EURURO Vol. 72 No. 2

275 320

Prostate Cancer
Magnetic Resonance Imaging–Ultrasound Fusion Biopsy During
Prostate Cancer Active Surveillance
Geraldine N. Tran Michael S. Leapman [3_TD$DIFF] Hao G. Nguyen [4_TD$DIFF] Janet E. Cowan
Katsuto Shinohara [5_TD$DIFF] Antonio C. Westphalen Peter R. Carroll [6_TD$DIFF]
a School of Medicine, University of California, San Francisco, San Francisco, CA, USA; bDepartment of Urology, University of California, San Francisco, San
Francisco, CA, USA; c Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; dHelen Diller Family
Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
ava ilable at
journal homepage:
Article info
Article history:
Accepted August 8, 2016
Associate Editor:
Christian Gratzke
Keywords:
MRI-ultrasound fusion biopsy
Active surveillance
Prostate cancer
Abstract
Background: Fusion biopsy using multiparametric magnetic resonance imaging (MRI) and
transrectal ultrasound has demonstrated favorable detection rates of high-grade prostate
cancer (PCa) among previously undiagnosed men. However, the diagnostic yield among
men with active surveillance (AS) remains undefined.
Objective: To determine the utility of MRI-ultrasound fusion biopsy during AS by reporting
rates of PCa upgrading and comparing findings with systematic biopsy.
Design, setting, and participants: We identified patients with low- and intermediate-risk
PCa enrolled in AS who received MRI-ultrasound fusion surveillance biopsies. All completed
prostate multiparametric MRI with 3-T and endorectal coil reviewed by radiologists
selecting regions of interest, and all underwent MRI-ultrasound fusion biopsy with con-
current systematic biopsy.
Outcome measurements and statistical analysis: We report MRI-ultrasound fusion biopsy
findings, rates of Gleason score (GS) upgrading to 3 + 4 (any upgrading) and to 4 + 3
(major upgrading), tumor involvement estimates using descriptive statistics, McNemar’s
test of symmetry, and multivariate logistic regression.
Results and limitations: Overall, 207 men underwent MRI-ultrasound fusion biopsy follow-
ing radiologic suspicion on multiparametric MRI and met inclusion criteria. Agreement
between systematic and MRI-ultrasound fusion biopsy GS was borderline statistically signif-
icant (p < 0.047). In total, 83 men (40%) experienced any upgrading, including 49 (24%) on
systematic sampling, 30 (14%) on MRI-targeted cores, and four (2%) on both. Among those
with negative results onMRI-ultrasound fusion biopsy, seven (9%) exhibited major upgrading
with systematic biopsy. MRI suspicion scores were high (4/5) for all but two patients with any
upgrading and for all who experienced major upgrading. On multivariate analysis, older age
was associated with higher odds of any upgrading for men with GS 3 + 3 on previous biopsy
(odds ratio: 1.10; 95% confidence interval, 1.01–1.20; p = 0.03).
Conclusions: MRI-ultrasound fusion biopsy resulted in upgrading otherwise undetected by
systematic biopsy among a proportion of men with PCa managed with AS. However,
upgrading also occurred in areas outside targeted biopsy, suggesting that systematic
sampling should be offered to men with AS even with history of extended sextant biopsy.
Patient summary: This study examined the role of magnetic resonance imaging (MRI)–
ultrasound fusion biopsy for men with prostate cancer managed with active surveillance
(AS). In some patients, MRI-ultrasound fusion biopsy resulted in the detection of upgrade
otherwise missed with systematic sampling. The findings indicate that MRI-ultrasound
fusion biopsy may help with better sampling during AS.
# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. School of Medicine, University of California, 550 16th Street, San Francisco,
CA 94158, USA. Tel. +1 408 568 7431.
E-mail address: (G.N. Tran).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.