Multiparametric Magnetic Resonance Imaging Guided Biopsy May Improve The Detection Rate Of Significant Prostate Cancer And Enhance The Predictive Accuracy Of Gleason Score Assessment After Radical Prostatectomy

PART 1 Multiparametric Magnetic Resonance Imaging Guided In-bore Biopsy May Enhance the Diagnostic Accuracy of Significant Prostate CancerObjective:To evaluate the value of multiparametric magnetic resonance imaging(mp MRI)guided In-bore transperineal biopsy in detection of clinically significant prostate cancer.Methods:We performed a retrospective study in 375 men with suspected prostate cancer from December 2013 to December 2015 in the First Affiliated Hospital of Fujian Medical University, in which 136 men underwent transperineal MRI guided In-bore biopsy(MRGB) and 239 men accepted standard systematic transrectal ultrasound guided biopsy(TRUSB). Initially all patients underwent 3 Tesla mp MRI of the prostate. Pathological results of all biopsy specimen were analized and clinically significant prostate cancer was defined as any total cancer length greater than 5 mm or any Gleason pattern greater than 3 in the biopsy core.Results:There was no significant difference between two groups in age, BMI, abnormal DRE, PSA, PV, PSAD, mp MRI lesions and PI-RADS score(P>0.05). Prostate cancer was detected in 151 of 375 patients(40.3%). PCa detection rates of MRGB and TRUSB were 43.4% and 38.5%, respectively(P=0.353). However, MRGB provided a higher detection rate of clinically significant PCa than TRUSB,(39.0% vs 28.9%, P=0.045). Clinically insignificant PCa detection rates of MRGB and TRUSB were 4.4% and 9.6%, respectively(P=0.069). Cancer-detected rates of MRGB and TRUSB cores were 26.6% and 22.5%, respectively(P=0.001). The positive core length of MRGB and TRUSB cores was 4.71±3.42 mm and 3.49±2.57 mm, respectively(P<0.001). The positive core percent of MRGB and TRUSB cores was 31.53±23.55% and 24.27±20.58%, respectively(P=0.001). Moreover, the percent of clinically significant PCa cores detected by the MRGB and TRUSB was 13.8 % and 10.0%, respectively(P<0.001). But, the percent of clinically insignificant PCa cores detected by the MRGB and TRUSB was 12.8 % and 12.5%, respectively(P=0.760). The Kappa consistency test was conducted for targeted biopsy(TB) and systematic added targeted biopsy(SB+TB) in MRGB group(Kappa value=0.940, P<0.001). And targeted biopsy required significantly fewer cores.Conclusion:Transperineal mpMRI guided in-bore biopsy has the ability to detect more clinically significant PCa, improve sampling quality and reduce unnecessary biopsy compared with TRUSB.PART 2 Multiparametric MRI Guided Targeted Biopsy May Improve the Predictive Accuracy of Gleason Score Assessment after Radical ProstatectomyObjective:Multiparametric magnetic resonance imaging(mp MRI) guided targeted biopsy may improve the accuracy of Gleasonscore(GS) determination. The aim of this study was to compare the rate of GS upgrading on radical prostatectomy(RP) for MR-guided targeted biopsy(MRGB-TB) and transrectalultrasound guided biopsy(TRUSGB). The second purpose was to determine the predictors of GS upgradingbetween biopsy and surgical specimens.Methods:Clinical information was obtained from 110 men treated with RP for prostate cancer(PCa) diagnosed on prostate biopsy between December 2013 and December 2015 in our center.All patients had received an mp MRI of the prostate and subsequently accepted transperineal MRGB-TB(43 men)or standard 12 cores TRUSB(67 men). For the aim of analysis, all subjects were divided into twogroups:upgraded group and non upgraded group. The primary endpoint of this study was the distribution of highest GSandthe different rate of GSupgrading on RPbetween MRGB-TB and TRUSB. Secondaryendpoint was to identify predictorsof GS upgrading using univariate and multivariate logistic regression analyses.Results:When considering the highest GS on RP, MRGB-TB significantly reduced the risk of upgrading when compared to TRUSB(11.63% vs. 29.85%, P=0.035). In all 110 patients enrolled, GSupgrading and non-upgrading were seen in 22.7% and 77.3%, respectively. The results of theunivariate analysisdemonstrated that PSAD(P=0.010), PV<30ml(P<0.001), biopsy protocols(P=0.035), biopsy GS(P=0.003) and lympho node metastasis in mp MRI(P=0.033) were statistically significant inpredicting the probability of a GS upgrade. On multivariate analysis, PV<30ml(P=0.001, OR=0.023,95%CI: 0.003-0.205) and biopsy protocols(P=0.024, OR=4.198,95%CI: 1.266-38.487) were the significantpredictors of GS upgrading.Conclusion:Multiparametric MRI Guided targeted biopsy may improve the predictive accuracy of Gleason score assessment after radical prostatectomy.Smaller prostate volume and biopsy protocols were important factors affecting GS upgrading.