Oral & Poster Presentation – Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2013

Abstract number 1

MRI – Ultrasound Fusion Targeted Biopsies (M-U FTB) using Varian Brachytherapy Software

Rick Popert
Consultant Urologist, Guy’s Hospital, London
Paul Sturch
Research Fellow, Guy’s Hospital, London
Mark McGovern
Radiation Physicist, Guy’s Hospital London
Andrew Robinson
Radiation Physicist, Harley St Clinic, London
Giles Rottenberg
Consultant Radiologist, Guy’s Hospital, London
Stephen Morris
Consultant Oncologist, Guy’s Hospital, London

Aims/Introduction: MRI-ultrasound fusion targeted biopsies (M-UFTB) of ‘suspicious lesions’ is a developing area in prostate cancer diagnostics but commercial systems are expensive. We report the use of Variseed 8.0.2 standard brachytherapy software system (Varian Medical Systems), with the additional ‘image-fusion’ license option.

Materials/Methods: 67 men with a lesion suspicious for cancer on multiparametric MRI underwent transperineal MRI-UFTB. MRI images were imported into the Variseed software and the Region of Interest (ROI) and peripheral zone (PZ) sectors outlined separately.  Live US images of the prostate were acquired from base to apex, outlined and fused with the pre contoured MRI images.

The ROI was biopsied first followed by targeted PZ sector biopsies using our localisation protocol. The primary outcome measure was detection of clinically significant disease; max cancer core length 4mm and/or Gleason Grade 3+4.

Results: 67 patients with a mean age 62 years (45-80), mean PSA 7.5 ug/L (1.2-34) and a mean prostate volume 47mls (14-120) underwent MRI-US fusion targeted biopsy with an overall cancer detection rate of 66% (44/67). Clinically significant disease was identified within the fusion targeted lesion in 77% (34/44) but 36% (16/34) also had disease outside the identified lesion in areas normal on MRI. The majority, 14 were in the same or an adjoining quadrant but 5 (15%) had CSD in a non-adjoining quadrant, entirely normal on MRI review.

Conclusions: Unmodified Varian brachytherapy software can be used for MRI fusion targeted biopsies. Restricting biopsies to MRI identified lesions alone may miss clinically significant disease elsewhere and systematic biopsies are still necessary. The pathological information derived can help in the planning of targeted brachytherapy to the dominant pathological lesions.