title: Magnetic Resonance Imaging/Transrectal Ultrasonography Fusion Prostate Biopsy Significantly Outperforms Systematic 12-Core Biopsy for Prediction of Total Magnetic Resonance Imaging Tumor Volume in Active Surveillance Patients.
abstract: OBJECTIVE
  To correlate the highest percentage core involvement (HPCI) and corresponding tumor length (CTL) on systematic 12-core biopsy (SBx) and targeted magnetic resonance imaging/transrectal ultrasonography (MRI/TRUS) fusion biopsy (TBx), with total MRI prostate cancer (PCa) tumor volume (TV).
  
  
  METHODS
  Fifty patients meeting criteria for active surveillance (AS) based on outside SBx, who underwent 3.0T multiparametric prostate MRI (MP-MRI), followed by SBx and TBx during the same session at our institution were examined. PCa TVs were calculated using MP-MRI and then correlated using bivariate analysis with the HPCI and CTL for SBx and TBx.
  
  
  RESULTS
  For TBx, HPCI and CTL showed a positive correlation (R(2)=0.31, P<0.0001 and R(2)=0.37, P<0.0001, respectively) with total MRI PCa TV, whereas for SBx, these parameters showed a poor correlation (R(2)=0.00006, P=0.96 and R(2)=0.0004, P=0.89, respectively). For detection of patients with clinically significant MRI derived tumor burden greater than 500 mm(3), SBx was 25% sensitive, 90.9% specific (falsely elevated because of missed tumors and extremely low sensitivity), and 54% accurate in comparison with TBx, which was 53.6% sensitive, 86.4% specific, and 68% accurate.
  
  
  CONCLUSIONS
  HPCI and CTL on TBx positively correlates with total MRI PCa TV, whereas there was no correlation seen with SBx. TBx is superior to SBx for detecting tumor burden greater than 500 mm(3). When using biopsy positive MRI derived TVs, TBx better reflects overall disease burden, improving risk stratification among candidates for active surveillance.
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Chinonyerem
authors.initials: C
authors.lastname: Okoro
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: M Minhaj
authors.initials: MM
authors.lastname: Siddiqui
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Annerleim
authors.initials: A
authors.lastname: Walton-Diaz
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Nabeel A
authors.initials: NA
authors.lastname: Shakir
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Rothwax
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Dima
authors.initials: D
authors.lastname: Raskolnikov
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Lambros
authors.initials: L
authors.lastname: Stamatakis
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Su
authors.affiliation: 2 Molecular Imaging Program, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
authors.affiliation: 2 Molecular Imaging Program, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
authors.affiliation: 3 Laboratory of Pathology, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.affiliation: 4 Division of Cancer Prevention, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Howard L
authors.initials: HL
authors.lastname: Parnes
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.|5 Center for Interventional Oncology, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.|5 Center for Interventional Oncology, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D014463:Ultrasonography / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen