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MRI-targeted TRUS-guided fusion biopsy: Are anterior targeted lesions different then posterior lesions now that we have targeting technology?
Michael Geffin, MD1, James Lin, MD2, Dean Leocadio, MD3, Michael Curran, MD1.
1Greater Boston Urology, Dedham, MA, USA, 2Greater Boston Urology, Milton, MA, USA, 3Greater Boston Urology, Falmouth, MA, USA.

MRI-targeted TRUS-guided fusion biopsy: Are anterior targeted lesions different then posterior lesions now that we have targeting technology?
Introduction and Objectives
Accurately targeting anterior prostate lesions for biopsy remains a clinical challenge. MRI imaging of prostatic lesions has improved significantly in recent years. With computer-aided drafting models we are now able to perform targeted biopsies of these lesions by overlaying MRI images on ultrasound images in real time. We assessed whether these anterior targets are more likely to be cancerous then their posterior lesion counterparts.
Methods
Patients from a single large urology group practice who underwent MRI-fused ultrasound-guided trans rectal biopsy between July 2015 and December 2016 were retrospectively studied. Multiparametric prostate MRI including T2 weighted, diffusion weighted, and dynamic contrast image sequencing was performed on all patients. A single radiology group read all MRIs to score lesions using Prostate Imaging Reporting and Data System version 2 (PI RADs v2) criteria. For inclusion, each patient must have had a standard 12 core systematic biopsy procedure, with 1-2 cores per lesion. Data on PI RADs v2 score, age, PSA, previous biopsy history, prostate size and cancer outcomes were analyzed.
Results
Of the 212 patients meeting inclusion criteria, there were 86 patients representing 108 mpMRI Anterior lesions (Average Age 66.2, PSA 10.7, TRUS size 56.9 cm3), and 126 patients representing the 153 mpMRI Posterior lesions (Average Age 65.4 , PSA 7.5 , TRUS size 61.7 cm3). The cancer rates found in Anterior vs. Posterior lesions was 49.1% vs. 29.4%, respectively (Chi squares, p=0.001235). Higher grade disease (Gleason 4 or 5) was found in 83% of Anterior lesions vs. 71% in Posterior lesions, but the difference was not statistically significant (Chi Square, p=0.14). No statistically significant differences were found between the groups in terms of age, PSA, previous biopsy history, or prostate size.
Conclusion
Anterior prostatic lesions found on mpMRI are more likely to be cancerous when compared to Posterior lesions, and there is trend toward a higher grade disease in Anterior lesions.


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