title: MRI/US fusion prostate biopsy: Our initial experience.
abstract: OBJECTIVE
  The objective of this study is to present our initial experience with magnetic resonance imaging/ultrasound (MRI/US) fusion biopsy using the Koelis Trinity device after the first consecutive 59 patients.
  
  
  METHODS
  59 consecutive patients with suspected prostate cancer (PCA) underwent prostate biopsy using Trinity Koelis® (Koelis, Grenoble, France). We divided the patients into 2 groups: patients with a previous negative mapping underwent to a MRI/US fusion re-biopsy (Group A); and biopsy-naïve patients who underwent to a first stereotactic 3-D mapping of the prostate (Group B). Group A (22 patients):mean age 64 years (CI 48-73), mean PSA = 7.7 ng/ml (CI 4.2- 9.9); mean prostate volume 55 ml(CI 45-82), Digital Rectal Examination (DRE) positive in 2/22, number of lesions detected by MRI 1.4, mean cores from each MRI target lesion 3 (CI 2-5), mean total cores 15 ( CI 12-19). Group B (37 patients): mean age 66 years (CI 49-77), mean PSA= 4.7 (3.2- 7.9); mean prostate volume 45 ml (33-67), DRE positive in 5/37, mean total cores 14 ( CI 10-16) Results: In Group A 10/22 patients were positive for PCA (overall detection rate of 45.5%): 6 PCA were detected by target biopsy and 4 cancer by random biopsy. Significant prostate cancer (defined as the presence of Gleason pattern 4) was detected in 4/10 patients (Significant PCA detection rate of 40%) and all significant PCA were detected by MRI target biopsy. All PCA detected by random biopsy had Gleason score 3 + 3 = 6. In Group B (biopsy naïve patients) 14/37 patients were positive for PCA (overall detection rate of 37.8%), Significant prostate cancer was detected in 5/14 patients (Significant PCA detection rate of 35,7%). No significant side effects were recorded.
  
  
  CONCLUSIONS
  Our overall detection rate was 45.5% and 37.8% in Group A (patients with previous negative biopsy and persistent suspicion of PCA) and in Group B (biopsy naïve patients) respectively; clinical significant PCA detection rate was respectively 40% and 35.7%. These results are similar to current literature and promising for the future. We believe that using platforms of co-registered MRI/US fusion biopsy can potentially improve risk stratification and reduces understaging, undergrading and the need for repeat biopsies in biopsy naïve patients (using a stereotactic first mapping) and in patients with previous negative biopsy and persistent suspicion of PCA ( using a second MRI/US fusion biopsy).
authors.affiliation: Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro. Vito.Lacetera@gmail.com.
authors.forename: Vito
authors.initials: V
authors.lastname: Lacetera
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cervelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicetti
authors.forename: Giuliana
authors.initials: G
authors.lastname: Gabrielloni
authors.forename: Michele
authors.initials: M
authors.lastname: Montesi
authors.forename: Roberto
authors.initials: R
authors.lastname: Morcellini
authors.forename: Gianni
authors.initials: G
authors.lastname: Parri
authors.forename: Emilio
authors.initials: E
authors.lastname: Recanatini
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giglioni
authors.forename: Andrea Benedetto
authors.initials: AB
authors.lastname: Galosi
authors.forename: Valerio
authors.initials: V
authors.lastname: Beatrici
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology; D014463:Ultrasonography