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Tweedle MF, Ding H, Drost WT, Dowell J, Spain J, Joseph M, Elshafae SM, Menendez MI, Gong L, Kothandaraman S, Dirksen WP, Wright CL, Bahnson R, Knopp MV, Rosol TJ. Development of an orthotopic canine prostate cancer model expressing human GRPr. Prostate 2018; 78:10.1002/pros.23686. [PMID: 29992622 PMCID: PMC6409197 DOI: 10.1002/pros.23686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ace-1 canine prostate cancer cells grow orthotopically in cyclosporine immunosuppressed laboratory beagles. We previously transfected (human Gastrin-Releasing Peptide Receptor, huGRPr) into Ace-1 cells and demonstrated receptor-targeted NIRF imaging with IR800-G-Abz4-t-BBN, an agonist to huGRPr. Herein, we used the new cell line to develop the first canine prostate cancer model expressing a human growth factor receptor. METHODS Dogs were immunosuppressed with cyclosporine, azathioprine, prednisolone, and methylprednisolone. Their prostate glands were implanted with Ace-1huGRPr cells. The implantation wounds were sealed with a cyanoacrylic adhesive to prevent extraprostatic tumor growth. Intraprostatic tumors grew in 4-5 week. A lobar prostatic artery was then catheterized via the carotid artery and 25-100 nmol IR800-Abz4-t-BBN was infused in 2 mL followed by euthanasia in dogs 1-2, and recovery for 24 h before euthanasia in dogs 3-6. Excised tissues were imaged optically imaged, and histopathology performed. RESULTS Dog1 grew no tumors with cyclosporine alone. Using the four drug protocol, Dogs 2-6 grew abundant 1-2 mm intracapsular and 1-2 cm intraglandular tumors. Tumors grew >5 cm when the prostate cancer cells became extracapsular. Dogs 4-6 with sealed prostatic capsule implantation sites had growth of intracapsular and intraglandular tumors and LN metastases at 5 weeks. High tumor to background BPH signal in the NIRF images of sectioned prostate glands resulted from the 100 nmol dose (∼8 nmol/kg) in dogs 2-4 and 50 nmol dose in dog 5, but not from the 25 nmol dose in Dog 6. Imaging of mouse Ace-1huGRPr tumors required an intravenous dose of 500 nmol/kg body wt. A lymph node that drained the prostate gland was detectable in Dog 4. Histologic findings confirmed the imaging data. CONCLUSION Ace-1huGRPr cells created viable, huGRPr-expressing tumors when implanted orthotopically into immune-suppressed dogs. Local delivery of an imaging agent through the prostatic artery allowed a very low imaging dose, suggesting that therapeutic agents could be used safely for treatment of early localized intraglandular prostate cancer as adjuvant therapy for active surveillance or focal ablation therapies, or for treating multifocal intraglandular disease where focal ablation therapies are not indicated or ineffective.
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Affiliation(s)
- Michael F. Tweedle
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Haiming Ding
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - William T. Drost
- Deptartment of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | - Joshua Dowell
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - James Spain
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Mathew Joseph
- University Laboratory Animal Resources, The Ohio State University, Columbus, Ohio
| | - Said M. Elshafae
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Maria-Isabela Menendez
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Li Gong
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Shankaran Kothandaraman
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Wessel P. Dirksen
- Deptartment of Veterinary Biosciences, The Ohio State University, Columbus, Ohio
| | - Chadwick L. Wright
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Robert Bahnson
- Deptartment of Urology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Michael V. Knopp
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, Ohio
| | - Thomas J. Rosol
- Deptartment of Biomedical Sciences, Ohio University, Athens, Ohio
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Ploussard G, Borgmann H, Briganti A, de Visschere P, Fütterer JJ, Gandaglia G, Heidegger I, Kretschmer A, Mathieu R, Ost P, Sooriakumaran P, Surcel C, Tilki D, Tsaur I, Valerio M, van den Bergh R. Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies? World J Urol 2018; 37:243-251. [PMID: 29967944 DOI: 10.1007/s00345-018-2399-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/28/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI. METHODS A review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting. RESULTS Evidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques. CONCLUSION A pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc/La Croix du Sud Hospital, 20, route de Revel, 31400, Toulouse, France. .,IUCT-O, Avenue Joliot-Curie, 31000, Toulouse, France.
| | - Hendrik Borgmann
- Department of Urology, University Hospital of Mainz, Mainz, Germany
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | | | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Isabel Heidegger
- Department of Urology, University Hospital of Innsbrück, Innsbrück, Austria
| | | | | | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Cristian Surcel
- Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
| | - Derya Tilki
- Department of Urology, Martini Klinik, Hamburg, Germany
| | - Igor Tsaur
- Department of Urology, University Hospital of Mainz, Mainz, Germany
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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203
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Westhoff N, Siegel F, Peter C, Hetjens S, Porubsky S, Martini T, von Hardenberg J, Michel MS, Budjan J, Ritter M. Defining the target prior to prostate fusion biopsy: the effect of MRI reporting on cancer detection. World J Urol 2018; 37:327-335. [PMID: 29967946 DOI: 10.1007/s00345-018-2400-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/28/2018] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Definition of targets in multiparametric MRI (mpMRI) prior to MRI/TRUS fusion prostate biopsy either by urologist or radiologist, as a prose report or by illustration is crucial for accurate targeted biopsies (TB). The objective was to analyze the effect of MRI reporting on target definition and cancer detection. METHODS 202 patients underwent MRI/TRUS fusion biopsy with Artemis™ (Eigen, USA). mpMRI results were submitted in written form to urologists, who marked the targets in the proprietary software. An expert uroradiologist reviewed and marked mpMRI targets blinded to biopsy data. We compared number, localization and volume of targets between the observers and analyzed whether variations impaired TB results by bivariate and logistic regression models. RESULTS Interobserver variability was moderate regarding number and low regarding localization of targets. Urologists overestimated target volumes significantly compared to radiologists (p = 0.045) and matching target volume between both observers was only 43.9%. Overall cancer detection rate was 69.8 and 52.0% by TB. A higher matching target volume was a significant predictor of cancer in TB (p < 0.001). Logistic regression revealed prostate volume and PI-RADS as independent predictors. Defining targets in incorrect T2w slices in the cranio-caudal axis are one presumable reason for missing cancer in TB. CONCLUSIONS A high concordance of the target definition between radiologist and urologist is mandatory for accurate TB. Optimized ROI definition is recommended to improve TB results, preferably as contouring in MRI sequences by the radiologist or, if not feasible, by precise MRI reports including specific localization in sequence and slice as well as an illustration. High prostate volume and low PI-RADS score have to be considered as limiting factors for target definition.
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Affiliation(s)
- Niklas Westhoff
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Fabian Siegel
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Peter
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biometry, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefan Porubsky
- Department of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Martini
- Department of Urology, University Medical Center Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Jost von Hardenberg
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Manuel Ritter
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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68
Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study. J Urol 2018; 200:95-103. [DOI: 10.1016/j.juro.2018.01.079] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/12/2022]
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Rosenkrantz AB, Hemingway J, Hughes DR, Duszak R, Allen B, Weinreb JC. Evolving Use of Prebiopsy Prostate Magnetic Resonance Imaging in the Medicare Population. J Urol 2018; 200:89-94. [DOI: 10.1016/j.juro.2018.01.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew B. Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, New York
| | | | - Danny R. Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bibb Allen
- Department of Radiology, Grandview Medical Center, Birmingham, Alabama
| | - Jeffrey C. Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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206
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Brizmohun Appayya M, Adshead J, Ahmed HU, Allen C, Bainbridge A, Barrett T, Giganti F, Graham J, Haslam P, Johnston EW, Kastner C, Kirkham AP, Lipton A, McNeill A, Moniz L, Moore CM, Nabi G, Padhani AR, Parker C, Patel A, Pursey J, Richenberg J, Staffurth J, van der Meulen J, Walls D, Punwani S. National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection - recommendations from a UK consensus meeting. BJU Int 2018; 122:13-25. [PMID: 29699001 PMCID: PMC6334741 DOI: 10.1111/bju.14361] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify areas of agreement and disagreement in the implementation of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in the diagnostic pathway. MATERIALS AND METHODS Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California-Los Angeles (UCLA-RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9-point scale. A panel median score of ≥7 constituted 'agreement' for an item; for an item to reach 'consensus', a panel majority scoring was required. RESULTS Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mpMRI might consider avoiding an immediate biopsy. CONCLUSIONS Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high-quality prostate mpMRI as a diagnostic test before biopsy in men at risk.
