Midline lesions of the prostate: role of MRI/TRUS fusion biopsy and implications in Gleason risk stratification.
OBJECTIVE
MRI-TRUS fusion biopsy (FBx) has proven efficacy in targeting suspicious areas that are traditionally missed by systematic 12-core biopsy (SBx). Midline prostate lesions are undersampled during SBx, as traditional approaches aim laterally during TRUS biopsy. The aim of our study was to determine the utility of FBx for targeting midline lesions identified on multiparametric MRI (mpMRI).


METHODS
A review was performed of a prospectively maintained database of patients undergoing mpMRI followed by FBx and SBx from 2007 to 2015. Midline location was defined as any lesion crossing the midline on axial imaging and involving both prostatic lobes. Index lesion was defined as lesion with highest Gleason score on biopsy. Patient demographic, imaging, and histopathologic data were collected. Multivariate logistic regression was conducted to determine independent predictors of having clinically significant (CS) cancer (Gleason ≥ 7) in midline lesions.


RESULTS
Out of 1266 patients, we identified 202 suspicious midline lesions in 190 patients [median (IQR) age 63 (10) years; PSA 7.6 (6.6)]. Eighty-eight (46.3 %) patients had cancer detection on FBx of midline lesion. A midline target represented the index lesion of the prostate in 63/190 (33.2 %) patients. Risk category upgrading based on FBx of a midline lesion compared to SBx occurred in 45/190 patients (23.7 %). On multivariate analysis, higher PSA (p = .001), lower MRI-derived prostate volume (p < .001), and moderate-high or high suspicion on mpMRI (p = .014) predicted CS cancer in midline lesions.


CONCLUSIONS
MRI-TRUS FBx facilitates sampling of midline lesions. Integration of mpMRI and FBx for targeting of midline lesions improves detection of CS prostate cancer.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA. akhil.muthigi@nih.gov.
Akhil
A
Muthigi
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Abhinav
A
Sidana
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Arvin K
AK
George
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Michael
M
Kongnyuy
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Nabeel
N
Shakir
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Meet
M
Kadakia
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Mahir
M
Maruf
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Thomas P
TP
Frye
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Francesca
F
Mertan
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Daniel
D
Su
Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Maria J
MJ
Merino
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Peter L
PL
Choyke
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Baris
B
Turkbey
Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Bradford J
BJ
Wood
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 1-5940, 20892, Bethesda, MD, USA.
Peter A
PA
Pinto
D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies
Fusion biopsy; Midline; Multiparametric MRI; Prostate cancer