MP57-11: Impact of lesion visibility on transrectal ultrasound on the prediction of clinically significant pr

Impact of lesion visibility on transrectal ultrasound on the prediction of clinically significant prostate cancer (Gleason score ? 3+4) with TRUS-MRI fusion biopsy

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INTRODUCTION

TRUS-MRI fusion biopsy has been added to the assessment of men with known or suspected prostate cancer. PROMIS, a large prospective multicenter study of 576 men, concluded MRI-targeted biopsy alone is sufficient to assess men with suspected PCA. Yet, other studies support the combination of targeted and systematic biopsies. The impact of the presence of a visible lesion on TRUS on TRUS-MRI fusion biopsy remains unclear. The purpose of this study was to estimate this impact on the prediction of Gleason>=3+4 PCA.

METHODS

This HIPAA compliant, IRB approved retrospective study included 178 men (age, 64.7 years; PSA, 8.9 ng/ml) who underwent TRUS-MRI fusion biopsy from January/2013 to September/2016. Visible lesions on MRI were those assigned a PI-RADS v2 score>=3. TRUS was positive when a hypoechoic lesion was identified. We used a three-level mixed-effects logistic regression model to determine how TRUS-MRI concordance predicts the presence of CS-PCA. The diagnostic performance of both methods was estimated using ROC curves.

RESULTS

1331 locations were targeted by TRUS-MRI fusion or systematic biopsies. CS-PCAs were diagnosed by TRUS or MRI alone in 20.5% and 19.7% of these locations, respectively. Men with positive imaging had higher odds of having a CS-PCA than men without visible lesions, regardless of modality (TRUS, OR=14.75, 95% CI=5.22-41.69; MRI, OR=12.27, 95% CI=6.39-23.58; both, OR=28.68, 95% CI=14.45-56.89, all P