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MRI and TRUS Biopsy outcomes
Poster Title: MRI and TRUS Biopsy outcomes
Submitted on 15 Oct 2020
Author(s): Dr E Mayo, Dr J Pathak, Dr A Rangaraj, Dr M Rashid, Dr S Morgan
Affiliations: South Wales Deanery
This poster was presented at BIR 2020
Poster Views: 73
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Poster Information
Abstract: Submission title
MRI and TRUS Prostate Outcomes
Prostate cancer is diagnosed in approximately 40,000 men in the UK annually. Low-grade disease may not impact life expectancy. Treatment benefit may be limited given significant medication side-effects and impact of surgery. Historically trans-rectal ultrasound guided biopsies has lead disease diagnosis. TRUS has limited ability to accurately identify and specifically target abnormal prostate tissue and risks pain, haematuria and serious infection.
MRI is superior in assessing prostate volume, surrounding structures and vascularity. The PROMIS Trial considered MRI may reduce unnecessary biopsies. Low-risk patients with normal imaging may be reassured and discharged under follow up.
Materials and Methods
As per PROMIS Trial recommendations, MRI should be performed and reported prior to considering TRUS biopsy. PIRAD/Likert scores should be included in all MRI reports and TRUS biopsies offered with scores of 3 or more. MRI findings of prostate density >0.15ng/ml should be offered biopsy.
Patients undergoing Prostate MRI were identified between Jan –March 2019. Patients subsequently undergoing TRUS biopsies were also identified. Correlation of biopsy histopathology with initial MRI evaluated accuracy of disease identification.
148 identified patients. PIRADs and Likert score recorded in 95.9% patients. 41.9% subsequent TRUS-guided biopsies. 58.1% biopsies targeted based on MRI report. 74.2% histopathology specimens correlated positively with the reported MRI abnormality. 29.0% high grade prostate cancers. 64.5% low grade (Gleason 3+3 and 3+4) or normal tissue. 79.3% prostate densities >0.15ng/ml had tissue positive for malignancy.
MRI assessment of prostates prior to consideration of biopsy prevented almost half of biopsies. This improved patient experience and enabled better use of departmental resources.
Summary: MRI assessment of prostates reduces the number of biopsies and associated patient pain or symptoms. Our MRI findings correlate well with biopsy results locally.References: PROMIS — Prostate MR imaging study: A paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer. A.El-Shater BosailyabC.ParkercL.C.BrowndR.GabeeR.G.HindleyfR.KaplandM.Embertonab1H.U.Ahmedab1on behalf of the PROMIS Group2.
Ahmed HU et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017. 389 (10071): 815-822. DOI: 10.1016/S0140-6736(16)32401
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