T Ullrich1, C Arsov2, M Quentin3, N Laqua4, M Klingebiel5, O Martin6, A Hiester7, D Blondin8, R Rabenalt9, P Albers10, G Antoch11, L Schimmöller12. 1. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Tim.Ullrich@med.uni-duesseldorf.de. 2. Department of Urology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Christian.Arsov@med.uni-duesseldorf.de. 3. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: micha.quentin@gmail.com. 4. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Nina.Laqua@uni-duesseldorf.de. 5. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Maximilian.klingebiel@med.uni-duesseldorf.de. 6. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Ole.martin@med.uni-duesseldorf.de. 7. Department of Urology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Andreas.Hiester@med.uni-duesseldorf.de. 8. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Dirk.Blondin@sk-mg.de. 9. Department of Urology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Robert.Rabenalt@vkkd-kliniken.de. 10. Department of Urology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Peter.Albers@med.uni-duesseldorf.de. 11. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Antoch@med.uni-duesseldorf.de. 12. Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Medical Faculty, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Lars.Schimmoeller@med.uni-duesseldorf.de.
Abstract
PURPOSE: To evaluate if subgroups of patients assigned to MRI category PI-RADS 4 regarding clinical and MRI imaging aspects have distinct risks of prostate cancer (PCa) to facilitate adequate clinical management of this population, especially after negative targeted biopsy. METHODS: This prospective, IRB approved single center cross-sectional study includes 931 consecutive patients after mp-MRI at 3 T for PCa detection. 193 patients with PI-RADS assessment category 4 received subsequent combined targeted MRI/US fusion-guided and systematic 12-core TRUS-guided biopsy as reference standard and were finally analyzed. The primary endpoint was PCa detection of PI-RADS 4 with MRI subgroup analyses. Secondary endpoints were analyses of clinical data, location of PCa, and detection of targeted biopsy cores. RESULTS: PCa was detected in 119 of 193 patients (62%) including clinically significant PCa (csPCa; Gleason score ≥3 + 4 = 7) in 92 patients (48%). MRI subgroup analysis revealed 95% PCa (73% csPCa) in unambiguous PI-RADS 4 index lesions without additional, interfering signs of prostatitis in the peripheral zone or overlaying signs of severe stromal hyperplasia in the transition zone according to PI-RADS v2. Transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia showed PCa only in 11% (4% csPCa). Targeted biopsy cores missed the csPCa index lesion in 7% of the patients. PSA density (PSAD) was significantly higher in PCa patients. CONCLUSIONS: Small csPCa can reliably be detected with mp-MRI by experienced readers, but can be missed by targeted MR/US fusion biopsy alone. Targeted re-biopsy of unambiguous (peripheral) PI-RADS-4-lesions is recommended; whereas transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia might be followed-up by re-MRI primarily.
PURPOSE: To evaluate if subgroups of patients assigned to MRI category PI-RADS 4 regarding clinical and MRI imaging aspects have distinct risks of prostate cancer (PCa) to facilitate adequate clinical management of this population, especially after negative targeted biopsy. METHODS: This prospective, IRB approved single center cross-sectional study includes 931 consecutive patients after mp-MRI at 3 T for PCa detection. 193 patients with PI-RADS assessment category 4 received subsequent combined targeted MRI/US fusion-guided and systematic 12-core TRUS-guided biopsy as reference standard and were finally analyzed. The primary endpoint was PCa detection of PI-RADS 4 with MRI subgroup analyses. Secondary endpoints were analyses of clinical data, location of PCa, and detection of targeted biopsy cores. RESULTS: PCa was detected in 119 of 193 patients (62%) including clinically significant PCa (csPCa; Gleason score ≥3 + 4 = 7) in 92 patients (48%). MRI subgroup analysis revealed 95% PCa (73% csPCa) in unambiguous PI-RADS 4 index lesions without additional, interfering signs of prostatitis in the peripheral zone or overlaying signs of severe stromal hyperplasia in the transition zone according to PI-RADS v2. Transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia showed PCa only in 11% (4% csPCa). Targeted biopsy cores missed the csPCa index lesion in 7% of the patients. PSA density (PSAD) was significantly higher in PCa patients. CONCLUSIONS: Small csPCa can reliably be detected with mp-MRI by experienced readers, but can be missed by targeted MR/US fusion biopsy alone. Targeted re-biopsy of unambiguous (peripheral) PI-RADS-4-lesions is recommended; whereas transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia might be followed-up by re-MRI primarily.
Authors: Daniel Stocker; Andrei Manoliu; Anton S Becker; Borna K Barth; Daniel Nanz; Markus Klarhöfer; Olivio F Donati Journal: Eur J Radiol Open Date: 2021-02-03
Authors: Kira Kornienko; Miriam Reuter; Andreas Maxeiner; Karsten Günzel; Beatrice Kittner; Maximilian Reimann; Sebastian L Hofbauer; Laura E Wiemer; Robin Heckmann; Patrick Asbach; Johann Jakob Wendler; Martin Schostak; Thorsten Schlomm; Frank Friedersdorff; Hannes Cash Journal: Sci Rep Date: 2022-08-10 Impact factor: 4.996