Biópsia prostática dirigida por fusão cognitiva após ressonância magnética multiparamétrica. Comparação com a técnica habitual de biópsia aleatória

Abstract

Introduction and Objectives

Multiparametric Magnetic Resonance Imaging of the prostate (Mp‐MRI) allows the detection, localization and characterization of suspicious lesions for prostate cancer (PCa). When done prior to the diagnosis it also allows targeting of the biopsy, significantly improving the performance of the standard random prostate biopsy.

Our goal is to compare a targeted biopsy technique (cognitive fusion) with the standard double sextant randomized prostate biopsy, and to determine which has better accuracy in the detection of cinically significant prostate cancer.

Materials and Methods

30 patients aged 61‐67 were selected with a PSA greater than 4 ng/mL (PSA between 5.6 – 19.2) and with suspicious PCa lesions on Mp‐MRI (Pi‐RADS 3‐5). A total of 75 suspicious lesions were detected.

All biopsies were performed by the same Urologist (JMP), using trans‐rectal ultrasound guidance and after previous visualization of MRI images. Sampling was targeted to the area considered suspicious on MRI, using a Cognitive Fusion Technique, collecting two samples per area. After that, a double‐sextant standard prostate biopsy was also done in all patients. The variables used for statistical analysis were PCa detection rate and amount of cancer per sample.

Results

22 patients were diagnosed with PCa. In 5 patients, cancer was only detected on targeted cores. Targeted biopsies diagnosed 17% more PCa when compared to random biopsies, and almost doubled the amount of cancer per sample.

The overall PCa detection rate was 61% for all samples. 360 fragments were collected from standard randomized prostate biopsy, of which 169 were positive for PCa (47%), with a median Gleason score of 6 (3+3). The average amount of cancer per sample was 25% (5%‐85%).

105 of 150 fragments collected by cognitive fusion targeted biopsies were positive for PCa (70%). The median Gleason score was 7(3+4) with a median amount of cancer per sample of 45% (10%‐90%).

Conclusions

Multiparametric prostatic MRI detects areas highly suspicious for PCa, allowing targeted biopsies, which increases diagnostic accuracy and improves the detection of clinically significant PCa.