3D Fusion MRI and (18)F-Choline-Positron Emission Tomography-Targeted Prostate Biopsies: A New Concept

Background: Contemporary transrectal ultrasound (TRUS) prostate biopsy can be guided by high-resolution ultrasound (US), magnetic resonance imaging (MRI), or MRI–US fusion. Objectives: To assess the feasibility and the accuracy of targeted prostate biopsy with standard (systematic 12-core) biopsies after fusion imaging of choline-positron emission tomography (PET)/CT (choline-PET) and multiparametric MRI (mpMRI) with 3D-transrectal ultrasound (3DTRUS) to detect prostate cancer (PCa). Methods: From December 2014 to October 2016, 31 patients with a rising prostate-specific antigen (PSA) ≥10 ng/mL or with a history of negative prostate biopsies were included, and underwent a choline-PET and an mpMRI. PET and T2-weighted MR volumes of the prostate were spatially registered. Biopsy targets were selected on both modalities. TRUS biopsy was done using the real-time 3DTRUS-tracking system (Urostation Touch®). Biopsy procedure was performed after registration of real-time TRUS with mpMRI and choline-PET by the same operator, using 3DTRUS-tracking system. At the time of biopsy, volume data of the mpMRI and PET 18Ch were elastically fused with TRUS. Each target was biopsied twice. Histologic results were determined from standard and targeted biopsy cores. Results: Mean PSA was 13.01 ng/mL (5.32–73). Mean number of biopsies was 16 (13–21) and mean prostate volume was 63.41 cc (25–169). The cancer detection rate was 69%. The cancer detection rate with standard biopsies off target was 42% and that with prostate-targeted biopsy was 50% using PET, 65% using mpMRI with a sensibility of 72%, 94%, and 100%, respectively, for PET, mpMRI, or both. The average number of positive cores was, respectively, 1.77 (1–7) and 2.74 (3–11) for PET and mpMRI. Conclusions: Double image fusion (MRI/PET 18Ch) is achievable with 3DTRUS to improve PCa detection. MRI is probably more reliable than PET 18Ch, but using both imageries could increase the sensibility of PCa detection. Study with the novel ligands targeting prostate-specific membrane antigen could improve our clinical results. No competing financial interests exists. Runtime of video: 6 mins 41 secs This video was presented at EAU 2017 in Munich, Germany.