David M. Hatcher*, Joshua A. Cohn, Robert Silvers, Michael S. McGuire
NorthShore University Hospital, Skokie, IL
Introduction and Objective: Magnetic resonance imaging-transrectal ultrasound fusion (MR fusion) techniques may have improved diagnostic reliability as compared with traditional transrectal ultrasound-guided (TRUS) biopsies in select patients. Its utilization to date has been primarily in research centers; we investigated its usage in a busy clinical Urology practice.
Methods: We reviewed men undergoing MR fusion biopsy between October 2012 and May 2013. Selection for MR fusion biopsy was based upon enrollment in active surveillance (AS), persistently elevated PSA with negative biopsy history, or patient preference. Transabdominal 3-tesla multiparametric prostate MRI was performed on all patients at least 1 week prior to clinic biopsy visit. One staff radiologist (RS) identified all suspicious lesions, and fusion images were generated and uploaded to the BioJet (DK North America, Atlanta, GA) fusion machine. Biopsies were targeted at MRI-identified regions of interest (ROI) as well as normal-appearing prostate (non-ROI). All biopsies were performed by a single urologist (MSM) with the assistance of one medical assistant. Analysis was performed to compare targeted and non-targeted biopsy results.
Results: 38 patients met inclusion criteria. Mean age was 66 years [95% CI 63-68] and median PSA 6.2 ng/mL [IQR 4.4-12.3]. 50% of men were enrolled in AS and 74% had undergone previous TRUS biopsy (mean 2.6 prior biopsies [95% CI 2.0-3.2]). The mean number of ROI and non-ROI cores sampled was 3.3 [95% CI 2.4-4.3] and 8.5 [95% CI 7.4-9.6], respectively (p<0.001). Mean Gleason score of identified cancers on targeted biopsy was significantly higher than those found on prior non-targeted TRUS biopsy (7.2 [95% CI 5.8-8.4] vs. 6.1 [95% CI 5.7-6.4]). Mean urologist time required for biopsy completion was 11 minutes [range 8-15].
Conclusions: MR fusion biopsy can be done effectively and efficiently in the busy urologist’s office. Given these findings and that MR fusion technology may increase the likelihood of diagnosing more aggressive cancers, more widespread use of this modality is warranted.
