MRI-Ultrasound Fusion-Guided Biopsy of the Prostate:

Results of Initial Experience in a Radiation Oncology Department

Department of Radiation OncologySylvester Comprehensive Cancer Center

University of Miami Miller School of Medicine

Michael Scott M.D., M.B.A.

Poster # 1123

Disclosures: None

Objective• To summarize our experience with MRI-US fusion-guided

biopsy (MUFgBx) to evaluate the impact on therapeutic recommendations.

• Multiparametric MRI (MP-MRI) has been integrated into our radiation oncology practice to:

• * Guide treatment on active surveillance (AS)• * Improve imaging after non-diagnostic biopsy

• Standard 12-core transrectal ultrasound (TRUS)-guided prostate biopsy has poor sensitivity/specificity.

• We utilize a targeted biopsy approach using real time MRI-ultrasound (US) fusion on a commercially available 3D US prostate biopsy system.

Patients and Methods• Retrospectively identified 29 men who underwent

MUFgBx since August 2012.

• Patients were divided into 2 groups to analyze the learning curve of the MUFgBx program:

• Group 1 (G1): 18 MUFgBx in first 10 months • Group 2 (G2): 11 MUFgBx in the next 8 months.

• 29 MUFgBx sessions were performed in patients with median age of 68 years (range, 53 – 86).

• 9 patients were under AS (Active Surveillance) at the time of MUFgBx. • 4 patients with negative TRUS biopsy underwent MUFgBx after MP-MRI revealed a

suspicious lesion. • 13 patients had MUFgBx to assess lesion receiving RT boost dose on an in-house

clinical protocol. • 3 patients had never received a prior biopsy.

Results• MUFgBx positive biopsy yield: 17 of 29 patients. • G1: 44.4% (n=18) • G2: 81.8% (n=11) (p=0.11)

• MUFgBx positive core yield: 42 of 187 cores. • G1: 11% (n=109) • G2: 38.5% (n=78)

• AS: MUFgBx upgraded 2 of 9 patients from Gleason 6, converting them to primary treatment.

• Overall, 5 of 29 patients had Gleason upgrade.

• 9 of 13 patients had positive MUFgBx prior to boost RT dose for in-house protocol.

Conclusion

• Our experience with prostate MUFgBx suggests that the method provides a novel tool for targeted assessment of dominant lesions on MP-MRI.

• Based on our single institution experience, the learning curve appears to be approximately 20 procedures.

• Our encouraging preliminary results suggest that the radiation oncology community should further investigate utilization of this technology in the management of active surveillance patients and in patients that may benefit from RT boost to dominant lesions.