Magnetic resonance imaging‑directed biopsy improves the prediction of prostate cancer aggressiveness compared with a 12‑core transrectal ultrasound‑guided prostate biopsy

Zhang,Jie; Xiu,Jianjun; Dong,Yin; Wang,Muwen; Han,Xue; Qin,Yejun; Huang,Zhaoqin; Cai,Shifeng; Yuan,Xianshun; Liu,Qingwei

doi:10.3892/mmr.2014.1994

Magnetic resonance imaging‑directed biopsy improves the prediction of prostate cancer aggressiveness compared with a 12‑core transrectal ultrasound‑guided prostate biopsy

Authors:
- Jie Zhang
- Jianjun Xiu
- Yin Dong
- Muwen Wang
- Xue Han
- Yejun Qin
- Zhaoqin Huang
- Shifeng Cai
- Xianshun Yuan
- Qingwei Liu
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Affiliations: Department of Radiology, Provincial Hospital, Shandong University, Jinan 250021, P.R. China, Minimally Invasive Urology Center, Provincial Hospital, Shandong University, Jinan 250021, P.R. China, Department of Pathology, Provincial Hospital, Shandong University, Jinan 250021, P.R. China
Published online on: February 28, 2014 https://doi.org/10.3892/mmr.2014.1994
Pages: 1989-1997

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Abstract

The Gleason grading system is a fundamental indicator of the aggressive nature of prostate cancer (PCa). Diffusion‑weighted imaging (DWI) and magnetic resonance (MR) spectroscopy (MRS) are methods for the assessment of PCa aggressiveness. The present study was designed to prospectively investigate whether transrectal ultrasound (TRUS)‑guided MR imaging (MRI)‑directed biopsies (TRUS‑MR‑Dbs) improve the prediction of PCa aggressiveness in comparison with 12‑core TRUS‑guided biopsies (TRUS‑Gbs). A total of 518 patients underwent pre‑biopsy multi‑parametric MRI to identify the clinically suspicious PCa regions. TRUS‑MR‑Dbs were performed on patients with suspected PCa by MRI in addition to TRUS‑Gbs. Only patients who underwent radical prostatectomy (RP) were included in the comparative analysis. TRUS‑biopsy was directed to those areas within suspicious regions with a minimum apparent diffusion coefficient obtained by DWI or with a maximum (choline + creatine)/citrate ratio obtained by MRS. The highest Gleason grades (HGGs) and the Gleason scores (GSs) of specimens were identified. The biopsies and RP results were evaluated using a McNemar test or χ2 analyses using Fisher' exact tests. MRI results were positive in 254 (49.0%) of the 518 patients. TRUS‑MR‑Db detected 165/254 (65.0%) cancer cases and TRUS‑Gb detected 190/518 (36.7%) cancer cases. Forty patients underwent RP. The TRUS‑MR‑Dbs method demonstrated a higher concordance rate (CR) with RP (89.6%) than TRUS‑Gbs (72.9%, P=0.008) for the overall HGG. The CRs with RP for TRUS‑MR‑Dbs vs. those for TRUS‑Gbs were 100 vs. 85.7% (P=0.5), 87.5 vs. 68.8% (P=0.031) and 50 vs. 50% (P=1) for HGG3, HGG4 and HGG5, respectively. The HGG CRs with RP for DWI‑directed biopsies (DWI‑Dbs) vs. MRS‑directed biopsies (MRS‑Dbs) were 77.1 vs. 50.0% (P=0.015) for the overall tumors, 80.0 vs. 40.0% (P=0.003) for peripheral zone tumors and 69.2 vs. 76.9% (P=1) for transition zone tumors. A total of 37 (77.1%) and 25 (52.1%; P=0.007) tumors were assigned accurate GS for TRUS‑MR‑Dbs and TRUS‑Gbs, respectively. The results revealed that TRUS‑MR‑Dbs improved the prediction of PCa aggressiveness and that DWI‑Dbs had a superior performance when compared with MRS‑Dbs in the peripheral zone.

