V12-08: Evaluating the diagnostic role of in-bore magnetic resonance imaging guided prostate biopsy
With the increasing role of magnetic resonance imaging (MRI) in prostate cancer diagnosis, in-bore MRI (IB-MRI) guided biopsy has become a feasible method of sampling suspicious lesions with real-time guidance. This may allow a focus on otherwise under-sampled areas while also reducing the diagnosis of clinically insignificant cancers. We aim to report the diagnostic role that IB-MRI guided biopsies have played in our initial cohort.
All patients intended for IB-MRI guided prostate biopsy at our institution are included. Retrospectively recorded data includes indication, previous biopsy results, PIRADS score of targeted lesion, histological results and complications. We also assessed the impact on clinical management.
31 patients with identified lesions attempted to undergo IB-MRI guided biopsy. A median number of 5 cores were taken (range 3-11). 19 patients had previously undergone a prostate biopsy (14 transperineal, 5 TRUS), 9 of whom were on active surveillance. Outcomes are summarised in Table 1 with results categorised according to the PIRADS score of the targeted lesion. Any grade of prostate cancer was considered a positive result. Two significant complications occurred (urinary sepsis and rectal bleeding), and 2 intended biopsies did not proceed (1 patient intolerability, 1 target lesion no longer seen). See Table 1: Summary of MRI guided biopsy results Of the 10 patients with no previous biopsy, 5 were offered radical therapy for clinically significant prostate cancer (Gleason grade greater than or equal to 7) and 1 was placed onto active surveillance for Gleason 6 disease. Excluding biopsy naïve patients, undergoing an IB-MRI changed the preferred clinical management in 10 out of 19 patients, 9 of whom have chosen to undergo definitive therapy.
IB-MRI guided biopsy appears to offer a reliable and acceptable method to accurately target identified lesions. Overall in our cohort, this method led to definitive therapy being offered to 52% of those patients biopsied. Its ongoing role in the prostate cancer diagnostic pathway should continue to be evaluated.