title: Accuracy of Magnetic Resonance Imaging/Ultrasound Fusion Targeted Biopsies to Diagnose Clinically Significant Prostate Cancer in Enlarged Compared to Smaller Prostates.
abstract: OBJECTIVE
  We assessed the accuracy of magnetic resonance imaging/transrectal ultrasound fusion biopsies to diagnose prostate cancer according to gland size.
  
  
  METHODS
  A prospective study was performed in 232 men with a first round biopsy, multiparametric magnetic resonance imaging with a lesion, a Likert score of 2 or greater and prostate specific antigen less than 10 ng/ml. All men underwent a standard 12-core protocol plus a protocol of 2 or 3 targeted cores. Significant prostate cancer was defined as at least 1 core with a Gleason score of 7 (3 + 4) or 6 with a greater than 4 mm maximal cancer core length.
  
  
  RESULTS
  Mean ± SD patient age was 64 ± 6.4 years, mean prostate specific antigen was 6.65 ± 1.8 ng/ml and mean prostate volume was 40 ± 24.3 ml. The overall detection rate of clinically significant prostate cancer was 44%. The detection rate of clinically significant prostate cancer by magnetic resonance imaging-transrectal ultrasound fusion guided biopsy was 77% for prostate glands less than 30 cm(3), and 61%, 47% and 34% for glands 30 to less than 38.5, 38.5 to less than 55 and 55 to 160 cm(3), respectively (p = 0.001). Differences in prostate cancer detection rates between the standard and targeted protocols were not significant for patients with a prostate volume of 40 cm(3) or less (p = 0.8). Conversely 12 patients with a prostate volume greater than 40 cm(3) had clinically significant prostate cancer using the targeted but not the standard protocol and in 3 prostate cancer was detected by the standard but not the targeted protocol (p = 0.04).
  
  
  CONCLUSIONS
  Magnetic resonance imaging-transrectal ultrasound fusion biopsies increased the yield of first round prostate biopsies in patients with a prostate volume greater than 40 cm(3).
authors.affiliation: Academic Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Arachk
authors.initials: A
authors.lastname: de Gorski
authors.affiliation: Academic Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France; GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie-Université Paris 06, Paris, France. Electronic address: mroupret@gmail.com.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Academic Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Academic Department of Biostatistics, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Le Cossec
authors.affiliation: Academic Department of Biostatistics, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.affiliation: Academic Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Eva
authors.initials: E
authors.lastname: Comperat
authors.affiliation: Academic Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France; GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Université Pierre et Marie Curie-Université Paris 06, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.affiliation: Academic Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Raphaële
authors.initials: R
authors.lastname: Renard-Penna
authors.affiliation: Academic Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Paris, France; Institute for Intelligent Systems and Robotics, Université Pierre et Marie Curie-Université Paris 06, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mozer
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional
keywords: biopsy; diagnostic imaging; magnetic resonance imaging; prostatic neoplasms; ultrasonography