Men with elevated serum levels of prostate-specific antigen (PSA) or abnormalities in digital rectal examination are usually referred to ultrasonography guided prostate biopsy to rule out prostate cancer (PCa). Such approach leads to over detection of clinical insignificant (low garde) acinar adenocarcinoma (CI-PCa) and under detection of high grade tumors (CS-PCa). Despite current protocols favoring active surveillance for CI-PCa, many patients will undergo radical treatment with known side effects. Even those who opt for active surveillance will be subject to repeated biopsies , costs and...
Methods and materials
This retrospective study was approved by the Ethics Committee of Faculty of Medicine, Federal University of Bahia-Brazil (approval No 3.709.229).
We identified in our database, 551 outpatients, referred for Prostate Cancer (PCa) suspicion because of elevated serum PSA or abnormal digital rectal examination, who underwent a Prostate mp-MRI, Target MRI-guided Prostate Transrectal Biopsy with cognitive fusion of images (COG-BX) and systematic prostate biopsies (SYS-BX) between December 2015 and October 2018.
The inclusion criteria were as follow:
All patients underwent mp-MRI followed by COG-BX and SYS-BX...
Detection rates stratified by PIRADS findings are detailed in tables 1 (for all patients) and 2 (for patients with no previous biopsy). Patients with unspicious MRI findings (PIRADS 1 and 2) were all submitted to SYS-BX and the detection rate of adenocarcinoma of any grade, >GG1 and GG4/5 was, respectively, 25/73 (34%), 10/73 (14%) and 2/73 (3%). Adenocarcinoma of any grade was detected in 27/62 (44%), 145/186 (78%) and 44/45 (98%) of the patients assigned as PIRADS 3,4 and 5, based on highest PIRADS lesions...
The use of MRI prior to biopsy in our series increased the detection of CS-PCa in 28%, among patients with focal lesions, and focal lesions were present in 293/365 (80%) of all patients.Clinical significant cancer in prostates without suspicious lesions at MRI (PI-RADS 1/2) was diagnosed in 14% of all cases indicating that systematic biopsy should not be abolished in this group of patients. In additional, SYS-BX improves the detection of CS-PCa and higher grade adenocarcinomas and, as a consequence, should be combined to MRI...
Personal information and conflict of interest
M. Novaes; Salvador, BAHIA/BR - nothing to disclose A. Mota; Salvador/BR - nothing to disclose D. A. Athanazio; Salvador/BR - nothing to disclose F. A. de Mendonça; Salvador/BR - nothing to disclose
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