Institutional Learning Curve Associated with Implementation of a Magnetic Resonance/Transrectal Ultrasound Fusion Biopsy Program Using PI‐RADS™ Version 2: Factors that Influence Success. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Truong, Matthew; Weinberg, Eric; Hollenberg, Gary; Borch, Marianne; Park, Ji Hae; Gantz, Jacob; Feng, Changyong; Frye, Thomas; Ghazi, Ahmed; Wu, Guan; Joseph, Jean; Rashid, Hani; Messing, Edward
• Is Part Of: Urology practice. Volume 5:Issue 1(2018)
• Publication Date: 2018-01
• Subjects: magnetic resonance imaging -- prostatic neoplasms -- early detection of cancer
• DOI: 10.1016/j.urpr.2016.11.007
• Languages: English
• ISSNs: 2352-0779

Abstract

Abstract : Introduction: : We assessed the institutional learning curve associated with adopting fusion biopsy using PI‐RADS™ (Prostate Imaging‐Reporting and Data System) Version 2 (v2) to detect clinically significant prostate cancer, defined as Gleason 7 or greater in men with prior negative biopsies, and identified patient and technical factors that predict success in detecting clinically significant prostate cancer. Methods: : A total of 113 consecutive patients with at least 1 prior negative biopsy and multiparametric magnetic resonance imaging examination of the prostate with a PI‐RADS 3 or greater index lesion underwent fusion biopsy at a single academic center previously naïve to fusion biopsy technology. Outcomes include detection rates for Gleason 6 cancer, clinically significant prostate cancer and any cancer. Multiple logistic regression with model selection was used to select covariates having significant effects on the outcome. Results: : Prostate cancer was identified in 52% of patients with prior negative prostate biopsies. Among the patients diagnosed with prostate cancer 80% had clinically significant cancer. The clinically significant prostate cancer detection rates using fusion biopsy when a PI‐RADS 3, 4 or 5 index lesion was present on multiparametric magnetic resonance imaging were 6%, 46% and 66%, respectively. PI‐RADS v2 score had a predictive accuracy (AUC) of 0.79 for clinically significant prostate cancer detection. Institutional experience over time, magnetic resonance imaging estimated prostate volume and PI‐RADS v2 score were independent predictors of clinically significant prostate cancer using fusion biopsy. Conclusions: : Since fusion biopsy is a highly technique driven process, development of internal quality measures to assess the institutional learning curve and the quality of PI‐RADS v2 scoring is critical with the adoption of this technology.