[3]
Padma-Nathan H. PDE-5 inhibitor therapy for erectile dysfunction
secondary to nerve-sparing radical retropubic prostatectomy. Rev
Urol 2005;7(Suppl 2):S33–8.
[4] Zelefsky MJ, Shasha D, Branco RD, et al. Prophylactic sildenafil
citrate improves selected aspects of sexual function in men treated
by radiotherapy for prostate cancer. J Urol. In press.
org/10.1016/j.juro.2014.02.097
.
[5]
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction
with outcome among prostate-cancer survivors. N Engl J Med 2008;
358:1250–61.
Gavin M. Langille, Jason R. Kovac, Ranjith Ramasamy,
James M. Dupree, Larry I. Lipshultz
*
Department of Urology, Baylor College of Medicine, Houston, TX, USA
*Corresponding author. 6624 Fannin Street, #1700,
Houston, TX 77030, USA.
E-mail address:
larryl@bcm.edu
(L.I. Lipshultz).
Re: A Prospective, Blinded Comparison of Magnetic
Resonance (MR) Imaging–Ultrasound Fusion and Visual
Estimation in the Performance of MR-targeted Prostate
Biopsy: The PROFUS Trial
Wysock JS, Rosenkrantz AD, Huang WC, et al.
Eur Urol 2014;66:343–51
Experts’ summary:
In this single-center prospective, blinded study, the authors
compare magnetic resonance imaging (MRI)-ultrasound fu-
sion targeted biopsy (MRF-TB), MRI-visual estimated targeted
biopsy (VE-TB, also known as
cognitive
MRI-targeted biopsy),
and standard 12-core biopsy in the detection of prostate
cancer (PCa). Patients with suspicious lesions on 3-T MRI were
included. Per patient, overall PCa detection was similar be-
tween MRF-TB and cognitive biopsy (36% vs 32%;
p
= 0.36). In
addition, Gleason sum
±
7 PCa detection was similar between
MRF-TB and cognitive biopsy (23% vs 19%;
p
= 0.27). Com-
bined MRI targeted biopsy results were compared with stan-
dard biopsy. Standard biopsy detected PCa more often than
targeted biopsy (55% vs 40%;
p
<
0.01). However, detection of
Gleason sum
±
7 PCa was equivalent between standard and
targeted biopsy (33% vs 33%;
p
= 0.68). On multivariate anal-
ysis, diameter of MRI suspicious region (mSR) was a predictor
of positive MRF-TB and negative VE-TB (odds ratio: 0.83;
p
<
0.01).
Experts’ comments:
The overdiagnosis of low-risk and potentially clinically insig-
nificant PCa and the associated overtreatment of these patients
has led to controversy regarding PCa screening
[1]
.Improv
ing
our diagnostic approach is an important step in refining our
PCa detection strategy. With recent improvements in MRI
technology, imaged-guided biopsy—the paradigm for diag-
nosis of many other solid organ cancers—has become possible
for PCa.
Early experiences with MRI-targeted prostate biopsy
have demonstrated equivalent detection rates of clinically
significant PCa compared with standard biopsy while
simultaneously decreasing the number of patients under-
going biopsy and the detection of clinically insignificant PCa
[2]
. The present study adds the following observations: (1)
software fusion (MRF-TB) and cognitive registration (VE-TB)
perform similarly, and (2) either MRI-targeted strategy
refines the detection of PCa toward clinically significant
disease. This underscores the benefits of a MRI-targeted
strategy in reducing overdiagnosis of clinically insignificant
PCa. The unavailability of software fusion at some centers
should not stand as a barrier to adoption of a MRI-targeted
strategy because cognitive MRI-targeted biopsy represents a
near-equivalent improvement over standard biopsy.
Further clinical follow-up of patients with no mSR is
required. A recent prospective study of MRI-targeted biopsy
in biopsy-naive men reported 6% (5 of 81) of those with no
mSR were found to have a Gleason sum
±
7 on standard
biopsy
[3]
. The rate of underdiagnosis of clinically signifi-
cant PCa with a MRI-targeted strategy must be defined
before widespread recommendations are made to only
biopsy men with mSR. Also, mSR diameter is not currently
mentioned in the standards of reporting for MRI-targeted
biopsy studies (START) recommendations
[4]
but should be
included in future studies.
Conflicts of interest:
Gerald L. Andriole is a compensated consultant/
adviser for Augmenix, Bayer, Genomic Health, GSK, and Myriad Genetics.
He is a compensated investigator for Johnson & Johnson, Medivation, and
Wilex. Eric H. Kim and Michael H. Johnson have nothing to disclose.
References
[1]
Loeb S, et al. Eur Urol 2014;65:1046–55.
[2]
Moore CM, et al. Eur Urol 2013;63:125–40.
[3]
Pokorny MR, et al. Eur Urol 2014;66:22–9.
[4]
Moore CM, et al. Eur Urol 2013;64:544–52.
Eric H. Kim, Michael H. Johnson, Gerald L. Andriole
*
Division of Urologic Surgery, Washington University School of Medicine,
St. Louis, MO, USA
*Corresponding author. Division of Urologic Surgery,
Washington University School of Medicine, 4960 Children’s Place,
Campus Box 8242, St. Louis, MO 63110, USA.
E-mail address:
andrioleg@wudosis.wustl.edu
(G.L. Andriole).
EUROPEAN UROLOGY 66 (2014) 593–598
595