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Celma A, López R, Roche S, Planas J, Regis L, Placer J, Borque A, Esteban L, de Torres I, Morote J. Are targeted prostate biopsies ready to replace systematic prostate biopsies? Actas Urol Esp 2019; 43:573-578. [PMID: 31679807 DOI: 10.1016/j.acuro.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/07/2018] [Accepted: 06/09/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the efficacy and efficiency of systematic prostatic biopsy (SPB) and cognitive fusion PB (CFPB) to diagnose prostate cancer (PCa) and significant PCa (SPCa), and to analyse if CFPB could safely replace SPB. MATERIAL AND METHODS A cohort of 314 consecutive men having PI-RADS ≥2 in a pre-biopsy 3T mp-MRI were prospectively subjected to trans-rectal ultrasound CFPB (two cores per suspicious area until a maximum of three areas) and a 12 peripheral core SPB. SPCa was considered when the WHO grade was higher than 2 (Gleason 4+3 or higher). RESULTS PCa was diagnosed in 133 patients (42.4%), being 83 (62.4%) SPCa. SPB detected PCa in 114 men (85.7%) while CFPB in 103 (77.4%), P<.001. SPB detected SPCa in 64 men (77.1%) while CFPB in 71 (85.5%), P<.001. In 52 of the 81 men (64.2%) SPCa was detected in SPB and CFPB. In 19 men SPCa was only detected in CFPB (23.5%) while in 10, it was only detected in SPB (12.3%). 33.1 cores were needed to diagnose one PCa in SPB while 8.5 in CFPB, P<.001. 58.9 cores were needed to diagnose one SPCa in SPB, while 12.4 in CFPB, P<.001. CONCLUSIONS CFPB are more effective and also more efficient than SPBs in detecting SPCa. However, CFPBs still can't safely replace SPBs because they are not able to detect up to 15% of SPCa.
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Wang L, Wang X, Zhao W, Zhao Z, Li Z, Fei S, Zhu H, Ji X, Yang B, Li N, Na Y. Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate: an original technique with a good cancer detection rate. BMC Urol 2019; 19:107. [PMID: 31684917 PMCID: PMC6830008 DOI: 10.1186/s12894-019-0535-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022] Open
Abstract
Background To report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB) . Methods We present a retrospective review of consecutive patients undergoing multiparametric magnetic resonance (mpMRI) imaging of the prostate with subsequent transperineal prostate biopsy from January 2016 to December 2018. A free-hand 12-core SB was performed for each patient. PI-RADS 3–5 lesions were further targeted for biopsy with our TB technique. Firstly, a central point of suspicious lesion (B′) was registered cognitively on a transverse section of transrectal ultrasound (TRUS). Then, biopsy gun punctured vertically through a fixed pioneer site (A) on skin of perineum, and deep into the TRUS section to get A’. Next, targeted site (B), the surface-projection of B′, would be determined on skin of perineum by A and distance from B′ to A’. Finally, puncture through B to reach B′. Pathological findings of SB and TB were analyzed. Results A total of 126 patients underwent transperineal prostate biopsy (47 SB only, 79 SB + TB). The age of the patients was 68.7 ± 9.2 years. The median preoperative PSA value was 11.8 ng/mL. Preoperative prostate volume was 60.5 ± 50.0 mL. The numbers of patients with PI-RADS scores of 1 through 5 were 4, 43, 27, 21 and 31, respectively. The overall detection rate of cancer was 61/126 (48.4%), and it was significantly higher in the combination cohort (56/79, 70.9%) compared with the SB only cohort (5/47, 10.6%, p<0.001). When focused on the combination cohort, TB detected a similar overall rate of PCa (53/79, 67.1% vs 52/79, 65.8%; p = 0.87) compared with SB. The clinically significant PCa (csPC) detection rate was 52/79 (65.8%), while for TB and SB the csPC/PC rate was 51/53 (96.2%) and 48/52 (92.3%), respectively(p = 0.44). TB demonstrated a better sampling performance (positive rate for each core) compared with SB (51.0% vs 31.3%, p < 0.001). Conclusions Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate has a good efficacy in detecting PCa.
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Affiliation(s)
- Lei Wang
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Xiaofei Wang
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Wenfeng Zhao
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Zichen Zhao
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Zhihu Li
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Shengmin Fei
- Department of medical imaging, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China
| | - He Zhu
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Xiang Ji
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Bing Yang
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
| | - Ningchen Li
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China. .,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China.
| | - Yanqun Na
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China
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Yang T, Zhang L, Chen Y, Cai Y, Jiang H, Ding Q. The predictive efficacy of hypoechoic lesion in ultrasound for prostate cancer in Chinese people: five-year experience in a moderated 10-core transperineal prostate biopsy procedure. Oncotarget 2017; 8:79433-79440. [PMID: 29108322 PMCID: PMC5668055 DOI: 10.18632/oncotarget.18342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/21/2017] [Indexed: 11/25/2022] Open
Abstract
We aim to investigate the predictive efficacy of hypoechoic lesion for prostate cancer at different levels of serum PSA in the procedure of transrectal ultrasound guided 10-core trans-perineal prostate biopsy (TP-PBx). In this study, we collected clinical parameters involving age, digital rectal examination (DRE), PSA, prostate volume, pathological diagnosis, Gleason score, novel Gleason group, and numbers of positive cores from 856 patients who had elevated level of PSA above 4 ng/ml or susceptible nodule of prostate gland in DRE received the moderated 10-core TP-PBx procedure. There were 481 cases (56.2%) with no visible lesion of hypoechoic nodule in transrectal ultrasound (TRUS) and 375 cases (43.8%) with the hypoechoic lesion. The total cancer detection rate is 45.56%. The predictive efficacy of hypoechoic lesion for prostate cancer varies among different PSA intervals. For PSA groups of 0-4, 4-10, 10-20, 20-100, > 100 ng/ml, the Youden's indexes are 0.3483, 0.3506, 0.3941, 0.2795 and 0.8667, respectively. Besides, the visible lesions are inclined to be detected in patients with higher Gleason score. We concluded that the hypoechoic lesions in TRUS could improve the predictive accuracy for diagnosing prostate cancer and present different predictive efficacy in the respective PSA intervals. Besides, it was probably associated with more aggressive clinical significance.
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Affiliation(s)
- Tian Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Limin Zhang
- Department of Urology, Huashan North Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yixin Chen
- Department of Ultrasonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Yehua Cai
- Department of Ultrasonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
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