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Ploussard G, Barret E, Fiard G, Lenfant L, Malavaud B, Giannarini G, Almeras C, Aziza R, Renard-Penna R, Descotes JL, Rozet F, Beauval JB, Salin A, Rouprêt M. Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsies for Prostate Cancer Diagnosis: Final Results of the Randomized PERFECT trial (CCAFU-PR1). Eur Urol Oncol 2024; 7:1080-1087. [PMID: 38403523 DOI: 10.1016/j.euo.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Recent guidelines favor transperineal (TP) prostate biopsies over the transrectal (TR) approach due to a reduced sepsis risk. Yet, evidence from controlled trial comparing both approaches within the MRI-targeted pathway for significant prostate cancer (PCa) detection is lacking. OBJECTIVE To compare the significant PCa detection rate between magnetic resonance imaging (MRI)-targeted TR and TP approaches in biopsy-naïve patients. DESIGN, SETTING, AND PARTICIPANTS In this noninferiority controlled trial, we randomized (ratio 1:1) 270 MRI-positive biopsy-naïve patients. INTERVENTION MRI-targeted TP versus TR biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES The primary outcome was the detection rate of significant PCa (International Society of Urological Pathology [ISUP] ≥2) in MRI-targeted biopsies. Secondary outcomes were any-grade PCa detection, detection on concomitant systematic biopsy, complications, and functional outcomes. RESULTS AND LIMITATIONS Targeted biopsies identified significant PCa in 47.2% of TP and 54.2% of TR participants (-7%, p = 0.6235). On a per-lesion analysis, posterior lesions yielded higher detection rates via TR (59.0% vs 44.3%, p = 0.0443), while anterior lesions were more frequently detected via TP (40.6% vs 26.5%, p = 0.2228). The overall (any grade) cancer detection rate in targeted biopsies was comparable between groups: 71.3% (TP) versus 64.1% (TR; p = 0.2209) with significantly more ISUP 1 cases detected in the TP arm. Adverse events of grade ≥2 were not different between TP (35.7%) and TR (40.5%, p = 0.4256). One TR patient (0.8%) experienced grade 3 sepsis. Quality of life, and urinary and sexual function, as well as pain scores, were comparable between groups. CONCLUSIONS Despite a comparable overall detection rate for any-grade PCa, noninferiority of TP over TR for MRI-targeted biopsies for significant PCa detection was not demonstrated. However, MRI lesion location influenced biopsy route performance, suggesting that a pragmatic approach based on lesion location might enhance significant PCa assessment. PATIENT SUMMARY This trial compared the efficacy and safety of two biopsy approaches for prostate cancer diagnosis. Both approaches seem complementary according to the lesion location.
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Affiliation(s)
| | - Eric Barret
- Institut Mutualiste Montsouris, Paris, France
| | - Gaëlle Fiard
- Grenoble Alpes University Hospital, University Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Louis Lenfant
- AP-HP - Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | | | | | - Christophe Almeras
- Clinique Capio La Croix du Sud Cabinet d'Urologie, Quint-Fonsegrives, France
| | - Richard Aziza
- Comprehensive Cancer Cancer IUCT-Oncopole, Toulouse, France
| | | | | | | | | | | | - Morgan Rouprêt
- AP-HP - Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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2
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Malewski W, Milecki T, Tayara O, Poletajew S, Kryst P, Tokarczyk A, Nyk Ł. Role of Systematic Biopsy in the Era of Targeted Biopsy: A Review. Curr Oncol 2024; 31:5171-5194. [PMID: 39330011 PMCID: PMC11430858 DOI: 10.3390/curroncol31090383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Prostate cancer (PCa) is a major public health issue, as the second most common cancer and the fifth leading cause of cancer-related deaths among men. Many PCa cases are indolent and pose minimal risk, making active surveillance a suitable management approach. However, clinically significant prostate carcinoma (csPCa) can lead to serious health issues, including progression, metastasis, and death. Differentiating between insignificant prostate cancer (inPCa) and csPCa is crucial for determining appropriate treatment. Diagnosis of PCa primarily involves trans-perineal and transrectal systematic biopsies. Systematic transrectal prostate biopsy, which typically collects 10-12 tissue samples, is a standard method, but it can miss csPCa and is associated with some complications. Recent advancements, such as magnetic resonance imaging (MRI)-targeted biopsies, have been suggested to improve risk stratification and reduce overtreatment of inPCa and undertreatment of csPCa, thereby enhancing patient quality of life and treatment outcomes. Guided biopsies are increasingly recommended for their ability to better detect high-risk cancers while reducing identification of low-risk cases. MRI-targeted biopsies, especially when used as an initial biopsy in biopsy-naïve patients and those under active surveillance, have become more common. Utilization of MRI-TB alone can decrease septic complications; however, the combining of targeted biopsies with perilesional sampling is recommended for optimal detection of csPCa. Future advancements in imaging and biopsy techniques, including AI-augmented lesion detection and robotic-assisted sampling, promise to further improve the accuracy and effectiveness of PCa detection.