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Affiliation(s)
- Mrishta Brizmohun Appayya
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Jim Adshead
- Department of UrologyHertfordshire and Bedfordshire Urological Cancer CentreLister HospitalStevenageHertfordshireUK
| | - Hashim U. Ahmed
- Division of Surgery and Interventional ScienceFaculty of Medical SciencesUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Division of SurgeryDepartment of Surgery and CancerImperial College London and Imperial UrologyImperial College Healthcare NHS TrustLondonUK
| | - Clare Allen
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Alan Bainbridge
- Department of Medical PhysicsUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Tristan Barrett
- Department of RadiologyAddenbrooke's Hospital and University of CambridgeCambridgeUK
| | - Francesco Giganti
- Division of Surgery and Interventional ScienceFaculty of Medical SciencesUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - John Graham
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Phil Haslam
- Department of RadiologyFreeman HospitalNewcastle upon TyneUK
| | - Edward W. Johnston
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Christof Kastner
- Department of UrologyAddenbrooke's Hospital and University of CambridgeCambridgeUK
| | - Alexander P.S. Kirkham
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | | | - Alan McNeill
- Department of UrologyNHS LothianWestern General HospitalEdinburghUK
| | | | - Caroline M. Moore
- Division of SurgeryDepartment of Surgery and CancerImperial College London and Imperial UrologyImperial College Healthcare NHS TrustLondonUK
- Department of UrologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Ghulam Nabi
- Division of Cancer ResearchNinewells HospitalDundeeUK
| | - Anwar R. Padhani
- Paul Strickland Scanner CentreMount Vernon HospitalNorthwoodMiddlesexUK
| | - Chris Parker
- Department of Academic UrologyRoyal Marsden HospitalSuttonSurreyUK
| | - Amit Patel
- Department of RadiologyLister HospitalStevenageHertfordshireUK
| | | | - Jonathan Richenberg
- Department of RadiologyRoyal Sussex County Hospital Brighton and Brighton and Sussex Medical SchoolBrightonSussexUK
| | - John Staffurth
- Division of Cancer and GeneticsSchool of MedicineCardiff UniversityCardiffUK
| | | | - Darren Walls
- Division of Nuclear MedicineUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
| | - Shonit Punwani
- Centre for Medical ImagingUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
- Department of RadiologyUniversity College London Hospitals NHS Foundation TrustUniversity College LondonLondonUK
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207
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Das CJ, Razik A, Sharma S. Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy of the Prostate—An Update. Semin Roentgenol 2018; 53:219-226. [DOI: 10.1053/j.ro.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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208
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Warlick C, Futterer J, Maruf M, George AK, Rastinehad AR, Pinto PA, Bosaily AES, Villers A, Moore CM, Mendhiratta N, Taneja SS, Ukimura O, Konety BR. Beyond transrectal ultrasound-guided prostate biopsies: available techniques and approaches. World J Urol 2018; 37:419-427. [PMID: 29943220 DOI: 10.1007/s00345-018-2374-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/08/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Recent advances have led to the use of magnetic resonance imaging (MRI) alone or with fusion to transrectal ultrasound (TRUS) images for guiding biopsy of the prostate. Our group sought to develop consensus recommendations regarding MRI-guided prostate biopsy based on currently available literature and expert opinion. METHODS The published literature on the subject of MRI-guided prostate biopsy was reviewed using standard search terms and synthesized and analyzed by four different subgroups from among the authors. The literature was grouped into four categories-MRI-guided biopsy platforms, robotic MRI-TRUS fusion biopsy, template mapping biopsy and transrectal MRI-TRUS fusion biopsy. Consensus recommendations were developed using the Oxford Center for Evidence Based Medicine criteria. RESULTS There is limited high level evidence available on the subject of MRI-guided prostate biopsy. MRI guidance with or without TRUS fusion can lead to fewer unnecessary biopsies, help identify high-risk (Gleason ≥ 3 + 4) cancers that might have been missed on standard TRUS biopsy and identify cancers in the anterior prostate. There is no apparent significant difference between MRI biopsy platforms. Template mapping biopsy is perhaps the most accurate method of assessing volume and grade of tumor but is accompanied by higher incidence of side effects compared to TRUS biopsy. CONCLUSIONS Magnetic resonance imaging-guided biopsies are feasible and better than traditional ultrasound-guided biopsies for detecting high-risk prostate cancer and anterior lesions. Judicious use of MRI-guided biopsy could enhance diagnosis of clinically significant prostate cancer while limiting diagnosis of insignificant cancer.
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Affiliation(s)
| | - Jurgen Futterer
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | | | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Arnauld Villers
- Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Neil Mendhiratta
- School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Samir S Taneja
- School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Osamu Ukimura
- Department of Urology, University of Southern California, Los Angeles, CA, USA
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209
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Leyh-Bannurah SR, Kachanov M, Beyersdorff D, Preisser F, Tilki D, Fisch M, Graefen M, Budäus L. Anterior Localization of Prostate Cancer Suspicious Lesions in 1,161 Patients Undergoing Magnetic Resonance Imaging/Ultrasound Fusion Guided Targeted Biopsies. J Urol 2018; 200:1035-1040. [PMID: 29935274 DOI: 10.1016/j.juro.2018.06.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Based on findings in transrectal ultrasound guided biopsy series standard sampling of the prostate targets the posterior/peripheral zone. However, a substantial proportion of lesions that are prostate cancer suspicious and PI-RADS™ (Prostate Imaging Reporting and Data System) 3 or greater on magnetic resonance imaging is located in the anterior segment of the prostate, requiring deeper placement and targeting of the biopsy needle. MATERIALS AND METHODS Overall 1,161 patients underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy. Prostate cancer suspicious lesions on magnetic resonance imaging were dichotomized into anterior vs posterior prostate segments. Patients were stratified by the number of prior negative systematic biopsy sessions. Descriptive statistics included the frequency and proportion of multiparametric magnetic resonance imaging findings and corresponding histological results. RESULTS Targeted biopsy was performed in 513 patients (44%) who were systematic biopsy naïve, 396 (34%) with 1 prior negative systematic biopsy and 252 (22%) with 2 or more prior negative systematic biopsies. When patients were stratified by the number of prior systematic biopsy sessions, the proportion with exclusively anterior, PI-RADS 3 or greater lesions on magnetic resonance imaging increased from 3.5% to 9.1% (p = 0.006). Unfavorable 3 + 4 and 4 + 3 or greater primary Gleason patterns were identified in exclusively anterior vs posterior lesions in 31% vs 21% of the 448 patients, of whom 64 had exclusively anterior and 384 had posterior PI-RADS 3 or greater lesions, respectively, on magnetic resonance imaging. Multivariable logistic regression analyses confirmed these findings. CONCLUSIONS After multiple previous negative systematic biopsy sessions the proportion of anterior lesions on magnetic resonance imaging increased. Such lesions harbored a greater amount of unfavorable prostate cancer. Therefore, image guidance for precise targeting should be considered, especially after initially negative transrectal ultrasound guided systematic biopsy.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mykyta Kachanov
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Beyersdorff
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Preisser
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Derya Tilki
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
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210
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Marks LS. Editorial Comment. J Urol 2018; 200:563. [PMID: 29913157 DOI: 10.1016/j.juro.2018.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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211
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Gorin MA, Walsh PC. Magnetic Resonance Imaging Prior to First Prostate Biopsy-Are we there yet? Eur Urol 2018; 74:409-410. [PMID: 29866464 DOI: 10.1016/j.eururo.2018.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Patrick C Walsh
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Meng X, Rosenkrantz AB, Huang R, Deng FM, Wysock JS, Bjurlin MA, Huang WC, Lepor H, Taneja SS. The Institutional Learning Curve of Magnetic Resonance Imaging-Ultrasound Fusion Targeted Prostate Biopsy: Temporal Improvements in Cancer Detection in 4 Years. J Urol 2018; 200:1022-1029. [PMID: 29886090 DOI: 10.1016/j.juro.2018.06.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE While magnetic resonance imaging-ultrasound fusion targeted biopsy allows for improved detection of clinically significant prostate cancer, a concerning amount of clinically significant disease is still missed. We hypothesized that a number of these misses are due to the learning curve associated with magnetic resonance imaging-ultrasound fusion targeted biopsy. We report the results of repeat magnetic resonance imaging-ultrasound fusion targeted biopsy in men with continued suspicion for cancer and the institutional learning curve in the detection of clinically significant prostate cancer with time. MATERIALS AND METHODS We analyzed the records of 1,813 prostate biopsies in a prospectively acquired cohort of men who presented for prostate biopsy in a 4-year period. All men were offered prebiopsy magnetic resonance imaging and were assigned a maximum PI-RADS™ (Prostate Imaging Reporting and Data System version 2) score. Biopsy outcomes in men with a suspicious region of interest were compared. The relationship between time and clinically significant prostate cancer detection was analyzed. RESULTS The clinically significant prostate cancer detection rate increased 26% with time in men with a PI-RADS 4/5 region of interest. On repeat magnetic resonance imaging-ultrasound fusion targeted biopsy in men with continued suspicion for cancer 53% of those with a PI-RADS 4/5 region of interest demonstrated clinically significant discordance from the initial magnetic resonance imaging-ultrasound fusion targeted biopsy compared to only 23% with a PI-RADS 1/2 region of interest. Significantly less clinically significant prostate cancer was missed or under graded in the most recent biopsies compared to the earliest biopsies. CONCLUSIONS The high upgrade rate on repeat magnetic resonance imaging-ultrasound fusion targeted biopsy and the increasing cancer detection rate with time show the significant learning curve associated with magnetic resonance imaging-ultrasound fusion targeted biopsy. Men with low risk or negative biopsies with a persistent, concerning region of interest should be promptly rebiopsied. Improved targeting accuracy with operator experience can help decrease the number of missed cases of clinically significant prostate cancer.
