Nahar B, et al. – This study was undertaken to investigate the effect of adding MRI–US fusion biopsy cores to standard 12–core biopsy in selecting men for Active Surveillance(AS). It was revealed that the addition of fusion biopsy to standard 12–core biopsy significantly increased the number of men who became ineligible for AS. Applying the percent of positive cores, instead of an absolute number, allowed fewer exclusions. AS criteria may need to be updated to prevent the unnecessary exclusion of men due to an oversampling of low–risk disease.

Methods

• Researchers enrolled men who were eligible for at least one of seven different AS criteria based on the standard biopsy alone among men undergoing a fusion biopsy for evaluation of prostate cancer.
• They evaluated each patient's eligibility for each AS criteria with and without the inclusion of fusion biopsy cores.
• The preliminary outcome was the proportion of men who were initially eligible for AS but became ineligible after addition of the fusion biopsy cores.

Results

• In this study, 100 men were eligible for at least one AS criteria.
• The proportion of men who became ineligible for AS varied from 10.3% to 40.7% after addition of fusion biopsy cores.
• Criteria that incorporated an absolute maximum number of cores positive had the highest rates of ineligibility.
• Applying a percentage of positive cores helped to reduce the number of patients who would have been excluded.
• In addition, combining the targeted biopsy cores into one, or taking the single core with the highest grade or volume did not appear to reduce the proportion of men who became ineligible.