Die Echtzeit-MRT/US-Fusionsbiopsie in Patienten mit und ohne Vorbiopsie mit Verdacht auf ein Prostatakarzinom

Zusammenfassung

Hintergrund: Die Magnet Resonanz Tomografie (MRT)/Ultraschall (US) fusionierte Biopsie detektiert in Patienten mit Indikation zur Wiederholungsbiopsie mehr Prostatakarzinome (PCa) als die konventionelle transrektal Ultraschall (TRUS) gestützte Biopsie. Ziel der Studie war es a) die Detektionsraten der MRT/US-Fusionsbiopsie mit der konventionell TRUS gestützten Biopsie in einer Doppelzentrums-Kohorte gemeinsam zu evaluieren und b) die Detektionsraten in Abhängigkeit der Anzahl der Vorbiopsien zu untersuchen.

Material und Methoden: Im Zeitraum von Januar 2012 bis Juli 2014 erhielten 310 Patienten mit mindestens einer PCa suspekten Läsion in einer zuvor erfolgten multiparametrischen MRT bei 3 Tesla eine MRT/US fusionierte Biopsie der Prostata. Konsekutiv wurde zum direkten Vergleich eine randomisierte 10-fach konventionelle TRUS gestützte Biopsie durchgeführt. Detektionsraten wurden nach Methode, Gleason Score und in Abhängigkeit der Vorbiopsien ermittelt.

Ergebnisse: In 310 biopsierten Patienten konnte eine Gesamtdetektionsrate für ein PCa mit 51% (158 Patienten) erreicht werden. Die histologische Auswertung ergab für die detektierten 158 PCa einen Gleason Score 6 in 60 Patienten (38%), einen Gleason Score 7 in 54 Patienten (34%) und einen Gleason Score≥8 in 44 Patienten (28%). Unter den 158 Patienten mit PCa wurden 110 (69,7%) mittels MRT/US Fusion detektiert. Unter den singulär mittels TRUS detektierten PCa zeigte sich eine höhere Rate an Gleason Score 6 Karzinomen (54% vs. 38%) und eine geringere Detektion von Gleason≥8 Karzinomen (15% vs. 28%). Hingegen imponierte eine höhere Anzahl niedriger Gleason Scores in Patienten mit einer höheren Anzahl an Vorbiopsien. Die Detektionsrate lag bei Patienten mit primärer Fusionsbiopsie bei 75% (40 Patienten). Hierbei wurden 75% PCa mit einem Gleason Score≥7 diagnostiziert.

Schlussfolgerung: Die MRT/US-Fusionsbiopsie detektiert auch in dieser Doppelzentrums-Analyse mehr und auch signifikante PCa als die konventionelle TRUS. Die Anzahl an Vorbiopsien divergiert mit der Anzahl signifikanter PCa. Eingeschlossene Primärbiopsien mit 75% Detektionsrate gilt es in einer Folgestudie näher zu evaluieren.

Abstract

Background: Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy detects more prostate cancer (PCa) than transrectal US (TRUS)-guided biopsy in patients with an indication for prostate re-biopsy. The aim of this study was a) to compare the detection rates of MRI/US fusion-guided biopsy with conventional TRUS in a double centre cohort and b) to investigate the influence of the number of pre-biopsies on the PCa detection rate.

Material and Methods: In the period from January 2012 to July 2014, 310 consecutive patients gave written informed consent and underwent 3 Tesla MRI scans of the prostate. All patients had at least one PCa suspicious lesion in the MRI and were biopsied by MRI/US fusion followed by a conventional 10-core biopsy of the prostate. Detection rates based on technique, Gleason score and number of pre-biopsies were calculated.

Results: The overall detection rate of the study was 51% (158 patients). Among these 158 patients a histopathological Gleason score of 6 was detected in 60 patients (38%), a Gleason score of 7 in 54 patients (34%) and a Gleason score≥8 in 44 patients (28%). MRI/US fusion-guided biopsy detected 110 (69.7%) of the overall detected 158 PCa. TRUS-guided biopsy detected a higher rate of Gleason score 6 (54%) and a lower rate of Gleason score≥8 (15%) lesions in comparison to 38% Gleason 6 and 28% Gleason≥8 in the MRI/US fusion-guided biopsy, respectively. Furthermore, a lower Gleason score was observed in patients with more than one pre-biopsy. The detection rate in biopsy-naïve patients undergoing MRI/US fusion was 75% (40 patients) among 75% detected Gleason score≥7.

Conclusion: MRI/US fusion-guided biopsy detected more PCa and also more clinically significant cancer than conventional TRUS. In our cohort patients with more than one pre-biopsy showed lower Gleason scores. The included patients with an initial MRI/US fusion-guided biopsy should be further investigated.

Schlüsselwörter

Prostatakarzinom - Prostatakarzinomdiagnostik - Prostatabiopsie - bildgebende Verfahren - Prostata MRT - MRT/US-Fusion

Key words

prostate cancer - prostate cancer diagnostics - prostate biopsies - imaging procedures - prostate MRI - MRT/US fusion

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