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Affiliation(s)
- Xiaosong Meng
- Department of Urology, New York University Langone Health, New York, New York
| | | | - Richard Huang
- Department of Urology, New York University Langone Health, New York, New York
| | - Fang-Ming Deng
- Department of Pathology, New York University Langone Health, New York, New York
| | - James S Wysock
- Department of Urology, New York University Langone Health, New York, New York
| | - Marc A Bjurlin
- Department of Urology, New York University Langone Hospital-Brooklyn, Brooklyn, New York
| | - William C Huang
- Department of Urology, New York University Langone Health, New York, New York
| | - Herbert Lepor
- Department of Urology, New York University Langone Health, New York, New York
| | - Samir S Taneja
- Department of Urology, New York University Langone Health, New York, New York; Department of Radiology, New York University Langone Health, New York, New York.
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213
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Schoots IG, Nieboer D, Giganti F, Moore CM, Bangma CH, Roobol MJ. Is magnetic resonance imaging-targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low-risk prostate cancer? A systematic review and meta-analysis. BJU Int 2018; 122:946-958. [PMID: 29679430 DOI: 10.1111/bju.14358] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematically review and meta-analyse evidence regarding the additional value of magnetic resonance imaging (MRI) and MRI-targeted biopsies to confirmatory systematic biopsies in identifying high-grade prostate cancer in men with low-risk disease on transrectal ultrasonography (TRUS) biopsy, as active surveillance (AS) of prostate cancer is recommended for men with Gleason 3 + 3 on standard TRUS-guided biopsy. Confirmatory assessment can include repeat standard TRUS-guided biopsy, and/or MRI with targeted biopsy when indicated. METHODS A systematic review of the Embase, Medline, Web-of-science, Google scholar, and Cochrane library was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Identified reports were critically appraised according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. Studies reporting men with Gleason 3 + 3 prostate cancer who had chosen AS based on transrectal systematic biopsy findings and had undergone MRI with systematic ± targeted biopsy at confirmatory assessment were included. The primary outcome was detection of any Gleason pattern ≥4. RESULTS Included reports (six) of men on AS (n = 1 159) showed cancer upgrading (Gleason ≥3 + 4) in 27% (95% confidence interval [CI] 22-34%) using a combined approach of MRI-targeted biopsies and confirmatory systematic biopsies. MRI-targeted biopsies alone would have missed cancer upgrading in 10% (95% CI 8-14%) and standard biopsies alone would have missed cancer upgrading in 7% (95% CI 5-10%). No pathway was more favourable than the other (relative risk [RR] 0.92, 95% CI 0.79-1.06). In all, 35% (95% CI 27-43%) of men with a positive MRI were upgraded, compared to 12% (95% CI 8-18%) of men with a negative MRI being upgraded (RR 2.77, 95% CI 1.76-4.38). CONCLUSIONS A pre-biopsy MRI should be performed before confirmatory systematic TRUS-guided biopsies in men on AS, together with MRI-targeted biopsies when indicated. A combined approach maximises cancer detection, although other factors within multivariate risk prediction can be used to aid the decision to biopsy in these men.
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Affiliation(s)
- Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London Hospital NHS Foundation Trust, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Tavolaro S, Mozer P, Roupret M, Comperat E, Rozet F, Barret E, Drouin S, Vaessen C, Lucidarme O, Cussenot O, Boudghène F, Renard-Penna R. Transition zone and anterior stromal prostate cancers: Evaluation of discriminant location criteria using multiparametric fusion-guided biopsy. Diagn Interv Imaging 2018; 99:403-411. [DOI: 10.1016/j.diii.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 01/12/2023]
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215
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Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive treatment of the whole gland, including radical prostatectomy, radiation therapy, and cryosurgery. Active surveillance is a growing alternative option for patients with documented low-volume and low-grade prostate cancer. However, many patients are wanting a less morbid focal treatment alternative. With recent advances in software and hardware of magnetic resonance imaging (MRI), multiparametric MRI of the prostate has been shown to improve the accuracy in detecting and characterizing clinically significant prostate cancer. Targeted biopsy is increasingly utilized to improve the yield of MR detected, clinically significant prostate cancer and to decrease in detection of indolent prostate cancer. MR-guided targeted biopsy techniques include cognitive MR fusion transrectal ultrasound (TRUS) biopsy, in-bore transrectal targeted biopsy using robotic transrectal device, and in-bore direct MR-guided transperineal biopsy with a software based transperineal grid template. In addition, advances in MR-compatible thermal ablation technology allow accurate focal or regional delivery of thermal ablative energy to the biopsy-proved, MRI-detected tumor. MR-guided ablative treatment options include cryoablation, laser ablation, and high-intensity focused ultrasound with real-time or near simultaneous monitoring of the ablation zone. We present a contemporary review of MR-guided techniques for prostatic interventions.
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216
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Boesen L, Nørgaard N, Løgager V, Balslev I, Bisbjerg R, Thestrup KC, Winther MD, Jakobsen H, Thomsen HS. Assessment of the Diagnostic Accuracy of Biparametric Magnetic Resonance Imaging for Prostate Cancer in Biopsy-Naive Men: The Biparametric MRI for Detection of Prostate Cancer (BIDOC) Study. JAMA Netw Open 2018; 1:e180219. [PMID: 30646066 PMCID: PMC6324414 DOI: 10.1001/jamanetworkopen.2018.0219] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Multiparametric magnetic resonance imaging (MRI) enhances detection and risk stratification for significant prostate cancer but is time-consuming (approximately 40 minutes) and expensive. Rapid and simpler (approximately 15-minute) biparametric MRI (bpMRI) using fewer scan sequences could be implemented as a prostate MRI triage test on a larger scale before performing biopsies. OBJECTIVES To assess the diagnostic accuracy and negative predictive value (NPV) of a novel bpMRI method in biopsy-naive men in detecting and ruling out significant prostate cancer in confirmatory biopsies. DESIGN, SETTING, AND PARTICIPANTS A single-institutional, paired, prospective cohort study of biopsy-naive men with clinical suspicion of prostate cancer from November 1, 2015, to June 15, 2017. INTERVENTIONS All patients underwent bpMRI (T2-weighted and diffusion-weighted imaging) followed by standard transrectal ultrasound-guided biopsies (all men) and targeted biopsies of men with suspicious bpMRI findings. MAIN OUTCOMES AND MEASURES Suspicion grades of bpMRI, biopsy results, and NPV of bpMRI were evaluated for detection of or ruling out significant prostate cancer (Gleason score ≥4 + 3 or maximum cancerous core length >50% for Gleason score 3 + 4). We compared the diagnostic performance of standard biopsies in all men vs standard plus targeted (combined) biopsies restricted to men with suspicious bpMRI findings. The reference standard was combined biopsy results from all men. RESULTS A total of 1020 men were enrolled, with a median age of 67 years (interquartile range, 61-71 years) and a median prostate-specific antigen level of 8.0 ng/mL (interquartile range, 5.7-13.0 ng/mL). Combined biopsies detected any and significant prostate cancer in 655 of 1020 men (64%) and 404 of 1020 men (40%), respectively. Restricting combined biopsies to men with suspicious bpMRI findings meant 305 of 1020 men (30%) with low-suspicious bpMRIs could avoid prostate biopsies (biopsy in 715 men with suspicious bpMRIs vs all 1020 men who required standard biopsies [70%]; P < .001). Significant prostate cancer diagnoses were improved by 11% (396 vs 351 men; P < .001), and insignificant prostate cancer diagnoses were reduced by 40% (173 vs 288 men; P < .001) compared with our current diagnostic standard, standard biopsies alone in all men. The NPV of bpMRI findings in ruling out significant prostate cancer was 97% (95% CI, 95%-99%). CONCLUSIONS AND RELEVANCE Low-suspicion bpMRI has a high NPV in ruling out significant prostate cancer in biopsy-naive men. Using a simple and rapid bpMRI method as a triage test seems to improve risk stratification and may be used to exclude aggressive disease and avoid unnecessary biopsies with its inherent risks. Future studies are needed to fully explore its role in clinical prostate cancer management.
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Affiliation(s)
- Lars Boesen
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Nis Nørgaard
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Ingegerd Balslev
- Department of Pathology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Rasmus Bisbjerg
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | | | - Mads D. Winther
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Henrik Jakobsen
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Henrik S. Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
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217
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Hofbauer SL, Maxeiner A, Kittner B, Heckmann R, Reimann M, Wiemer L, Asbach P, Haas M, Penzkofer T, Stephan C, Friedersdorff F, Fuller F, Miller K, Cash H. Validation of Prostate Imaging Reporting and Data System Version 2 for the Detection of Prostate Cancer. J Urol 2018; 200:767-773. [PMID: 29733838 DOI: 10.1016/j.juro.2018.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The second version of the PI-RADS™ (Prostate Imaging Reporting and Data System) was introduced in 2015 to standardize the interpretation and reporting of prostate multiparametric magnetic resonance imaging. Recently low cancer detection rates were reported for PI-RADS version 2 category 4 lesions. Therefore the aim of the study was to evaluate the cancer detection rate of PI-RADS version 2 in a large prospective cohort. MATERIALS AND METHODS The study included 704 consecutive men with primary or prior negative biopsies who underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy and 10-core systematic prostate biopsy between September 2015 and May 2017. All lesions were rated according to PI-RADS version 2 and lesions with PI-RADS version 2 category 3 or greater were biopsied. An ISUP (International Society of Urological Pathology) score of 2 or greater (ie Gleason 3 + 4 or greater) was defined as clinically significant prostate cancer. RESULTS The overall cancer detection rate of PI-RADS version 2 categories 3, 4 and 5 was 39%, 72% and 91% for all prostate cancer, and 23%, 49% and 77% for all clinically significant prostate cancer, respectively. If only targeted biopsy had been performed, 59 clinically significant tumors (16%) would have been missed. The PI-RADS version 2 score was significantly associated with the presence of prostate cancer (p <0.001), the presence of clinically significant prostate cancer (p <0.001) and the ISUP grade (p <0.001). CONCLUSIONS PI-RADS version 2 is significantly associated with the presence of clinically significant prostate cancer. The cancer detection rate of PI-RADS version 2 category 4 lesions was considerably higher than previously reported. When performing targeted biopsy, the combination with systematic biopsy still provides the highest detection of clinically significant prostate cancer.
