Boston—Transrectal saturation biopsy resulted in higher rates of disease reclassification compared with magnetic resonance (MR) fusion biopsy plus extended sextant prostate biopsy in patients with low-risk prostate cancer on active surveillance.
In a review of 228 unique biopsy encounters from 177 men initially managed by active surveillance at Cleveland Clinic, the reclassification rate was about double with saturation biopsy than with MR target only or MR target plus extended template biopsy, reported Yaw Nyame, MD, MBA, at the AUA annual meeting in Boston, in a project that is mentored by Ahmed Elshafei, MD, PhD, and J. Stephen Jones, MD, from Cleveland Clinic.
Active surveillance as a management strategy has increased considerably over the past decade. In the ProtecT study, about 50% of the men who chose active surveillance as a strategy for management of localized prostate cancer received an intervention during the 10-year follow-up, driven in part by disease reclassification.
In a large prospective study, Siddiqui et al found that among men undergoing biopsy for suspected prostate cancer, targeted MR/ultrasound fusion biopsy was associated with increased detection of clinically significant prostate cancer compared with standard extended-sextant ultrasound-guided biopsy (JAMA 2015; 313:390-7). Dr. Elshafei and colleagues found that up to 18% more cases of clinically significant cancer could be detected using multiparametric MR compared with standard transrectal ultrasound biopsy.
“However, there are mixed results from recent studies looking at MR in active surveillance cohorts, with most recently the UCSF group demonstrating that there is more reclassification detected on the extended biopsy portion of their combined MR fusion and ultrasound biopsies,” said Dr. Nyame, urology resident at Cleveland Clinic’s Glickman Urological and Kidney Institute. “Additionally, any time you have a new technology, you have to factor in the cost and expertise as significant barriers in times to entry for certain practitioners.”
The authors hypothesized that transrectal saturation biopsy could provide similar rates of disease reclassification compared with multiparametric MR-guided biopsy in patients receiving confirmatory or surveillance biopsy while on active surveillance.