title: Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies.
abstract: BACKGROUND
  The current study was conducted to evaluate the performance of magnetic resonance (MR)-ultrasound-guided fusion biopsy in diagnosing clinically significant prostate cancer (csCaP).
  
  
  METHODS
  A total of 1042 men underwent multiparametric MR imaging (mpMRI) and fusion biopsy consecutively in a prospective trial (2009-2014). An expert reader graded mpMRI regions of interest (ROIs) as 1 to 5 using published protocols. The fusion biopsy device was used to obtain targeted cores from ROIs (when present) followed by a fusion image-guided, 12-core systematic biopsy in all men, even if no suspicious ROI was noted. The primary endpoint of the study was the detection of csCaP (ie, Gleason score ≥ 7).
  
  
  RESULTS
  Among 825 men with ≥ 1 suspicious ROI of ≥ grade 3, 289 (35%) were found to have csCaP. Powerful predictors of csCaP were ROI grade (grade 5 vs grade 3: odds ratio, 6.5 [P<.01]) and prostate-specific antigen density (each increase of 0.05 ng/mL/cc: odds ratio, 1.4 [P<.01]). Combining systematic and targeted biopsies resulted in the detection of more patients with csCaP (289 patients) than targeting (229 patients) or systematic (199 patients) biopsy alone. Among patients with no suspicious ROI, 35 (16%) were found to have csCaP on systematic biopsy.
  
  
  CONCLUSIONS
  In this prospective trial, MR-ultrasound fusion biopsy allowed for the detection of csCaP, with a direct relationship noted with ROI grade and prostate-specific antigen density. The combination of targeted and systematic biopsy detected more csCaP than either modality alone; systematic biopsies revealed csCaP in 16% of men with no suspicious MRI target. The advantages of this new biopsy method are apparent, but issues of cost, training, and reliability await resolution before its widespread adoption.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Department of Urology, Emory University, Atlanta, Georgia.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Shyam
authors.initials: S
authors.lastname: Natarajan
authors.affiliation: Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Daniel J A
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Department of Pathology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Jiaoti
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lieu
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Dorey
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Reiter
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Marks
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018084:Ultrasonography, Interventional
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: biopsy; cancer staging; diagnostic imaging; magnetic resonance imaging; prostate cancer