Accuracy of MRI-Targeted in-Bore Prostate Biopsy According to the Gleason Score with Postprostatectomy Histopathologic Control--a Targeted Biopsy-Only Strategy with Limited Number of Cores.
OBJECTIVE
Accuracy of ultrasound-guided biopsy and Gleason score is limited, and diagnosis of insignificant cancer with Gleason score ≤6 is frequent when extended biopsy schemes are used. We evaluated whether the magnetic resonance imaging (MRI)-targeted in-bore prostate biopsy correctly identifies the Gleason score of prostate cancer in histopathologic correlation after prostatectomy. Simultaneously a targeted concept is expected to keep down the rate of insignificant cancer.


METHODS
We compared retrospectively the Gleason score of the MRI-targeted in-bore biopsy with prostatectomy specimens in 50 men with prostate cancer. Endorectal MRI included T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and spectroscopy. Lesions with a prostate imaging-reporting and data system (PI-RADS) score ≥3 were considered. Upgrading and downgrading of tumors was evaluated, and significant upgrading was defined as a shift in Gleason score from 6 to 7 or more.


RESULTS
Gleason score was concordant in 66% of the patients, overall upgraded in 30% of patients, and downgraded in 4% of patients. Significant upgrading of the Gleason score from 6 to 7 occurred in eight patients; upgrading did not exceed one step in the Gleason score. After prostatectomy the Gleason score 6 was found in 20% of patients. The median number of cores obtained was 4 (range 2-6), and the median number of positive cores was 2 (range 1-4).


CONCLUSIONS
In-bore MRI-targeted biopsy offers good accuracy in the Gleason score with postprostatectomy histopathologic control when compared to the literature. A limited number of cores are sufficient to achieve these results. The fraction of insignificant cancer identified by targeted only-biopsy is low. Upgrading is restricted to one step in the Gleason score. Clinicians should be aware of positive findings in MRI and the biopsy technique used when assessing prostate biopsy results.
Grönemeyer Institute of Microtherapy, Universitätsstrasse 142, 44799 Bochum, Germany. Electronic address: garmer@groenemeyer.com.
Marietta
M
Garmer
Grönemeyer Institute of Microtherapy, Universitätsstrasse 142, 44799 Bochum, Germany.
Martin
M
Busch
Grönemeyer Institute of Microtherapy, Universitätsstrasse 142, 44799 Bochum, Germany.
Serban
S
Mateiescu
Witten/Herdecke University, Radiology Center, Wuppertal/Cologne-Merheim, Germany.
David E
DE
Fahlbusch
Medical Center-Urology, Bochum, Germany.
Birgit
B
Wagener
Grönemeyer Institute of Microtherapy, Universitätsstrasse 142, 44799 Bochum, Germany.
Dietrich H W
DH
Grönemeyer
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography
Magnetic resonance imaging; interventional; neoplasm grading; prostate biopsy; prostatic neoplasms