Power Doppler Sonography (PDS) and modified TRUS Systematic Biopsies – can this combination adequately replace Multiparametric Prostate Magnetic Resonance Imaging (mp-MRI) in candidates for re-biopsies who cannot undergo mp-MRI.
The MRI targeted biopsy (MRI-TBx) in candidates for re-biopsy is currently considered as a gold standard. Nevertheless, there is a certain population in whom mp-MRI is contraindicated. We hypothesize that a combination of PDS-guided biopsies (PDS-TBx) with Systematic biopsies (TRUS-SBx) can be helpful in detecting clinical significant Prostate Cancer (sPCa) in this group of patients.
We reviewed the records of 154 patients with persistently elevated PSA who underwent mp-MRI before re-biopsy. Our protocol included combination of MRI-TBx, DPS-TBx and modified SBx. MRI findings were defined as suspicious (3 on a 5-point PIRADS scale) and the highly suspicious lesion (> 3 PIRADS). To decrease the post-biopsy changes that could affect power doppler signals, we primarily performed PDS-TBx, and only afterward MRI-TBx. We calculated the strongest predictors of sPCa detection and assesses a possible correlation between sPCa and different schemes of re-biopsy.
MRI suspicious lesions were identified in 52 and this was considered as the group of interest. In 36 of these patients sPCa was diagnosed. MRI highly suspicious lesion (MRI-HSL) were detected in 36 (23%) and PDS hypervascular areas in 38 (25%) of these patients. Nearly 58% (21/36) of MRI -HSL were also recognized by PDS (Fig.1a-b). Clinical significant cancer was detected in 92% of MRI-TBx from HSL and in 72% of PDS-TBx. MRI-TBx missed 8% of sPCa. while PDS-TBx + TSUS-SBx detected nearly 85%(28/33) of sPCa diagnosed by MRI-TBx. Multivariant analysis revealed 3 strong predictors of sPCa: MRI-HSL, PDS suspicious areas and TRUS-Bx from anterior gland. A strong correlation was found between MRI-HSL, PDS' lesions and sPCa.
MRI-TBx from the highly suspicious lesion is the most accurate in predicting and detecting sPCa. Yet, combination of PDS- and TRUS-TBx can be a reasonable option in patients who cannot undergo MRI studies.