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Targeted fusion biopsy superior for suspected prostate cancer

Key clinical point: Targeted magnetic resonance/ultrasound fusion biopsy detected more high-risk and fewer low-risk prostate cancers than standard ultrasound-guided biopsy.

Major finding: Targeted biopsy detected 173 high-risk tumors, compared with only 122 identified on standard biopsy (30% more), and targeted biopsy detected 213 low-risk tumors, compared with 258 identified on standard biopsy (17% fewer).

Data source: A prospective cohort study involving 1,003 men undergoing both standard ultrasound-guided biopsy and targeted magnetic resonance/ultrasound fusion biopsy of the prostate during a 7-year period at a single medical center.

Disclosures: This study was supported by the National Cancer Institute, the National Institutes of Health, the Center for Cancer Research, and the Center for Interventional Oncology. Dr. Siddiqui reported having no financial disclosures; his associates reported holding multiple patents related to biopsies and imaging,

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Will biopsy technique improve outcomes?

Despite these promising results, it remains unknown whether improved risk stratification with targeted biopsy will translate into clinically meaningful outcomes such as better functional status or higher survival rates.

Improved classification of tumor grades should lead to more appropriate treatment recommendations – more intense therapy for men with higher-risk disease and active surveillance for those with lower-risk disease. But further study is needed to assess this technique’s impact on quality of life, disease progression, and life expectancy.

Dr. Lawrence H. Schwartz is in the department of radiology at Columbia University, New York, and at New York Presbyterian Hospital. Dr. Ethan Basch is at Lineberger Comprehensive Cancer Center and the University of North Carolina, Chapel Hill, as well as an associate editor at JAMA. Dr. Schwartz reported ties to Pfizer, Celgene, Novartis, Icon, and BioImaging, and Dr. Basch reported having no financial conflicts of interest. They made these remarks in an editorial accompanying Dr. Siddiqui’s report (JAMA 2015 Jan. 27 [doi:10.1001/jama.2014.17943]).


 

References

Targeted biopsy using magnetic resonance/ultrasound fusion imaging increased the detection of high-risk prostate cancer by 30% and decreased the detection of low-risk prostate cancer by 17%, compared with standard biopsy, according to a report published online Jan. 27 in JAMA.

Researchers compared the two approaches in a prospective cohort study involving 1,003 men referred to the National Cancer Institute during a 7-year period for evaluation of suspected prostate cancer. All the study participants had an elevated PSA or abnormal findings on digital rectal exam plus a multiparametric MRI showing at least 1 lesion in the prostate, said Dr. M. Minhaj Siddiqui of the urologic oncology branch, National Cancer Institute, Bethesda, Md., and his associates.

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All the patients underwent both standard extended-sextant ultrasound-guided biopsy and targeted magnetic resonance/ultrasound fusion biopsy at the same visit. The latter technique involves electronically superimposing multiparametric MR images in real time onto transrectal ultrasound images, which improves spatial localization and capture of location in three planes. The lesions were separately categorized as low-risk, intermediate-risk, or high-risk by highly experienced genitourinary radiologists.

The two image-guided biopsy techniques agreed on these classifications in 69% of cases and identified a similar number of cancers. However, targeted biopsy detected 173 high-risk tumors, compared with only 122 identified on standard biopsy, and targeted biopsy detected 213 low-risk tumors, compared with 258 identified on standard biopsy. In a subset of 170 cases, these biopsy results could be compared against pathology found at whole-gland prostatectomy. Targeted biopsy proved to be much more accurate than standard biopsy, with sensitivities of 77% and 53%, respectively, the investigators said (JAMA 2015 Jan. 27 [doi:10.1001/jama.2014.17942]).

These findings show that targeted biopsy “could significantly change the distribution of risk in men newly diagnosed with prostate cancer toward diagnosis of more high-risk disease. Although these improvements in risk stratification could translate into substantial clinical benefits, it is important to recognize that this study is preliminary” and didn’t include clinical end points such as cancer recurrence or prostate cancer–specific mortality, Dr. Siddiqui and his associates said.

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