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Defining Novel and Practical Metrics to Assess the Deliverables of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy
J Urol. 2018 Apr;199(4) :969-975
PMID: 28988963    PMCID: PMC7603901    URL: https://www.ncbi.nlm.nih.gov/pubmed/28988963
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Abstract
PURPOSE: Multiparametric magnetic resonance (mpMRI)/ultrasound targeted prostate biopsy (TB) is touted as a tool to improve prostate cancer care. Yet, the true clinical utility of TB over transrectal ultrasound-guided prostate biopsy (TRUS-B) has not been systematically analyzed. We introduce two metrics to better quantify and report the deliverables of TB. MATERIALS AND METHODS: We reviewed our prospective database containing patients who underwent simultaneous TB/TRUS-B. Actionable Intelligence Metric (AIM) was defined as the proportion of patients for whom TB provided actionable information over TRUS-B. Reduction Metric (ReM) was defined as the proportion of men in whom TRUS-B could have been omitted. We compared metrics within our cohort and prior reports. RESULTS: 371 men were included. AIM and ReM were 22.2% and 83.6% for biopsy naive, 26.7% and 84.2% for prior negative TRUS-B, and 24% and 77.5% for active surveillance patients. No significant differences among groups were observed (p = 0.89 for AIM; p = 0.27 for ReM). AIM was 25.0% for PIRADS 3, 27.5% for PIRADS 4 and 21.7% for PIRADS 5 (p = 0.73) lesions. TRUS-B could have been avoided in more patients with PIRADS 3 compared to PIRADS 4/5 lesions (ReM 92.0% vs. 76.7%, p < 0.01). Our results compare favorably to other reported series. CONCLUSIONS: AIM and ReM are novel, clinically relevant quantification metrics to standardize reporting of TB deliverables. TB affords actionable information (AIM) in approximately 25% of men. ReM assessment highlights that TRUS-B may only be omitted after carefully considering the risk of missing clinically significant cancers.
Notes
1527-3792 Ristau, Benjamin T Chen, David Y T Ellis, Jeffrey Malhotra, Aseem DeMora, Lyudmilla Parsons, Rosaleen B Milestone, Barton Brody, Marion Viterbo, Rosalia Greenberg, Richard Smaldone, Marc Uzzo, Robert Anaokar, Jordan Kutikov, Alexander Journal Article United States J Urol. 2018 Apr;199(4):969-975. doi: 10.1016/j.juro.2017.09.124. Epub 2017 Oct 6.