Simmons LAM, et al. - Authors assessed the detection of clinically significant prostate cancer (csPCa) using MRI-targeted biopsies, and compared visual-estimation to image-fusion targeting, in patients requiring repeat prostate biopsies. In order to detect csPCa and reduce over-diagnosis of insignificant cancers, MRI-targeted biopsies are accurate. Findings suggested the requirement of both visual-estimation and image-fusion targeted biopsies to maximise detection.

Methods

• Experts performed a prospective, ethics-committee approved, registered PICTURE trial which enrolled 249 consecutive patients (11^th/January/2012-29^th/January/2014).
• The men who were included in this study underwent an mpMRI and were blinded to its results.
• Transperineal template prostate mapping (TTPM) biopsies were done in all.
• This was preceded by visual-estimation and image-fusion targeted biopsies in 200 with a lesion.
• csPCa was defined as Gleason >/=4+3 and/or any grade of cancer length >/=6mm.
• Other definitions of csPCa were also evaluated for the primary endpoint.

Results

• Findings suggested that the mean (SD) age was 62.6 (7) years, median (IQR) PSA 7.17ng/ml (5.25, 10.09), mean primary lesion size 0.37cc (SD1.52), with mean 4.3 (SD2.3) targeted cores per lesion (visual-estimation and image-fusion combined) and mean 48.7 (SD12.3) TTPM-biopsy cores.
• As per data, 97 (48.5%) cases of csPCa and 85 (42.5%) insignificant cancers were detected by TTPM-biopsies.
• Overall, 81 (40.5%) csPCa and 63 (31.5%) insignificant cancers were detected by mpMRI-targeted biopsies.
• Results demonstrated that 18 (9%) with csPCa on MRI-targeted biopsies were benign or clinically insignificant on TTPM-biopsy.
• On TTPM-biopsy but not on MRI-targeted biopsies, 34 (17%) were detected with csPCa; approximately half of these were present in non-targeted areas.
• In 53/169 (31.3%) and 48/169 (28.4%), csPCa was found with visual-estimation and image-fusion (McNemar’s test, p=0.5322).
• Researchers noted that visual-estimation missed 23 (13.6%) csPCa detected by image-fusion; image-fusion missed 18 (10.8%) csPCa that visual-estimation detected.