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1	Gleason DF and Mellinger GT: Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol. 111:58–64. 1974.
2	Egevad L, Granfors T, Karlberg L, Bergh A and Stattin P: Prognostic value of the Gleason score in prostate cancer. BJU Int. 89:538–542. 2002. View Article : Google Scholar : PubMed/NCBI
3	Yang CW, Lin TP, Huang YH, et al: Does extended prostate needle biopsy improve the concordance of Gleason scores between biopsy and prostatectomy in the Taiwanese population? J Chin Med Assoc. 75:97–101. 2012. View Article : Google Scholar : PubMed/NCBI
4	Divrik RT, Eroglu A, Sahin A, Zorlu F and Ozen H: Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens. Urol Oncol. 25:376–382. 2007. View Article : Google Scholar : PubMed/NCBI
5	Delongchamps NB, Rouanne M, Flam T, et al: Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int. 107:1411–1418. 2011. View Article : Google Scholar
6	Mazaheri Y, Shukla-Dave A, Hricak H, et al: Prostate cancer: identification with combined diffusion-weighted MR imaging and 3D ¹H MR spectroscopic imaging - correlation with pathologic findings. Radiology. 246:480–488. 2008. View Article : Google Scholar : PubMed/NCBI
7	Park BK, Park JW, Park SY, et al: Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy. AJR Am J Roentgenol. 197:W876–W881. 2011. View Article : Google Scholar
8	Haffner J, Lemaitre L, Puech P, et al: Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int. 108:E171–E178. 2011. View Article : Google Scholar
9	Pinto PA, Chung PH, Rastinehad AR, et al: Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 186:1281–1285. 2011. View Article : Google Scholar
10	Vourganti S, Rastinehad A, Yerram NK, et al: Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol. 188:2152–2157. 2012. View Article : Google Scholar
11	Kobus T, Vos PC, Hambrock T, et al: Prostate cancer aggressiveness: in vivo assessment of MR spectroscopy and diffusion-weighted imaging at 3 T. Radiology. 265:457–467. 2012. View Article : Google Scholar : PubMed/NCBI
12	Hambrock T, Somford DM, Huisman HJ, et al: Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology. 259:453–461. 2011. View Article : Google Scholar
13	Kobus T, Hambrock T, Hulsbergen-van de Kaa CA, et al: In vivo assessment of prostate cancer aggressiveness using magnetic resonance spectroscopic imaging at 3 T with an endorectal coil. Eur Urol. 60:1074–1080. 2011. View Article : Google Scholar : PubMed/NCBI
14	Scheenen TW, Heijmink SW, Roell SA, et al: Three-dimensional proton MR spectroscopy of human prostate at 3 T without endorectal coil: feasibility. Radiology. 245:507–516. 2007. View Article : Google Scholar : PubMed/NCBI
15	Wang XZ, Wang B, Gao ZQ, et al: Diffusion-weighted imaging of prostate cancer: correlation between apparent diffusion coefficient values and tumor proliferation. J Magn Reson Imaging. 29:1360–1366. 2009. View Article : Google Scholar : PubMed/NCBI
16	Wang XZ, Wang B, Gao ZQ, et al: ¹H-MRSI of prostate cancer: the relationship between metabolite ratio and tumor proliferation. Eur J Radiol. 73:345–351. 2010. View Article : Google Scholar
17	Stackhouse DA, Sun L, Schroeck FR, et al: Factors predicting prostatic biopsy Gleason sum under grading. J Urol. 182:118–124. 2009. View Article : Google Scholar
18	Zakian KL, Sircar K, Hricak H, et al: Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy. Radiology. 234:804–814. 2005. View Article : Google Scholar : PubMed/NCBI
19	Delongchamps NB, Peyromaure M, Schull A, et al: Prebiopsy magnetic resonance imaging and prostate cancer detection: comparison of random and targeted biopsies. J Urol. 189:493–499. 2013. View Article : Google Scholar : PubMed/NCBI
20	Moore CM, Robertson NL, Arsanious N, et al: Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol. 63:125–140. 2013. View Article : Google Scholar : PubMed/NCBI
21	Verma S, Rajesh A, Morales H, et al: Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy. AJR Am J Roentgenol. 196:374–381. 2011. View Article : Google Scholar : PubMed/NCBI
22	San Francisco IF, DeWolf WC, Rosen S, Upton M and Olumi AF: Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy. J Urol. 169:136–140. 2003.PubMed/NCBI
23	Park BK, Lee HM, Kim CK, Choi HY and Park JW: Lesion localization in patients with a previous negative transrectal ultrasound biopsy and persistently elevated prostate specific antigen level using diffusion-weighted imaging at three Tesla before rebiopsy. Invest Radiol. 43:789–793. 2008. View Article : Google Scholar
24	Prando A, Kurhanewicz J, Borges AP, Oliveira EM Jr and Figueiredo E: Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients with elevated prostate specific antigen levels and prior negative biopsy findings: early experience. Radiology. 236:903–910. 2005. View Article : Google Scholar
25	Tamada T, Sone T, Jo Y, et al: Apparent diffusion coefficient values in peripheral and transition zones of the prostate: comparison between normal and malignant prostatic tissues and correlation with histologic grade. J Magn Reson Imaging. 28:720–726. 2008. View Article : Google Scholar
26	Hambrock T, Hoeks C, Hulsbergen-van de Kaa C, et al: Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-core transrectal ultrasound prostate biopsy cohort. Eur Urol. 61:177–184. 2012. View Article : Google Scholar
27	Na R, Jiang H, Kim ST, et al: Outcomes and treands of prostate biopsy for prostate cancer in Chinese men from 2003 to 2011. PLoS One. 7:e499142012. View Article : Google Scholar : PubMed/NCBI
28	Miyagawa T, Ishikawa S, Kimura T, et al: Real-time Virtual Sonography for navigation during targeted prostate biopsy using magnetic resonance imaging data. Int J Urol. 17:855–860. 2010. View Article : Google Scholar : PubMed/NCBI
29	Rastinehad AR, Baccala AA Jr, Chung PH, et al: D’Amico risk stratification correlates with degree of suspicion of prostate cancer on multiparametric magnetic resonance imaging. J Urol. 185:815–820. 2011.