Impact of direct MRI-guided biopsy of the prostate on clinical management

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purpose of this study is to investigate the impact of direct MRI-guided biopsy of the prostate on clinical management in practice. MATERIALS AND METHODS. We retrospectively identified 127 patients with unknown (n = 98) or untreated prostate cancer with a Gleason score of 6 (n = 29) who underwent direct MRI-guided biopsy of the prostate at our institution between August 2013 and January 2018, after initial multiparametric endorectal MRI examination revealed one or more Prostate Imaging Reporting and Data System (PI-RADS or PI-RADSv2) category 4 or 5 target lesion. All available medical and imaging records were reviewed to determine pertinent clinical details, biopsy findings, and postbiopsy management. RESULTS. The mean patient age was 68 years (interquartile range, 63-73 years). Findings from MRI-guided biopsy were positive for 93 of 127 patients (73%), with prostate cancer of Gleason score of 7 or higher diagnosed in 84 of these 93 patients (90%). When stratified by clinical scenario, the rate of positive biopsy findings was 66% (57/86) for patients who had negative findings from one or more prior transrectal ultrasound–guided biopsies, 83% (10/12) for biopsy-naive patients, and 90% (26/29) for patients undergoing active surveillance. Overall, 90 of 127 patients (71%) received a new (n = 67) or upgraded (n = 23) diagnosis of prostate cancer, and 57 of these 90 patients (63%) proceeded to receive treatment with prostatectomy, radiation, or androgen deprivation therapy. CONCLUSION. The results of this study suggest that direct MRI-guided biopsy is associated with high rates of significant prostate cancer detection and subsequent definitive treatment across common clinical scenarios and should be considered an important supplementary diagnostic tool in the appropriate setting.

Original languageEnglish (US)
Pages (from-to)371-376
Number of pages6
JournalAmerican Journal of Roentgenology
Volume213
Issue number2
DOIs
StatePublished - Jan 1 2019

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Prostate
Biopsy
Prostatic Neoplasms
Neoplasm Grading
Practice Management
Diagnostic Imaging
Prostatectomy
Information Systems
Androgens
Medical Records
Therapeutics
Radiation

Keywords

  • MRI
  • MRI-guided biopsy
  • Prostate cancer

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Impact of direct MRI-guided biopsy of the prostate on clinical management. / Meermeier, Nicholas P.; Foster, Bryan; Liu, Jen-Jane; Amling, Christopher; Coakley, Fergus.

In: American Journal of Roentgenology, Vol. 213, No. 2, 01.01.2019, p. 371-376.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. The purpose of this study is to investigate the impact of direct MRI-guided biopsy of the prostate on clinical management in practice. MATERIALS AND METHODS. We retrospectively identified 127 patients with unknown (n = 98) or untreated prostate cancer with a Gleason score of 6 (n = 29) who underwent direct MRI-guided biopsy of the prostate at our institution between August 2013 and January 2018, after initial multiparametric endorectal MRI examination revealed one or more Prostate Imaging Reporting and Data System (PI-RADS or PI-RADSv2) category 4 or 5 target lesion. All available medical and imaging records were reviewed to determine pertinent clinical details, biopsy findings, and postbiopsy management. RESULTS. The mean patient age was 68 years (interquartile range, 63-73 years). Findings from MRI-guided biopsy were positive for 93 of 127 patients (73{\%}), with prostate cancer of Gleason score of 7 or higher diagnosed in 84 of these 93 patients (90{\%}). When stratified by clinical scenario, the rate of positive biopsy findings was 66{\%} (57/86) for patients who had negative findings from one or more prior transrectal ultrasound–guided biopsies, 83{\%} (10/12) for biopsy-naive patients, and 90{\%} (26/29) for patients undergoing active surveillance. Overall, 90 of 127 patients (71{\%}) received a new (n = 67) or upgraded (n = 23) diagnosis of prostate cancer, and 57 of these 90 patients (63{\%}) proceeded to receive treatment with prostatectomy, radiation, or androgen deprivation therapy. CONCLUSION. The results of this study suggest that direct MRI-guided biopsy is associated with high rates of significant prostate cancer detection and subsequent definitive treatment across common clinical scenarios and should be considered an important supplementary diagnostic tool in the appropriate setting.",
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