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Affiliation(s)
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robin Heckmann
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Laura Wiemer
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Florian Fuller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Stabile A, Dell’Oglio P, De Cobelli F, Esposito A, Gandaglia G, Fossati N, Brembilla G, Cristel G, Cardone G, Deho’ F, Losa A, Suardi N, Gaboardi F, Del Maschio A, Montorsi F, Briganti A. Association Between Prostate Imaging Reporting and Data System (PI-RADS) Score for the Index Lesion and Multifocal, Clinically Significant Prostate Cancer. Eur Urol Oncol 2018; 1:29-36. [DOI: 10.1016/j.euo.2018.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/20/2017] [Accepted: 01/09/2018] [Indexed: 10/14/2022]
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219
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Liu W, Patil D, Howard DH, Moore RH, Wang H, Sanda MG, Filson CP. Adoption of Prebiopsy Magnetic Resonance Imaging for Men Undergoing Prostate Biopsy in the United States. Urology 2018; 117:57-63. [PMID: 29679601 DOI: 10.1016/j.urology.2018.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess adoption of prebiopsy prostate magnetic resonance imaging (MRI) in the United States and to evaluate factors associated with magnetic resonance imaging-guided prostate biopsy (MRI-Bx) use. Prior reports have shown improved cancer detection with MRI-Bx vs transrectal ultrasound-guided methods (transrectal ultrasound-guided biopsy [TRUS-Bx]). Population-based trends of their use and outcomes have not been previously characterized. MATERIALS AND METHODS Using private insurance claims (2009-2015), we identified men who underwent prostate biopsy. Exposures were biopsy year and geographic region defined by metropolitan statistical area. Outcomes included biopsy type (MRI-Bx, TRUS-Bx, or transperineal biopsy) based on procedure codes and cancer detection based on a new diagnosis for prostate cancer (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] 185). Hierarchical mixed-effects multivariable regression estimated odds of undergoing MRI-Bx. RESULTS We identified 241,681 men (mean age 57.5 ± 5.4 years) who underwent biopsy. The use of MRI-Bx rose rapidly (0.2% in 2009 to 6.5% in 2015, P <.001). Overall, 3429 men underwent MRI before biopsy, more commonly in metropolitan statistical areas (odds ratio 1.90, 95% confidence interval 1.66-2.19). In 2015, nearly 18% of men with prior negative biopsy underwent a prebiopsy MRI. Patients with prior negative biopsies were over 4 times more likely to use MRI guidance (vs no prior biopsies, odds ratio 4.63, 95% confidence interval 4.27-5.02) and had a greater chance of cancer detection with MRI-Bx (25.2%) vs TRUS-Bx (19.7%, P = .010). CONCLUSION Among men undergoing prostate biopsy, prebiopsy prostate MRI utilization was concentrated within urban areas and among patients with prior negative biopsies, where its use was associated with superior cancer detection compared with traditional TRUS-Bx.
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Affiliation(s)
- Wen Liu
- Emory University School of Medicine, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - David H Howard
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Renee H Moore
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Heqiong Wang
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Atlanta Veterans Administration Medical Center, Decatur, GA.
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220
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Curci NE, Lane BR, Shankar PR, Noyes SL, Moriarity AK, Kubat A, Brede C, Montgomery JS, Auffenberg GB, Miller DC, Montie JE, George AK, Davenport MS. Integration and Diagnostic Accuracy of 3T Nonendorectal coil Prostate Magnetic Resonance Imaging in the Context of Active Surveillance. Urology 2018; 116:137-143. [PMID: 29653121 DOI: 10.1016/j.urology.2018.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the integration of 3T nonendorectal coil multiparametric prostate magnetic resonance imaging (mpMRI) at 2 high-volume practices that routinely use mpMRI in the setting of active surveillance. MATERIALS AND METHODS This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, and dual-institution retrospective cohort study. Subjects undergoing 3T mpMRI without endorectal coil at either study institution over a 13-month period (August 1, 2015-August 31, 2016) were selected based on predefined criteria: clinical T1/T2 Gleason 6 prostate cancer, prostate-specific antigen <15 ng/mL, ≥40 years old, mpMRI within 2 years of prostate biopsy, and Prostate Imaging Reporting and Data System (PI-RADS) v2 score assigned. Subjects surveilled for Gleason ≥3 + 4 prostate cancer were excluded. The primary outcome was detection of Gleason ≥3 + 4 prostate cancer on magnetic resonance-ultrasound fusion biopsy, standard biopsy, or prostatectomy within 6 months following mpMRI. Positive predictive values (PPVs) were calculated. RESULTS A total of 286 subjects (N = 193 from institution 1, N = 93 from institution 2) met the criteria. Most (87% [90 of 104]) with maximum PI-RADS v2 scores of 1-2 did not receive immediate biopsy or treatment and remained on active surveillance. Incidence and PPVs for PI-RADS v2 scores of ≥3 were the following: PI-RADS 3 (n = 57 [20%], PPV 21% [6 of 29]), PI-RADS 4 (n = 96 [34%], PPV 51% [39 of 77]), and PI-RADS 5 (n = 29 [13%], PPV 71% [20 of 28]). No Gleason ≥4 + 3 prostate cancer was identified for PI-RADS v2 scores of 1-3 (0 of 43 with histology). Following mpMRI and subsequent biopsy, 21% (61 of 286) of subjects were removed from active surveillance and underwent definitive therapy. CONCLUSION The 3T nonendorectal coil mpMRI has been integrated into the care of patients on active surveillance and effectively stratifies risk of Gleason ≥3 + 4 prostate cancer in this population.
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Affiliation(s)
- Nicole E Curci
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | | | - Sabrina L Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | - Andrew K Moriarity
- Advanced Radiology Services, Spectrum Health Medical Group, Grand Rapids, MI
| | - Anthony Kubat
- Department of Pathology, Spectrum Health Medical Group, Grand Rapids, MI
| | - Chris Brede
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI
| | | | | | | | | | | | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, Ann Arbor, MI; Department of Urology, Michigan Medicine, Ann Arbor, MI; Michigan Radiology Quality Collaborative, Ann Arbor, MI.
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Elkhoury FF, Simopoulos DN, Marks LS. MR-guided biopsy and focal therapy: new options for prostate cancer management. Curr Opin Urol 2018; 28:93-101. [PMID: 29232269 PMCID: PMC7314431 DOI: 10.1097/mou.0000000000000471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Options for prostate cancer management are rapidly expanding. The recent advent of MRI technology has led to guided prostate biopsies by radiologists working in-bore or by urologists using MR/US fusion technology. The resulting tumor visualization now provides the option of focal therapy. Currently available are highly directed energies - focused ultrasound (HIFU), cryotherapy, and laser - all offering the hope of curing prostate cancer with few side effects. RECENT FINDINGS MRI now enables visualization of many prostate cancers. MR/US fusion biopsy makes possible the targeted biopsy of suspicious lesions efficiently in the urology clinic. Several fusion devices are now commercially available. Focal therapy, a derivative of targeted biopsy, is reshaping the approach to treatment of some prostate cancers. Focal laser ablation, originally done in the MRI gantry (in-bore), promises to soon become feasible in a clinic setting (out-of-bore) under local anesthesia. Other focal therapy options, including HIFU and cryotherapy, are currently available. Herein are summarized outcomes data on focal therapy modalities. SUMMARY MRI-guided biopsy is optimizing prostate cancer diagnosis. Focal therapy, an outgrowth of guided biopsy, promises to become a well tolerated and effective approach to treating many men with prostate cancer while minimizing the risks of incontinence and impotence from radical treatment.
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Affiliation(s)
- Fuad F. Elkhoury
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095, Phone: 310-794-8659, Fax: 310-794-8653
| | - Demetrios N. Simopoulos
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095, Phone: 310-794-8659, Fax: 310-794-8653
| | - Leonard S. Marks
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095, Phone: 310-794-8659, Fax: 310-794-8653
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Miller ET, Salmasi A, Reiter RE. Anatomic and Molecular Imaging in Prostate Cancer. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a030619. [PMID: 28710256 DOI: 10.1101/cshperspect.a030619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Prostate cancer is characterized by a complex set of heterogeneous disease states. This review aims to describe how imaging has been studied within each specific state. As physicians transition into an era of precision medicine, multiparametric magnetic resonance imaging (mpMRI) is proving to be a powerful tool leading the way for a paradigm shift in the diagnosis and management of localized prostate cancer. With further research and development, molecular imaging modalities will likely change the way we approach recurrent and metastatic disease. Given the range of possible oncological progression patterns, a thorough understanding of the underlying carcinogenesis, as it relates to imaging, is a requisite if we are to appropriately manage prostate cancer in future decades.
