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Value of magnetic resonance imaging/ultrasound fusion prostate biopsy to select patients for focal therapy

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Abstract

Purpose

To investigate the role of transrectal MRI fusion biopsy to select patients for prostate cancer focal therapy.

Methods

Patients with suspected prostate cancer underwent transrectal MRI fusion biopsy with the Koelis trinity device. Two focal therapy eligibility criteria were subsequently defined: Group 1: PSA ≤ 15 ng/ml, unilateral csPCa, ISUP grade ≤ 2, no contralateral PIRADS 3–5 lesion; Group 2: same criteria but ISUP grade 3. These subgroups were correlated with histopathological post-prostatectomy parameters for stage pT2, unilateral csPCa, no ISUP upgrading. In addition, parameters of csPCa detection were analyzed for patients undergoing primary and re-biopsy.

Results

Four hundred fourteen consecutive patients were analyzed (314 for primary biopsy, 100 for re-biopsy). Post-prostatectomy whole mount section analysis was available from 155 patients. 39 and 62 of these patients met focal therapy inclusion criteria for group 1 and group 2, respectively. A correlation with final pathology parameters following radical prostatectomy (stage pT2, unilateral csPCa, no ISUP upgrading) revealed a positive predictive value of only 53.8% and 64.5% for Group 1 and 2, respectively. The overall csPCa detection rate was 73.7%. In the re-biopsy group 20% additional patients with csPCa were detected by targeted biopsy.

Conclusion

Despite high csPCa detection rates following MRI fusion biopsy our study demonstrated that, using final pathology to confirm locally advanced tumor stage, presence of bilateral csPCa and ISUP upgrading, between 35.5 and 46.2% of patients would have been incorrectly selected for focal therapy.

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Funding

No funding was received to perform the study or to assist with the preparation of this manuscript.

Author information

Author notes

  1. Roman Ganzer and Alexander Mangold contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany

    Roman Ganzer, Alexander Mangold, Fiona Sofia Siokou & Wolfgang Brummeisl

  2. Institute of Pathology, Starnberg, Germany

    Christian Brinkschmidt

Authors
  1. Roman Ganzer
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  2. Alexander Mangold
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  3. Fiona Sofia Siokou
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  4. Christian Brinkschmidt
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  5. Wolfgang Brummeisl
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Contributions

RG: Protocol project development, Data collection and management, Data analysis, Manuscript writing and editing. AM: Protocol project development, Data collection and management, Data analysis, Manuscript writing and editing, Statistical analysis. FSS: Data collection and management. CB: Data collection and management, Histopathological processing and analysis. WB: Protocol project development, Data collection and management.

Corresponding author

Correspondence to Roman Ganzer.

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Conflict of interest

All authors declare that they do not have any financial or non-financial interest that are directly or indirectly related to the work in the study.

Ethical approval

The study protocol was evaluated by the local ethics committee and it was confirmed that the retrospective study does not need ethics approval according to §15 of professional regulations.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Ganzer, R., Mangold, A., Siokou, F.S. et al. Value of magnetic resonance imaging/ultrasound fusion prostate biopsy to select patients for focal therapy. World J Urol 40, 2689–2694 (2022). https://doi.org/10.1007/s00345-022-04157-2

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  • DOI: https://doi.org/10.1007/s00345-022-04157-2

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