urol 2016;69:149-56.

Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, et al. MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis. New Engl J Med 2020;382:917-28.

Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015;313:390-7.

Porpiglia F, Manfredi M, Mele F, Cossu M, Bollito E, Veltri A, et al. Diagnostic Pathway with Multi-parametric Magnetic Resonance Imaging Versus Standard Pathway: Results from a Randomized Prospective Study in Biopsy-naïve Patients with Suspected Prostate Cancer. Eur Urol 2017;72:282-8.

Kesch C, Schütz V, Dieffenbacher S, Bonekamp D, Hadaschik BA, Hohenfellner M, et al. Multiparametric MRI fusion-guided biopsy for the diagnosis of prostate cancer. Curr Opin Urol 2018;28:172-7.

Washino S, Kobayashi S, Okochi T, Kameda T, Konoshi T, Miyagawa T, et al. Cancer detection rate of prebiopsy MRI with subsequent systematic and targeted biopsy are superior to non-targeting systematic biopsy without MRI in biopsy naïve patients: A retrospective cohort study. BMC Urol 2018;18:51.

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Euro Urol 2013;64:876-92.

Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: A systematic review and meta-analysis. Vol. 17, World J Surg Oncol 2019;17:31.

Grummet JP, Weerakoon M, Huang S, Lawrentschuk N, Frydenberg M, Moon DA, et al. Sepsis and “superbugs”: Should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int 2014;114:384-8.

Kohl T, Sigle A, Kuru T, Salem J, Rolfs H, Kowalke T, et al. Comprehensive analysis of complications after transperineal prostate biopsy without antibiotic prophylaxis: results of a multicenter trial with 30 days’ follow-up. Prostate Cancer Prostatic Dis 2022;25:264-8.

Downloads

Published

2022-12-25

How to Cite

Boonseana, S., Srinualnad, S., Leewansangtong, S., Tantranont, N., & Woranisarakul, V. (2022). Prostate cancer detection rate using MRI/ultrasound fusion-guided prostate biopsy in Siriraj Hospital. Insight Urology, 43(2), 128–33. https://doi.org/10.52786/isu.a.58

Issue

Vol. 43 No. 2 (2022): July-Dec

Section

Original article

License

Copyright (c) 2022 Insight Urology

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.