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Affiliation(s)
- Eric T Miller
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Amirali Salmasi
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
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224
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Ledezma RA. Aportes actuales de la resonancia magnética para el manejo del cáncer de próstata. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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225
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Affiliation(s)
- Leonard S Marks
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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226
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Fourcade A, Payrard C, Tissot V, Perrouin-Verbe MA, Demany N, Serey-Effeil S, Callerot P, Coquet JB, Doucet L, Deruelle C, Joulin V, Nonent M, Fournier G, Valeri A. The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer. Scand J Urol 2018; 52:174-179. [PMID: 29463177 DOI: 10.1080/21681805.2018.1438509] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Compared with standard systematic transrectal ultrasound (TRUS)-guided biopsies (SBx), targeted biopsies (TBx) using magnetic resonance imaging (MRI)/TRUS fusion could increase the detection of clinically significant prostate cancer (PCa-s) and reduce non-significant PCa (PCa-ns). This study aimed to compare the performance of the two approaches. MATERIALS AND METHODS A prospective, single-center study was conducted on all consecutive patients with PCa suspicion who underwent prebiopsy multiparametric MRI (mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS). All patients underwent mpMRI/TRUS fusion TBx (two to four cores/target) using UroStation™ (Koelis, Grenoble, France) and SBx (10-12 cores) during the same session. PCa-s was defined as a maximal positive core length ≥4 mm or Gleason score ≥7. RESULTS The study included 191 patients (at least one suspicious lesion: PI-RADS ≥3). PCa was detected in 55.5% (106/191) of the cases. The overall PCa detection rate and the PCa-s detection rate were not significantly higher in TBx alone versus SBx (44.5% vs 46.1%, p = .7, and 38.2% vs 33.5%, p = .2, respectively). Combined TBx and SBx diagnosed significantly more PCa-s than SBx alone (45% vs 33.5%, p = .02). PCa-s was detected only by TBx in 12% of cases (23/191) and only by SBx in 7.3% (14/191). Gleason score was upgraded by TBx in 16.8% (32/191) and by SBx in 13.6% (26/191) of patients (p = .4). CONCLUSIONS The combination of TBx and SBx achieved the best results for the detection and prognosis of PCa-s. The use of SBx alone would have missed the detection of PCa-s in 12% of patients.
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Affiliation(s)
- Alexandre Fourcade
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Charlotte Payrard
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Valentin Tissot
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Marie-Aimée Perrouin-Verbe
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Nicolas Demany
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Sophie Serey-Effeil
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Pierre Callerot
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Jean-Baptiste Coquet
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Laurent Doucet
- e Laboratoire d'Anatomo-Pathologie , CHU Brest , Brest , France
| | | | | | - Michel Nonent
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Georges Fournier
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,f Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP) , Paris , France
| | - Antoine Valeri
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,f Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP) , Paris , France
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227
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Pepe P, D'Urso D, Garufi A, Priolo G, Pennisi M, Russo G, Sabini MG, Valastro LM, Galia A, Fraggetta F. Multiparametric MRI Apparent Diffusion Coefficient (ADC) Accuracy in Diagnosing Clinically Significant Prostate Cancer. ACTA ACUST UNITED AC 2018; 31:415-418. [PMID: 28438871 DOI: 10.21873/invivo.11075] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 12/23/2022]
Abstract
AIM To evaluate the accuracy of multiparametric magnetic resonance imaging apparent diffusion coefficient (mpMRI ADC) in the diagnosis of clinically significant prostate cancer (PCa). PATIENTS AND METHODS From January 2016 to December 2016, 44 patients who underwent radical prostatectomy for PCa and mpMRI lesions suggestive of cancer were retrospectively evaluated at definitive specimen. The accuracy of suspicious mpMRI prostate imaging reporting and data system (PI-RADS ≥3) vs. ADC values in the diagnosis of Gleason score ≥7 was evaluated. RESULTS Receiver operating characteristics (ROC) curve analysis gave back an ADC threshold of 0.747×10-3 mm2/s to separate between Gleason Score 6 and ≥7. The diagnostic accuracy of ADC value (cut-off 0.747×10-3 mm2/s) vs. PI-RADS score ≥3 in diagnosing PCa with Gleason score ≥7 was equal to 84% vs. 63.6% with an area under the curve (AUC) ROC of 0.81 vs. 0.71, respectively. CONCLUSION ADC evaluation could support clinicians in decision making of patients with PI-RADS score <3 at risk for PCa.
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Affiliation(s)
- Pietro Pepe
- Urology Unit, Cannizzaro Hospital, Catania, Italy
| | - Davide D'Urso
- Department of Medical Physics, Cannizzaro Hospital, Catania, Italy
| | - Antonio Garufi
- Department of Imaging, Cannizzaro Hospital, Catania, Italy
| | | | | | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
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228
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Amasyalı AS, Yücetaş U, Erkan E, Demiray M, Karabay E, Murat C, Toktaş G, Ünlüer E. Transrectal ultrasound-guided prostate rebiopsy: How many core sampling should be applied to which patient? Urol Ann 2018; 10:15-19. [PMID: 29416269 PMCID: PMC5791451 DOI: 10.4103/ua.ua_110_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: We investigated the correlation between the sampled number of cores in rebiopsy and the cancer detection rate (CDR). Materials and Methods: Two hundred and twelve patients with normal rectal examination who had undergone rebiopsy in the past 5 years were examined retrospectively. Moreover, 68% of them had undergone 12 cores (Group 1) while 32% had undergone 20 cores (Group 2). Both groups were compared with respect to the CDR. Results: There was no difference between groups in terms of age, total prostate-specific antigen, and prostate volume (P > 0.05). Forty-one (19%) of 212 patients were diagnosed with cancer, and the CDR was significantly higher in Group 2 (30.9% vs. 13.9%, P = 0.004). This rate increased from 6.5% to 20% (P = 0.025) and from 0% to 33.3% (P = 0.023), respectively, with 12-core and 20-core rebiopsies in patients whose initial pathology indicated benign and high-grade prostatic intraepithelial neoplasia (HGPIN). Furthermore, cancer was detected in 24 (40%) of 60 patients who were diagnosed with atypical small acinar proliferation (ASAP) in the initial biopsy. However, despite being higher in 20-core biopsy group (47.6% vs. 35.9%), this was not statistically significant (P = 0.377). Conclusions: At least 20 cores should be sampled in rebiopsy, especially in the patients diagnosed with benign and HGPIN. However, we believe that standard systematic sampling will be sufficient for the patients diagnosed with ASAP.
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Affiliation(s)
- Akın Soner Amasyalı
- Department of Urology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Uğur Yücetaş
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Erkan Erkan
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Murat Demiray
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Emre Karabay
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cemalettin Murat
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Toktaş
- Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Erdinç Ünlüer
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
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229
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Schoots IG, Osses DF, Drost FJH, Verbeek JFM, Remmers S, van Leenders GJLH, Bangma CH, Roobol MJ. Reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSA-density, with different thresholds for significant disease. Transl Androl Urol 2018; 7:132-144. [PMID: 29594027 PMCID: PMC5861278 DOI: 10.21037/tau.2017.12.29] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The fear of undergrading prostate cancer (PCa) in men on active surveillance (AS) have led to strict criteria for monitoring, which have resulted in good long-term cancer-specific survival, proving the safety of this approach. Reducing undergrading, MRI-targeted biopsies are increasingly used in men with low-risk disease despite their undefined role yet. The objective of this study is to investigate the rate of upgrading using MRI-targeted biopsies in men with low-risk disease on AS, stratified on the basis of PI-RADS and PSA-density, with the aim to reduce potential unnecessary repeat biopsy procedures. Methods A total of 331 men were prospectively enrolled following the MRI-PRIAS protocol. MR imaging was according to Prostate Imaging Reporting and Data System (PI-RADSv2) guidelines. Suspicious MRI lesions (PI-RADS 3–5) were additionally targeted by MRI-TRUS fusion biopsies. Outcome measure was upgrading to Gleason score (GS) ≥3+4 with MRI-targeted biopsies, stratified for PI-RADS and PSA-density. Results In total, 25% (82/331) of men on AS showed upgrading from GS 3+3. Only 3% (11/331) was upgraded to GS ≥8. In 60% (198/331) a suspicious MRI lesion was identified, but in only 41% (82/198) of men upgrading was confirmed. PI-RADS 3, 4 and 5 categorized index lesions, showed upgrading in 30%, 34% and 66% of men, respectively. Stratification to PI-RADS 4–5, instead of PI-RADS 3–5, would have missed a small number of high volume Gleason 4 PCa in PI-RADS 3 category. However, further stratification into PI-RADS 3 lesions and PSA-density <0.15 ng/mL2 could result in a safe targeted biopsy reduction of 36% in this category, without missing any upgrades. Conclusions Stratification with the combination of PI-RADS and PSA-density may reduce unnecessary additional MRI biopsy testing. Overall, the high rate of detected upgrading in men on AS may result in an unintended tightening of continuing in AS. Since patients, included under current AS criteria showed extremely favorable outcome, there might be no need to further restrict continuing on AS with MRI and targeted biopsies.
