First round of targeted biopsies using magnetic resonance imaging/ultrasonography fusion compared with conventional transrectal ultrasonography-guided biopsies for the diagnosis of localised prostate cancer
Menée sur 152 patients devant subir une première série de biopsies de la prostate (niveau du PSA inférieur ou égal à 10 ng/ml, score de Likert supérieur ou égal à 2), cette étude française évalue, par rapport à une biopsie transrectale à 12 carottes sous échographie, la performance d'une biopsie ciblée à l'aide de fusions d'images échographiques et d'IRM pour le diagnostic d'un cancer de la prostate
Objectives : To assess the accuracy of magnetic resonance imaging (MRI)/transrectal ultrasonography (TRUS) fusion to guide first-round biopsies in the diagnosis of localised prostate cancer (PCa) in men with a prostate-specific antigen (PSA) ≤10 ng/mL.
Patients and Methods : A prospective study was conducted on men who met the following criteria: first-round biopsy, multiparametric MRI (mpMRI) showing a lesion with a Likert score ≥2 and a PSA <10 ng/mL. All men underwent a extended 12-core protocol plus a protocol of two or three targeted cores on the mpMRI index lesion. The UroStation™ (Koelis, Grenoble, France) and a V10 ultrasound system with an end-fire three-dimensional TRUS transducer were used for the fusion imaging procedure. Significant PCa was defined as: at least one core with a Gleason score of 3 + 4 or 6 with a maximum cancer core length ≥4 mm.
Results : A total of 152 men, whose median PSA level was 6 ng/mL, were included in the study. The proportion of positive cores was significantly higher with the targeted-core protocol than with the extended 12-core protocol (P < 0.001). The proportion of men with clinically significant PCa was higher with the targeted-core protocol than with the extended 12-core protocol (P = 0.03). The proportion of patients having at least one positive biopsy (targeted-core protocol) was significantly different among the Likert score categories (P < 0.001).
Conclusions : For the first round of biopsies, MRI/TRUS-fusion targeted biopsies detected more men with clinically significant PCa than did standard extended 12-core biopsy alone.
BJU International , résumé, 2013