Targeted prostate biopsies using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may enable surgeons to select candidates for focal therapy of early-stage prostate cancer, according to researchers.
Kazumi Kamoi, MD, and colleagues at Kyoto Prefectural University of Medicine in Kyoto, Japan, studied 362 men who had a DCE-MRI prior to undergoing a prostate biopsy. MRI-targeted biopsies were performed, with one to three cores obtained from MRI-based suspicious areas. In addition, eight cores were obtained from the usual areas sampled during octant biopsies.
Pre-biopsy DCE-MRI revealed no suspicious lesions in 219 patients (60%); of these, 26 had positive octant biopsy results, for a 12% detection rate, the researchers reported at the World Congress of Endourology in Chicago. In 143 patients who had solitary or multiple lesions demonstrated by pre-biopsy DCE-MRI, 33 (23%) had positive biopsy cores only from MRI-targeted lesions, 90 (63%) had positive biopsy cores from both targeted and octant lesions, three (2%) had positive cores only from octant lesions, and 17 (12%) had negative biopsy findings. Among 33 men with biopsy-proven solitary lesions demonstrated by DCE-MRI, 18 underwent radical prostatectomy.
The investigators concluded that a solitary lesion found on DCE-MRI together with positive findings from a biopsy of the targeted lesion and a negative systematic biopsy would correctly identify a solitary prostate tumor in 89% of cases.
“Targeted prostatic biopsy based on DCE-MRI findings revealed a remarkable potential to select candidates for focal therapy of prostate cancer,” the authors noted.