Targeted MRI biopsy more likely to find high-grade prostate cancer

Targeted biopsy locations using cognitive magnetic resonance imaging targeting were more than twice as likely to show prostate cancer compared with transrectal ultrasound (TRUS) template biopsy, and cancers in these locations were twice as likely to be high grade, researchers from Washington University, St. Louis reported yesterday.

Although additional study is needed, researchers say the technique could lead to fewer and more accurate prostate biopsies to accurately diagnose patients with clinically significant prostate cancer.

For the study, researchers performed 3-Tesla (3T) MRI with phased array coil. Cognitive targeted biopsies were performed using the TargetScan system (Best Nomos, Pittsburgh). In addition, a prostate biopsy was performed based on a sextant template.

In 58 patients, a total of 812 biopsies were taken from sites considered suspicious on MRI. At these sites, biopsies showed a sensitivity of 63.5%, specificity of 86.1%, and positive predictive value of 63%. The percentage of cancers detected on MRI generally correlated with the Gleason grade of the detected cancer. For cancers that were Gleason 7 or higher, the sensitivity was 64.8%, reported first author Adam Rensing, MD, who worked on the study with Gerald Andriole, MD, Goutham Vemana, MD, and colleagues.

“Using logistic regression analysis, controlling for the patients, we showed that there was an increased likelihood of having both prostate cancer and high-grade or clinically significant prostate cancer, especially in the anterior portion,” Dr. Rensing told Urology Times. “So if something was MRI suspicious anterior, there was almost an eight times chance of that being prostate cancer versus an anterior template-guided biopsy.

“With the help of experienced radiologists and urologists, MRI cognitive targeted biopsy could negate the need for further costly equipment,” he concluded. “However, much work is needed in the cognitive MRI targeted biopsy area to correlate MRI with what we see on TRUS.”

Dr. Andriole disclosed a relationship with Best Nomos.

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