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Affiliation(s)
- Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 02-511 Warsaw, Poland; (O.T.); (S.P.); (P.K.); (A.T.); (Ł.N.)
| | - Tomasz Milecki
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Omar Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, 02-511 Warsaw, Poland; (O.T.); (S.P.); (P.K.); (A.T.); (Ł.N.)
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 02-511 Warsaw, Poland; (O.T.); (S.P.); (P.K.); (A.T.); (Ł.N.)
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 02-511 Warsaw, Poland; (O.T.); (S.P.); (P.K.); (A.T.); (Ł.N.)
| | - Andrzej Tokarczyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 02-511 Warsaw, Poland; (O.T.); (S.P.); (P.K.); (A.T.); (Ł.N.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 02-511 Warsaw, Poland; (O.T.); (S.P.); (P.K.); (A.T.); (Ł.N.)
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3
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Baboudjian M, Diamand R, Uleri A, Beauval JB, Touzani A, Roche JB, Lacetera V, Roumeguère T, Simone G, Benamran D, Fourcade A, Gondran-Tellier B, Fiard G, Peltier A, Ploussard G. Does Overgrading on Targeted Biopsy of Magnetic Resonance Imaging-visible Lesions in Prostate Cancer Lead to Overtreatment? Eur Urol 2024; 86:232-237. [PMID: 38494379 DOI: 10.1016/j.eururo.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 11/24/2023] [Accepted: 02/04/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Targeted biopsy of the index prostate cancer (PCa) lesion on multiparametric magnetic resonance imaging (MRI) is effective in reducing the risk of overdiagnosis of indolent PCa. However, it remains to be determined whether MRI-targeted biopsy can lead to a stage shift via overgrading of the index lesion by focusing only on the highest-grade component, and to a subsequent risk of overtreatment. Our aim was to assess whether overgrading on MRI-targeted biopsy may lead to overtreatment, using radical prostatectomy (RP) specimens as the reference standard. METHODS Patients with clinically localized PCa who had positive MRI findings (Prostate Imaging-Reporting and Data System [PI-RADS] score ≥3) and Gleason grade group (GG) ≥2 disease detected on MRI-targeted biopsy were retrospectively identified from a prospectively maintained database that records all RP procedures from eight referral centers. Biopsy grade was defined as the highest grade detected. Downgrading was defined as lower GG for the RP specimen than for MRI-targeted biopsy. Overtreatment was defined as downgrading to RP GG 1 for cases with GG ≥2 on biopsy, or to RP low-burden GG 2 for cases with GG ≥3 on biopsy. KEY FINDINGS AND LIMITATIONS We included 1020 consecutive biopsy-naïve patients with GG ≥2 PCa on MRI-targeted biopsy in the study. Pathological analysis of RP specimens showed downgrading in 178 patients (17%). The transperineal biopsy route was significantly associated with a lower risk of downgrading (odds ratio 0.364, 95% confidence interval 0.142-0.814; p = 0.022). Among 555 patients with GG 2 on targeted biopsy, only 18 (3.2%) were downgraded to GG 1 on RP. Among 465 patients with GG ≥3 on targeted biopsy, three (0.6%) were downgraded to GG 1 and seven were downgraded to low-burden GG 2 on RP. The overall risk of overtreatment due to targeted biopsy was 2.7% (28/1020). CONCLUSIONS AND CLINICAL IMPLICATIONS Our multicenter study revealed no strong evidence that targeted biopsy results could lead to a high risk of overtreatment.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France; Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France; Department of Urology, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France.
