Faculty Bibliography

PURPOSE/OBJECTIVE:To determine whether the presence of an ultrasound hypoechoic region at the site of a MRI region of interest (ROI) results in improved prostate cancer (PCa) detection and predicts clinically significant PCa on MRI - ultrasound fusion targeted prostate biopsy (MRF-TB). MATERIALS AND METHODS/METHODS:Between July 2011 and June 2017, 1058 men who underwent MRF-TB and systematic biopsy by a single surgeon were prospectively entered into an IRB-approved database. MRI ROI were identified and scored for suspicion by a single radiologist. Each MRI ROI was prospectively evaluated for presence of a hypoechoic region at the site (ROI-HyR) by the surgeon and graded as 0,1,2 representing none, poorly demarcated, or well demarcated, respectively. Interaction of MRI suspicion score (mSS) and US grade (USG), and prediction of cancer detection rate (CDR) by USG, was evaluated by univariate and multivariate analysis. RESULTS:For 672 men, overall and Gleason Score (GS)≥7 CDR were 61.2% and 39.6%, respectively. CDR for USG 0,1,2 were 46.2%, 58.6%, 76.0% (p<0.001) for any cancer and 18.7%, 35.2%, 61.1% (p<0.001) for GS≥7, respectively. For MRF-TB only, GS≥7 CDR for USG 0,1,2 was 12.8%, 25.7%, 52.0% (p<0.001), respectively. On univariate analysis, among mSS 2-4, USG was predictive of GS≥7 CDR. Multivariable regression analysis revealed USG, PSAD, and mSS were predictive of GS≥7 PCa on MRF-TB. CONCLUSIONS:Ultrasound findings at the site of MRI ROI independently predict the likelihood of GS≥7 PCa, as men with a well demarcated ROI-HyR at the time of MRF-TB have a higher risk than men without.