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Affiliation(s)
- Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Daniel F Osses
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank-Jan H Drost
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan F M Verbeek
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Chris H Bangma
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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230
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Nassiri N, Chang E, Lieu P, Priester AM, Margolis DJA, Huang J, Reiter RE, Dorey FJ, Marks LS, Natarajan S. Focal Therapy Eligibility Determined by Magnetic Resonance Imaging/Ultrasound Fusion Biopsy. J Urol 2018; 199:453-458. [PMID: 28830754 PMCID: PMC5780241 DOI: 10.1016/j.juro.2017.08.085] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE We assessed focal therapy eligibility in men who underwent multiparametric magnetic resonance imaging and targeted biopsy with correlation to whole mount histology after radical prostatectomy. MATERIALS AND METHODS Subjects were selected from among the 454 men in whom targeted biopsy proven prostate cancer was derived from regions of interest on multiparametric magnetic resonance imaging from 2010 to 2016. Focal therapy eligibility was limited to a maximum Gleason score of 4 + 3 in regions of interest with or without other foci of low risk prostate cancer (Gleason score 3 + 3 and less than 4 mm). Men who did not meet NCCN® intermediate risk criteria were classified as ineligible for focal therapy. Of the 454 men 64 underwent radical prostatectomy and biopsy findings were compared to final pathology findings. RESULTS Of the 454 men with a biopsy proven region of interest 175 (38.5%) were eligible for focal therapy. Fusion biopsy, which combined targeted and template biopsy, had 80.0% sensitivity (12 of 15 cases), 73.5% specificity (36 of 49) and 75.0% accuracy (48 of 64) for focal therapy eligibility. Targeted cores alone yielded 73.3% sensitivity (11 of 15 cases), 47.9% specificity (23 of 48) and 54.7% accuracy (35 of 64). Gleason score and extension across the midline differed in 4 and 9, respectively, of the 13 cases that showed discordant biopsy and whole mount histology. CONCLUSIONS Using intermediate risk eligibility criteria more than a third of men with a targeted biopsy proven lesion identified on multiparametric magnetic resonance imaging would have been eligible for focal therapy. Eligibility determined by fusion biopsy was concordant with whole mount histology in 75% of cases. Improved selection criteria are needed to reliably determine focal therapy eligibility.
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Affiliation(s)
- Nima Nassiri
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Edward Chang
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California
| | - Daniel J A Margolis
- Department of Radiology, Weill Cornell at New York Presbyterian, New York, New York
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Frederick J Dorey
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Shyam Natarajan
- Department of Urology, David Geffen School of Medicine, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California.
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231
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Schoots IG. MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions? Transl Androl Urol 2018; 7:70-82. [PMID: 29594022 PMCID: PMC5861283 DOI: 10.21037/tau.2017.12.31] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This review focuses on indeterminate lesions on prostate magnetic resonance imaging (MRI), assigned as PI-RADS category 3. The prevalence of PI-RADS 3 index lesion in the diagnostic work-up is significant, varying between one in three (32%) to one in five (22%) men, depending on patient cohort of first biopsies, previously negative biopsies, and active surveillance biopsies. A management strategy must be developed for this group of men with an indeterminate suspicion of having clinically significant prostate cancer (csPCa). Currently available data show that the actual prevalence of csPCa after targeted biopsy in PI-RADS 3 lesions vary between patients groups from one in five (21%) to one in six (16%), depending on previous biopsy status. Although this prevalence is lower in comparison to PI-RADS 4 and PI-RADS 5 lesions, still a considerable proportion of men harbor significant disease. Men with such a PI-RADS 3 lesion should therefore be adequately managed. In general, the clinical approach of using a threshold of PI-RADS ≥4 instead of PI-RADS ≥3 to select MRI for targeted biopsies is not supported by data from our explorative literature search using current definitions of csPCa. A possible adaptation to the threshold of PI-RADS ≥4 in combination with other clinical markers could be considered within an active surveillance protocol, where the balance between the individual risk of missing csPCa and the constant process of repeating prostate biopsies is crucial. In the future, improvements in MR imaging and interpretation, combined with molecular biomarkers and multivariate risk models will all be employed in prostate cancer detection and monitoring. These combinations will aid decision-making in challenging circumstances, such as unclear and diagnostic equivocal results for csPCa at early detection.
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Affiliation(s)
- Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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232
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Elkhoury FF, Simopoulos DN, Marks LS. Targeted Prostate Biopsy in the Era of Active Surveillance. Urology 2018; 112:12-19. [PMID: 28962878 PMCID: PMC5856576 DOI: 10.1016/j.urology.2017.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 01/10/2023]
Abstract
Targeted prostate biopsy using magnetic resonance imaging (MRI) guidance is improving the accuracy of prostate cancer (CaP) diagnosis. This new biopsy technology is especially important for men undergoing active surveillance, improving patient selection for enrollment and enabling precise longitudinal monitoring. Magnetic resonance imaging/ultrasound fusion biopsy allows for 3 functions not previously possible with US-guided biopsy: targeting of suspicious regions, template-mapping for systematic sampling, and tracking of cancer foci over time. This article reviews the evolving role of the new biopsy methods in active surveillance, including the UCLA Active Surveillance pathway, which has incorporated magnetic resonance imaging/ultrasound fusion biopsy from program inception as a possible model.
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Affiliation(s)
- Fuad F Elkhoury
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095
| | - Demetrios N Simopoulos
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095
| | - Leonard S Marks
- UCLA Department of Urology, David Geffen School of Medicine, Wasserman Bldg, Suite 331, UCLA Medical Plaza, Los Angeles, CA 90095.
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233
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Prostate cancer detection in patients with prior negative biopsy undergoing cognitive-, robotic- or in-bore MRI target biopsy. World J Urol 2018; 36:761-768. [DOI: 10.1007/s00345-018-2189-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/19/2018] [Indexed: 12/28/2022] Open
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234
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Schütz V, Kesch C, Dieffenbacher S, Bonekamp D, Hadaschik BA, Hohenfellner M, Radtke JP. Multiparametric MRI and MRI/TRUS Fusion Guided Biopsy for the Diagnosis of Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:87-98. [DOI: 10.1007/978-3-319-99286-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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235
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Truong M, Weinberg E, Hollenberg G, Borch M, Park JH, Gantz J, Feng C, Frye T, Ghazi A, Wu G, Joseph J, Rashid H, Messing E. Institutional Learning Curve Associated with Implementation of a Magnetic Resonance/Transrectal Ultrasound Fusion Biopsy Program Using PI-RADS™ Version 2: Factors that Influence Success. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Truong
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eric Weinberg
- Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Gary Hollenberg
- Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marianne Borch
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ji Hae Park
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jacob Gantz
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Thomas Frye
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ahmed Ghazi
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Guan Wu
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jean Joseph
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Hani Rashid
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Edward Messing
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Pathology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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A Comparison of Radiologists' and Urologists' Opinions Regarding Prostate MRI Reporting: Results From a Survey of Specialty Societies. AJR Am J Roentgenol 2018; 210:101-107. [DOI: 10.2214/ajr.17.18241] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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237
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Prostate Cancer Biopsy: Strategies. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_70-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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238
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Abstract
Focal treatment of prostate cancer has evolved from a concept to a practice in the recent few years and is projected to fill an existing need, bridging the gap between conservative and radical traditional treatment options. With its low morbidity and rapid recovery time compared with whole-gland treatment alternatives, focal therapy is poised to gain more acceptance among patients and health care providers. As our experience with focal treatment matures and evidence continues to accrue, the landscape of this practice might look quite different in the future.
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239
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Bjurlin MA, Rosenkrantz AB, Sarkar S, Lepor H, Huang WC, Huang R, Venkataraman R, Taneja SS. Prediction of Prostate Cancer Risk Among Men Undergoing Combined MRI-targeted and Systematic Biopsy Using Novel Pre-biopsy Nomograms That Incorporate MRI Findings. Urology 2017; 112:112-120. [PMID: 29155186 DOI: 10.1016/j.urology.2017.09.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/26/2017] [Accepted: 09/14/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop nomograms that predict the probability of overall prostate cancer (PCa) and clinically significant PCa (Gleason ≥7) on magnetic resonance imaging (MRI)-targeted, and combined MRI-targeted and systematic, prostate biopsy. MATERIALS AND METHODS From June 2012 to August 2014, magnetic resonance imaging to ultrasound fusion-targeted prostate biopsy was performed on 464 men with suspicious regions identified on pre-biopsy 3T MRI along with systematic 12 core biopsy. Logistic regression modeling was used to evaluate predictors of overall and clinically significant PCa, and corresponding nomograms were generated for men who were not previously biopsied or had 1 or more prior negative biopsies. Models were created with 70% of a randomly selected training sample and bias-corrected using bootstrap resampling. The models were then validated with the remaining 30% testing sample pool. RESULTS A total of 459 patients were included for analysis (median age 66 years, prostate-specific antigen [PSA] 5.2 ng/mL, prostate volume 49 cc). Independent predictors of PCa on targeted and systematic prostate biopsy were PSA density, age, and MRI suspicion score. PCa probability nomograms were generated for each cohort using the predictors. Bias-corrected areas under the receiver-operating characteristic curves for overall and clinically significant PCa detection were 0.82 (0.78) and 0.91 (0.84) for men without prior biopsy and 0.76 (0.65) and 0.86 (0.87) for men with a prior negative biopsy in the training (testing) samples. CONCLUSION PSA density, age, and MRI suspicion score predict PCa on combined MRI-targeted and systematic biopsy. Our generated nomograms demonstrate high diagnostic accuracy and may further aid in the decision to perform biopsy in men with clinical suspicion of PCa.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, NY
| | | | - Herbert Lepor
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | - William C Huang
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | - Richard Huang
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY
| | | | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY.