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Alae Touzani
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | | | - Vito Lacetera
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | | | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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4
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Feng J, Chen K, Tian H, Abdulkarem AQM, Tuo Y, Wang X, Huang B, Gao Y, Lv Z, He R, Li G. Investigation of the Effectiveness of Prostate Biopsy Density in Predicting Prostate Cancer Under Cognitive and Systematic Biopsy in Multi-Parametric Magnetic Resonance Imaging (mpMRI). Cancer Manag Res 2024; 16:883-890. [PMID: 39072341 PMCID: PMC11283794 DOI: 10.2147/cmar.s476636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024] Open
Abstract
Objective To explore the effectiveness of prostate biopsy density in predicting prostate cancer under cognitive and systematic biopsy mode in multi-parametric magnetic resonance imaging (mpMRI). Methods A retrospective analysis was conducted on clinical data of 204 patients who were suspected of having prostate cancer with prostate-specific antigen (PSA) levels less than 50 ng mL-1 and underwent cognitive and systematic biopsy through the perineal approach in our hospital from 2022 to 2023. Univariate and multivariate logistic regression analyses were used to evaluate the odds ratios of prostate biopsy density and relevant clinical indicators. Logistic regression analysis was performed to establish a predictive model combining indicators with predictive value. The predictive value of each indicator and the new model was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Results The detection rate of prostate cancer in the study population was 32.35%. Multivariate analysis showed that age, PSAD, PI-RADS 2.1 score, and prostate biopsy density were independent predictors of prostate cancer. The ROC curve analysis revealed an AUC of 0.707 (95% CI 0.625-0.790) for biopsy density, with a cutoff value of approximately 0.22 needle mL-1. The best predictive model consisted of age, PSAD, PI-RADS 2.1 score, and biopsy density, with an AUC of 0.857. Conclusion Biopsy density is associated with the detection of prostate cancer, with a critical value of 0.22 needle mL-1. Combining biopsy density with other clinical indicators can significantly improve the ability to predict prostate cancer and avoid unnecessary prostate biopsy cores.
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Affiliation(s)
- Jiajin Feng
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Keming Chen
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Haifu Tian
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | | | - Yunshang Tuo
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Xuehao Wang
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Bincheng Huang
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Yu Gao
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Zhiyong Lv
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Rui He
- Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Guangyong Li
- General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
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5
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Schroeder DW, Foster BR, Young DJ, Coakley FV. Targeted biopsy of the prostate. Abdom Radiol (NY) 2024:10.1007/s00261-024-04452-z. [PMID: 38976055 DOI: 10.1007/s00261-024-04452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/21/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
Diagnostic multiparametric MRI of the prostate has steadily evolved over the last three decades and can now reliably depict the dominant tumor in most men with prostate cancer. In response, several methods of targeted biopsy to direct tissue sampling of suspected tumor foci seen at multiparametric MRI have been developed and successfully tested in recent years, including software-assisted MRI-ultrasound (US) fusion biopsy and direct MRI-guided in-bore biopsy. These advances are leading to a sea change in the approach to prostate cancer diagnosis, with the traditional approach of blind systematic biopsy increasingly being replaced by MRI directed targeted biopsy. This review aims to describe the current status of targeted biopsy, with an emphasis on the relative accuracy of different techniques. The results of several critical large multicenter trials are presented, while unanswered questions that require more research are highlighted.
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Affiliation(s)
- David W Schroeder
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR, 97239, United States
| | - Bryan R Foster
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR, 97239, United States
| | - Daniel J Young
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR, 97239, United States
| | - Fergus V Coakley
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR, 97239, United States.
