Impact of lesion visibility on transrectal ultrasound on the prediction of clinically significant prostate cancer (Gleason score ? 3+4) with TRUS-MRI fusion biopsy
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.
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.
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
Lesion visibility on MRI or TRUS denotes a similar probability of CS-PCA. This probability is greater when both exams are positive.