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240
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Mossanen M, Krasnow RE, Nguyen PL, Trinh QD, Preston M, Kibel AS. Approach to the Patient with High-Risk Prostate Cancer. Urol Clin North Am 2017; 44:635-645. [PMID: 29107279 DOI: 10.1016/j.ucl.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Men classified as having high-risk prostate cancer warrant treatment because durable outcomes can be achieved. Judicious use of imaging and considerations of risk factors are essential when caring for men with high-risk disease. Radical prostatectomy, radiation therapy, and androgen deprivation therapy all play pivotal roles in the management of men with high-risk disease, and potentially in men with metastatic disease. The optimal combinations of therapeutic regimens are an evolving area of study and future work looking into therapies for men with high-risk disease will remain critical.
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Affiliation(s)
- Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Ross E Krasnow
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Quoc D Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mark Preston
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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241
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Kam J, Yuminaga Y, Kim R, Aluwihare K, Macneil F, Ouyang R, Ruthven S, Louie-Johnsun M. Does magnetic resonance imaging-guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy. Prostate Int 2017; 6:88-93. [PMID: 30140657 PMCID: PMC6104474 DOI: 10.1016/j.prnil.2017.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/03/2017] [Accepted: 10/25/2017] [Indexed: 02/05/2023] Open
Abstract
Background The increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB. Methods Patients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management. Results A total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4–5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB. Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone. There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%). Conclusions This is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.
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Affiliation(s)
- Jonathan Kam
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Yuigi Yuminaga
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia
| | - Raymond Kim
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia
| | | | - Finlay Macneil
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Rupert Ouyang
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia
| | - Stephen Ruthven
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Mark Louie-Johnsun
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, Australia
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Bjurlin MA, Taneja SS. Prediagnostic Risk Assessment with Prostate MRI and MRI-Targeted Biopsy. Urol Clin North Am 2017; 44:535-546. [DOI: 10.1016/j.ucl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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243
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Hansen NL, Kesch C, Barrett T, Koo B, Radtke JP, Bonekamp D, Schlemmer HP, Warren AY, Wieczorek K, Hohenfellner M, Kastner C, Hadaschik B. Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. BJU Int 2017; 120:631-638. [PMID: 27862869 DOI: 10.1111/bju.13711] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres. PATIENTS AND METHODS A two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7-10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test. RESULTS The median (interquartile range) PSA level was 9.0 (6.7-13.4) ng/mL. PI-RADS 3-5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7-10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7-10 prostate cancer was 0.20 (±0.07) for PI-RADS 3, 0.32 (±0.09) for PI-RADS 4, and 0.70 (±0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1-2 was 0.92 (±0.04) for Gleason score 7-10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7-10 cancers. In patients with suspicious lesions (PI-RADS 4-5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7-10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846. CONCLUSION In patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7-10 cancer still required combined targeted and systematic MRI/US image-fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.
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Affiliation(s)
- Nienke L Hansen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tristan Barrett
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Brendan Koo
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Jan P Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, DKFZ, Heidelberg, Germany
| | | | | | - Anne Y Warren
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Pathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Kathrin Wieczorek
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | | | - Christof Kastner
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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244
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Lazzeri M, Lopci E, Lughezzani G, Colombo P, Casale P, Hurle R, Saita A, Leonardi L, Lista G, Peschechera R, Pasini L, Rodari M, Zandegiacomo S, Benetti A, Cardone P, Mrakic F, Balzarini L, Chiti A, Guazzoni G, Buffi NM. Targeted 11C-choline PET-CT/TRUS software fusion-guided prostate biopsy in men with persistently elevated PSA and negative mpMRI after previous negative biopsy. Eur J Hybrid Imaging 2017; 1:9. [PMID: 29782590 PMCID: PMC5954704 DOI: 10.1186/s41824-017-0011-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/18/2017] [Indexed: 12/22/2022] Open
Abstract
Background We evaluated the feasibility and accuracy of 11C–choline PET-CT/TRUS fusion-guided prostate biopsy in men with persistently elevated PSA and negative mpMRI or contraindication to MRI, after previous negative biopsy. Clinical data were part of a prospective on-going observational clinical study: “Diagnostic accuracy of target mpMRI/US fusion biopsy in patients with suspected prostate cancer after initial negative biopsy”. Patients with a negative biopsy and negative mpMRI (PI-RADS v.2 < 3) or absolute contraindications to MRI and persistently elevated PSA, were included. All patients underwent 11C–choline PET with dedicated acquisition of the pelvis and PET-CT/TRUS-guided prostate biopsy by Bio-Jet™ fusion system (D&K Technologies, Germany). The primary endpoint was to assess the accuracy of 11C–choline PET-CT to determine the presence and the topographical distribution of PCa. Results Overall, 15 patients (median age 71 yrs. ± 8.89; tPSA 13.5 ng/ml ± 4.3) were analysed. Fourteen had a positive PET scan, which revealed 30 lesions. PCa was detected in 7/15 patients (46.7%) and four patients presented a clinically significant PCa: GS > 6. Over 58 cores, 25 (43.1%) were positive. No statistically significant difference in terms of mean and median values for SUVmax and SUVratio between benign and malignant lesions was found. PCa lesions with GS 3 + 3 (n = 3) showed a median SUVmax and SUVratio of 4.01 and 1.46, compared to 5.45 and 1.57, respectively for lesions with GS >6 (n = 4). Conclusion Software PET-CT/TRUS fusion-guided target biopsy could be a diagnostic alternative in patients with a suspected primary PCa and negative mpMRI, but its specificity appeared low.
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Affiliation(s)
- Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Egesta Lopci
- Department of Nuclear-Medicine, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Piergiuseppe Colombo
- Department of Pathology, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Rodolfo Hurle
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Lorenzo Leonardi
- Department of Nuclear-Medicine, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy
| | - Giuliana Lista
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Roberto Peschechera
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Luisa Pasini
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Marcello Rodari
- Department of Nuclear-Medicine, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy
| | - Silvia Zandegiacomo
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Alessio Benetti
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Pasquale Cardone
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
| | - Federica Mrakic
- Department of Radiology, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy
| | - Luca Balzarini
- Department of Radiology, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy
| | - Arturo Chiti
- Department of Nuclear-Medicine, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy.,Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy.,Department of Pathology, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy.,Department of Radiology, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy.,5Humanitas University, Milan, Rozzano Italy
| | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy.,Department of Pathology, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy.,Department of Radiology, Humanitas Clinical and Research Hospital, Milan, Rozzano Italy.,5Humanitas University, Milan, Rozzano Italy
| | - Nicolò Maria Buffi
- Department of Urology, Humanitas Clinical and Research Hospital, via Manzoni 56, 20089 Milan, Rozzano Italy
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245
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Del Monte M, Leonardo C, Salvo V, Grompone MD, Pecoraro M, Stanzione A, Campa R, Vullo F, Sciarra A, Catalano C, Panebianco V. MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer. Radiol Med 2017; 123:227-234. [PMID: 29075977 DOI: 10.1007/s11547-017-0825-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/09/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to validate the role of MR/Ultrasound Fusion-Guided Targeted Biopsy as a first diagnostic modality in subjects with clinical suspicion of prostate cancer (PCa). MATERIALS AND METHODS 108 men (age range 46-78 years) with clinical suspicion for PCa (PSA > 4 ng/mL) underwent multiparametric MRI of the prostate (mpMRI) and, when suspicious lesion were found (according to the PIRADSv2 scoring system), targeted biopsy was performed. All patients without significant alteration patterns at mpMRI have been referred for follow-up at 1 year. RESULTS 91/108 patients showed on the mpMRI highly suspicious lesions (PIRADS 4 and 5); the remaining 17/108 patients revealed no significant alteration consistent with PCa (PIRADS 3). Among the first group of patients, 58/91 proved to be positive for PCa on the pathology report: 24 patients had a Gleason Score (GS) 6 (3 + 3); 18 patients GS 7 of which 7 (3 + 4) and 11 (4 + 3); 14 patients GS 8 (4 + 4); two patients GS 9 (5 + 4); 33 proved to be negative. Overall cancer detection rate (CDR) was 63%. However, the CDR rises significantly, up to 77%, after the 53 initial consecutive biopsies that were performed (p < 0,05) and thus identified as part of the learning curve. Patients of the second group (17/108) have been followed with serial PSA assessments, clinical reevaluation, and follow-up mpMRI. CONCLUSION Performing exclusively targeted MR/Ultrasound Fusion-Guided biopsies for the diagnosis of PCa in patients with suspicious PSA levels (> 4 ng/mL) increases the detection rate of clinically significant cancer, changing both the therapeutic options and the prognosis.
