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Clinical Research

Further reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance

Prostate Cancer and Prostatic Diseases volume 19, pages 283–291 (2016)Cite this article

Subjects

Abstract

Background:

Active surveillance (AS) is commonly based on standard 10–12-core prostate biopsies, which misclassify ~50% of cases compared with radical prostatectomy. We assessed the value of multiparametric magnetic resonance imaging (mpMRI)-targeted transperineal fusion-biopsies in men under AS.

Methods:

In all, 149 low-risk prostate cancer (PC) patients were included in AS between 2010 and 2015. Forty-five patients were initially diagnosed by combined 24-core systematic transperineal saturation biopsy (SB) and MRI/transurethral ultrasound (TRUS)-fusion targeted lesion biopsy (TB). A total of 104 patients first underwent 12-core TRUS-biopsy. All patients were followed-up by combined SB and TB for restratification after 1 and 2 years. All mpMRI examinations were analyzed using PIRADS. AS was performed according to PRIAS-criteria and a NIH-nomogram for AS-disqualification was investigated. AS-disqualification rates for men initially diagnosed by standard or fusion biopsy were compared using Kaplan–Meier estimates and log-rank tests. Differences in detection rates of the SB and TB components were evaluated with a paired-sample analysis. Regression analyses were performed to predict AS-disqualification.

Results:

A total of, 48.1% of patients diagnosed by 12-core TRUS-biopsy were disqualified from AS based on the MRI/TRUS-fusion biopsy results. In the initial fusion-biopsy cohort, upgrading occurred significantly less frequently during 2-year follow-up (20%, P<0.001). TBs alone were significantly superior compared with SBs alone to detect Gleason-score-upgrading. NPV for Gleason-upgrading was 93.5% for PIRADS⩽2. PSA level, PSA density, NIH-nomogram, initial PIRADS score (P<0.001 each) and PIRADS-progression on consecutive MRI (P=0.007) were significant predictors of AS-disqualification.

Conclusions:

Standard TRUS-biopsies lead to significant underestimation of PC under AS. MRI/TRUS-fusion biopsies, and especially the TB component allow more reliable risk classification, leading to a significantly decreased chance of subsequent AS-disqualification. Cancer detection with mpMRI alone is not yet sensitive enough to omit SB on follow-up after initial 12-core TRUS-biopsy. After MRI/TRUS-fusion biopsy confirmed AS, it may be appropriate to biopsy only those men with suspected progression on MRI.

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Acknowledgements

We cordially thank Mrs. Diana Tichy (Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany) for statistical advice and support. BAH is grateful for funding from the German Research Foundation and the European Foundation for Urology.

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None of the funding sources had any input whatsoever into this article.

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Author notes

  1. T H Kuru

    Present address: 5Current address: Department of Urology, RWTH University Hospital, Aachen, Germany.,

  2. S Boxler

    Present address: 6Current address: Department of Urology, University Hospital Berne, Berne, Switzerland.,

Authors and Affiliations

  1. Department of Urology, University Hospital Heidelberg, Heidelberg, Germany

    J P Radtke, T H Kuru, G Hatiboglu, S Boxler, S Pahernik, M Hohenfellner & B A Hadaschik

  2. Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    J P Radtke, D Bonekamp, M T Freitag, M B Wolf, M C Roethke & H P Schlemmer

  3. Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Düsseldorf, Germany

    C D Alt

  4. Institute of Pathology, University of Heidelberg, Heidelberg, Germany

    W Roth

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Correspondence to J P Radtke.

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BAH has received research funding from MedCom and Uromed. The remaining authors declare on conflict of interest.

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Radtke, J., Kuru, T., Bonekamp, D. et al. Further reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance. Prostate Cancer Prostatic Dis 19, 283–291 (2016). https://doi.org/10.1038/pcan.2016.16

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