Abstract
Objective: To determine whether the presence of an ultrasound hypoechoic region at the site of a region of interest (ROI) on magnetic resonance imaging (MRI) results in improved prostate cancer (PCa) detection and predicts clinically significant PCa on MRI–ultrasonography fusion-targeted prostate biopsy (MRF-TB). Materials and Methods: Between July 2011 and June 2017, 1058 men who underwent MRF-TB, with or without systematic biopsy, by a single surgeon were prospectively entered into an institutional review board-approved database. Each MRI ROI was identified and scored for suspicion by a single radiologist, and was prospectively evaluated for presence of a hypoechoic region at the site by the surgeon and graded as 0, 1 or 2, representing none, a poorly demarcated ROI-HyR, or a well demarcated ROI-HyR, respectively. The interaction of MRI suspicion score (mSS) and ultrasonography grade (USG), and the prediction of cancer detection rate by USG, were evaluated through univariate and multivariate analysis. Results: For 672 men, the overall and Gleason score (GS) ≥7 cancer detection rates were 61.2% and 39.6%, respectively. The cancer detection rates for USGs 0, 1 and 2 were 46.2%, 58.6% and 76.0% (P < 0.001) for any cancer, and 18.7%, 35.2% and 61.1% (P < 0.001) for GS ≥7 cancer, respectively. For MRF-TB only, the GS ≥7 cancer detection rates for USG 0, 1 and 2 were 12.8%, 25.7% and 52.0%, respectively (P < 0.001). On univariate analysis, in men with mSS 2–4, USG was predictive of GS ≥7 cancer detection rate. Multivariable regression analysis showed that USG, prostate-specific antigen density and mSS were predictive of GS ≥7 PCa on MRF-TB. Conclusions: Ultrasonography findings at the site of an MRI ROI independently predict the likelihood of GS ≥7 PCa, as men with a well-demarcated ROI-HyR at the time of MRF-TB have a higher risk than men without.
Original language | English (US) |
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Pages (from-to) | 439-446 |
Number of pages | 8 |
Journal | BJU International |
Volume | 123 |
Issue number | 3 |
DOIs | |
State | Published - Mar 2019 |
Keywords
- #PCSM
- #ProstateCancer
- #uroonc
- image- guided biopsies
- magnetic resonance imaging
- prostatic neoplasms
- ultrasonography
- Reproducibility of Results
- Prospective Studies
- Risk Assessment
- Humans
- Middle Aged
- Ultrasonography, Interventional
- Male
- Prostatic Neoplasms/diagnostic imaging
- Multimodal Imaging
- Neoplasm Grading
- Prostate/pathology
- Magnetic Resonance Imaging, Interventional
- Aged, 80 and over
- Adult
- Aged
- Early Detection of Cancer/instrumentation
- Image-Guided Biopsy
ASJC Scopus subject areas
- Urology