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Affiliation(s)
- Maurizio Del Monte
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Vincenzo Salvo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Marcello Domenico Grompone
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Martina Pecoraro
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Riccardo Campa
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Francesco Vullo
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | | | - Carlo Catalano
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy
| | - Valeria Panebianco
- Prostate Unit-Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161, Rome, Italy.
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246
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Javitt MC, Kravtsov A, Keidar Z, Abadi S, Amiel GE. Multimodality Image Fusion with PSMA PET/CT and High-Intensity Focused Ultrasound Focal Therapy for Primary Diagnosis and Management of Prostate Cancer: A Planned Research Initiative. Rambam Maimonides Med J 2017; 8:RMMJ.10312. [PMID: 28777073 PMCID: PMC5652928 DOI: 10.5041/rmmj.10312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recent developments in diagnostic imaging herald a new approach to diagnosis and management of prostate cancer. Multimodality fusion that combines anatomic with functional imaging data has surpassed either of the two alone. This opens up the possibility to "find and fix" malignancy with greater accuracy than ever before. This is particularly important for prostate cancer because it is the most common male cancer in most developed countries. This article describes technical advances under investigation at our institution and others using multimodality image fusion of magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), and PSMA PET/CT (defined as the combination of prostate-specific membrane antigen [PSMA], positron emission tomography [PET], and computed tomography [CT]) for personalized medicine in the diagnosis and focal therapy of prostate cancer with high-intensity focused ultrasound (HiFUS).
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Affiliation(s)
- Marcia C Javitt
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | | | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Sobhi Abadi
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | - Gilad E Amiel
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
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247
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Borkowetz A, Hadaschik B, Platzek I, Toma M, Torsev G, Renner T, Herout R, Baunacke M, Laniado M, Baretton G, Radtke JP, Kesch C, Hohenfellner M, Froehner M, Schlemmer HP, Wirth M, Zastrow S. Prospective comparison of transperineal magnetic resonance imaging/ultrasonography fusion biopsy and transrectal systematic biopsy in biopsy-naïve patients. BJU Int 2017; 121:53-60. [PMID: 28921850 DOI: 10.1111/bju.14017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the value of multiparametric magnetic resonance imaging (mpMRI) in the detection of significant prostate cancer (PCa) and to compare transperineal MRI/ultrasonography fusion biopsy (fusPbx) with conventional transrectal systematic biopsy (sysPbx) in biopsy-naïve patients. PATIENTS AND METHODS This multicentre, prospective trial investigated biopsy-naïve patients with suspicion of PCa undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PCa, defined as Gleason pattern 4 or 5. We analysed the results after a study period of 2 years. RESULTS The study included 214 patients. The median (range) number of targeted and systematic cores was 6 (2-15) and 12 (6-18), respectively. The overall PCa detection rate of comPbx was 52%. FusPbx detected more PCa than sysPbx (47% vs 43%; P = 0.15). The detection rate of significant PCa was 38% for fusPbx and 35% for sysPbx (P = 0.296). The rate of missed significant PCa was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PCa than fusPbx and sysPbx alone (44% vs 38% vs 35%; P < 0.005). In patients presenting with Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions there was a higher detection rate of significant PCa than in patients presenting with PI-RADS ≤3 lesions in comPbx (61% vs 14%; P < 0.005). CONCLUSIONS For biopsy-naïve men with tumour-suspicious lesions in mpMRI, the combined approach outperformed both fusPbx and sysPbx in the detection of overall PCa and significant PCa. Thus, biopsy-naïve patients may benefit from sysPbx in combination with mpMRI targeted fusPbx.
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Affiliation(s)
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.,Department of Urology, University Hospital Essen, Essen, Germany
| | - Ivan Platzek
- Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany
| | - Marieta Toma
- Department of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Georgi Torsev
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Theresa Renner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Roman Herout
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Michael Laniado
- Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany
| | - Gustavo Baretton
- Department of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Michael Froehner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | | | - Manfred Wirth
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Stefan Zastrow
- Department of Urology, Technische Universität Dresden, Dresden, Germany
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248
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Nguyentat M, Ushinsky A, Miranda-Aguirre A, Uchio E, Lall C, Shirkhoda L, Lee T, Green C, Houshyar R. Validation of Prostate Imaging-Reporting and Data System Version 2: A Retrospective Analysis. Curr Probl Diagn Radiol 2017; 47:404-409. [PMID: 29126575 DOI: 10.1067/j.cpradiol.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Use of magnetic resonance imaging (MRI)/transrectal ultrasound fusion biopsies to determine the accuracy of multiparametric MRI (mpMRI), using Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2), for detecting clinically significant prostate cancer in the overall gland and specifically the peripheral zone (PZ) and transitional zone (TZ). METHODS A retrospective analysis of patients who underwent fusion biopsy identified 137 men with 231 prostate lesions was approved by the Institutional Review Board. Subjects initially classified under PI-RADSv1 criteria were regraded using PI-RADSv2 by a radiologist blinded to PI-RADSv1 score and biopsy results. Spearman correlation, chi-squared, and logistic regression analysis were performed. RESULTS There was positive correlation between PI-RADSv2 and Gleason scores (P < 0.001). In the PZ, mpMRI demonstrated 100% sensitivity, 100% negative predictive value, and 35.9% positive predictive value, compared to 100%, 100%, and 27.1%, respectively, for TZ lesions. When predicting clinically significant prostate cancer, the PI-RADSv2 area under the curve for TZ lesions was 0.844 (95% CI: 0.753-0.935, P < 0.001) and 0.769 (95% CI: 0.684-0.854, P < 0.001) for PZ lesions. Combining PI-RADSv2 with additional risk factors (body mass index, prostate-specific antigen density, digital rectal examination) improved the area under curve. CONCLUSIONS PI-RADSv2 achieves excellent sensitivity and negative predictive value for both PZ and TZ lesions.
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Affiliation(s)
- Michael Nguyentat
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Alexander Ushinsky
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA.
| | | | - Edward Uchio
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Chandana Lall
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Layla Shirkhoda
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Thomas Lee
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Christopher Green
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
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249
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The Influence of Serum Prostate-Specific Antigen on the Accuracy of Magnetic Resonance Imaging Targeted Biopsy versus Saturation Biopsy in Patients with Previous Negative Biopsy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7617148. [PMID: 29159180 PMCID: PMC5660748 DOI: 10.1155/2017/7617148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/17/2017] [Accepted: 09/10/2017] [Indexed: 12/16/2022]
Abstract
Objective We compared the prostate cancer (PCa) detection rates of targeted biopsy (TB) and saturation biopsy (SB) in patients with previous negative biopsy and the accuracy of TB and SB stratified by different serum prostate-specific antigen (PSA) levels. Materials and Methods Overall 185 patients were enrolled. In the magnetic resonance imaging (MRI) group, 65 men underwent TB and SB. In the control group, 120 men underwent SB alone. The primary outcome was the difference in PCa detection rate between the MRI group and control group. The secondary outcome was the difference in accuracy between TB and SB in detecting clinically significant PCa by stratifying the patients in the MRI group into those with PSA < 10 ng/ml and PSA ≥ 10 ng/ml. Results The detection rates for overall and clinically significant PCa were higher in the MRI group than in the control group (46.2% versus 20.9% and 43.1% versus 16.7%, both p < 0.001). In the MRI group, the accuracy of TB was higher than SB (94.7% versus 84.2%, p = 0.001) for the patients with PSA ≥ 10 ng/mL. Conclusions Combining TB and SB achieved the best cancer detection rate. The accuracy of TB was better than SB in the patients with serum PSA ≥ 10 ng/mL.
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250
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Association between a 17-gene genomic prostate score and multi-parametric prostate MRI in men with low and intermediate risk prostate cancer (PCa). PLoS One 2017; 12:e0185535. [PMID: 29016610 PMCID: PMC5634556 DOI: 10.1371/journal.pone.0185535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to directly compare results from multi-parametric prostate MRI (mpMRI) and a biopsy-based 17-gene RT-PCR assay providing a Genomic Prostate Score (GPS) among individuals who were candidates for active surveillance with low and intermediate risk prostate cancer (PCa). Patients and methods We evaluated the association between GPS results (scale 0–100) and endorectal mpMRI findings in men with clinically localized PCa. MR studies were reviewed to a five-tier scale of increasing suspicion of malignancy. Mean apparent diffusion coefficient (ADC) was calculated from a single dominant lesion. Mean rank of the GPS (0–100) among MRI strata was compared with the Kruskal-Wallis test and Dunn's multiple comparison test. Spearman's correlation was performed to examine the association between mean ADC and scaled GPS. Results Of 186 patients who received GPS testing, 100 were identified who received mpMRI. Mean GPS results differed between mpMRI categories (p = 0.001); however a broad range was observed in all mpMRI categories. Among men with biopsy Gleason pattern 3+3, mean GPS results were not significantly different among MRI groups (p = 0.179), but GPS differences were seen among MRI categories for patients with pattern 3+4 (p = 0.010). Mean ADC was weakly associated with GPS (σ = -0.151). Stromal response (p = 0.015) and cellular organization (p = 0.045) gene group scores differed significantly by MRI findings, but no differences were seen among androgen signaling or proliferation genes. Conclusions Although a statistically significant association was observed between GPS results and MRI scores, a wide range of GPS values were observed across imaging categories suggesting that mpMRI and genomic profiling may offer non- overlapping clinical insights.
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