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Hoeh B, Wenzel M, Humke C, Cano Garcia C, Siech C, Schneider M, Lange C, Traumann M, Köllermann J, Preisser F, Chun FKH, Mandel P. Transition from Transrectal to Transperineal MRI-Fusion Prostate Biopsy Does Not Comprise Detection Rates of Clinically Significant Prostate Cancer at a Tertiary Care Center. Diagnostics (Basel) 2024; 14:1184. [PMID: 38893710 PMCID: PMC11171881 DOI: 10.3390/diagnostics14111184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A remarkable paradigm shift has emerged regarding the preferred prostate biopsy approach, favoring the transperineal (TP) over the transrectal (TR) approach due to the reduced risk of severe urinary tract infections. However, its impact on the detection of clinically significant prostate cancer (csPCa) remains unclear. MATERIALS AND METHODS We relied on a prospectively maintained tertiary care database to identify patients who underwent either TP or TR prostate biopsy between 01/2014 and 12/2023. Of those, only patients with suspicious magnetic resonance imaging (MRI) PIRADS lesions (Likert-scale: 3,4,5) received MRI-targeted and systematic biopsies. Detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥ 2) were compared between biopsy approach (TP vs. TR) according to index lesion. Subsequently, uni- and multivariable logistic regression models were applied to investigate the predictive status of the biopsy approach within each subcohort. RESULTS Of 2063 patients, 1118 (54%) underwent combined MRI-guided and systematic prostate biopsy and were included in the final cohort. Of those, 127 (11%) and 991 (89%) underwent TP vs. TR. CsPCa rates, regardless of differences in patients' demographics and distribution of index PIRDAS lesions, did not differ statistically significantly and were 51 vs. 52%, respectively (p = 0.8). CsPCa detection rates for PIRDAS-3, PIRADS-4 and PIRADS-5 did not differ and were 24 vs. 23%, 48 vs. 51% and 72 vs. 76% for PIRADS-3, PIRADS-4 and PIRADS-5 subgroups for TP vs. TR, respectively (all p ≥ 0.9) Conclusions: The current results support the available data indicating that TP biopsy approach is comparable to transrectal biopsy approach regarding csPCa detection rates.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Cristina Cano Garcia
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Carolin Siech
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada
| | - Melissa Schneider
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Carsten Lange
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Miriam Traumann
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
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7
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Wu Q, Tu X, Zhang C, Ye J, Lin T, Liu Z, Yang L, Qiu S, Bao Y, Wei Q. Transperineal magnetic resonance imaging targeted biopsy versus transrectal route in the detection of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024; 27:212-221. [PMID: 37783837 DOI: 10.1038/s41391-023-00729-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) has deeply altered the prostate biopsy strategy to detect prostate cancer. However, it is still debatable whether the detection rate differs between transrectal (TR) and transperineal (TP) MRI-targeted biopsy (MRI-TB). To compare the effectiveness of these two methods for detecting both overall prostate cancer (PCa) and clinically significant PCa (csPCa), We performed a review and meta-analysis. METHODS Until January 2023, we conducted a thorough search of Cochrane, Embase, Ovid, and PubMed. In total, 1482 references were identified, and 15 records were finally included. For PCa and csPCa discovered by TP and TR MRI-TB, we combined the relative sensitivity (RR) with 95% confidence intervals (CI). The RR between the TP and TR routes was established. RESULTS Our study included 8826 patients in total and revealed that TP MRI-TB detected more PCa (RR 1.25 [95% CI 1.12, 1.39], p < 0.0001). In patients who underwent TP MRI-TB and TR MRI-TB at the same time or separately, TP MRI-TB had a greater detection rate of csPCa in per-patient analysis (one cohort (RR 1.33 [95% CI 1.09, 1.63], p = 0.005); two cohorts (RR 1.37 [95% CI 1.16, 1.61], p = 0.0002)). However, the detection rate of csPCa between the TP route and the TR route was comparable in per-lesion analysis (RR 0.91 [95% CI 0.76, 1.08], p = 0.28). Additionally, in the prostate's anterior region, we found that TP MRI-TB detected more csPCa (per-lesion (RR 1.52 [95% CI 1.04, 2.23], p = 0.03); per-patient (RR 2.55 [95% CI 1.56, 4.16], p = 0.0002)). CONCLUSION According to this comprehensive study, TP MRI-TB is more effective than TR MRI-TB at detecting PCa and csPCa. Significant results persisted for detecting csPCa located in the anterior zone. The results need to be taken carefully notwithstanding the heterogeneity among the included studies.
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Affiliation(s)
- Qiyou Wu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Tu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chichen Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianjun Ye
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhai Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
- Department of Molecular Oncology, Institute of Oncology Research (IOR), Oncology Institute of Southern Switzerland (IOSI), Bellinzona, 6500, Switzerland
| | - Yige Bao
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
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8
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Hagens MJ, Ribbert LLA, Jager A, Veerman H, Barwari K, Boodt B, de Bruijn RE, Claessen A, Leter MR, van der Noort V, Smeenge M, Roeleveld TA, Rynja SP, Schaaf M, