The impact of prostate MR/ultrasound fusion-guided biopsy on radiation treatment recommendations.

Publication date: Available online 18 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Aaron Reed, Luca F. Valle, Uma Shankavaram, Andra Krauze, Aradhana Kaushal, Erica Schott, Theresa Cooley-Zgela, Bradford Wood, Peter Pinto, Peter Choyke, Baris Turkbey, Deborah E. Citrin
BackgroundTargeted magnetic resonance (MR)/ultrasound fusion prostate biopsy (MRI-Bx) has recently been compared to standard of care extended sextant ultrasound-guided prostate biopsy (SOC-Bx) and was associated with an increased rate of detection of clinically significant prostate cancer. This study sought to determine the influence of MRI-Bx on radiation and androgen deprivation therapy (ADT) treatment recommendations.Methods/Materials: All patients treated with radiotherapy that underwent SOC-Bx and MRI-Bx at our institution were included. Using clinical T stage, pretreatment PSA, and Gleason score, patients were categorized into NCCN risk groups and radiation/ADT treatment recommendations were assigned. Intensification of recommended treatment after multiparametric MRI, SOC-Bx, and MRI-Bx was evaluated.ResultsFrom January 2008 to January 2016, 73 patients received radiation therapy at our institution after undergoing a simultaneous SOC-Bx and MRI-Bx (n=47 with prior SOC-Bx). Repeat SOC-Bx and MRI-Bx resulted in frequent upgrading compared to prior SOC-Bx (Gleason 7: 6.7% vs. 44.6%, p<0.001; Gleason 8-10: 2.1% vs. 38%, p<0.001). MRI-Bx increased the proportion of patients classified as very-high risk from 24.7% to 41.1% (p=0.027). Compared to SOC-Bx alone, including MRI-Bx findings resulted in a higher percentage of pathologically positive cores (mean 37% vs. 44%). Incorporation of multiparametric MRI and MRI-Bx results increased the recommended use and duration of ADT (duration increased in 28/73 patients, addition in 8/73 patients).ConclusionIn patients referred for radiotherapy, MRI-Bx resulted in an increase in the percentage of positive cores, Gleason Score, and risk grouping. The benefit of treatment intensification based on MRI-Bx findings is unknown.

Teaser

Prostate MR/ultrasound fusion-guided biopsy has recently been shown to identify clinically significant prostate cancer at rates higher than standard extended sextant ultrasound guided biopsy. Targeted biopsy often results in an increase in tumor grade. As fusion biopsy becomes more prevalent, an understanding of how it may alter radiation recommendations as a result of risk group migration is important. This study demonstrates a general pattern of increasing risk group and treatment intensification when results of fusion biopsy are incorporated.


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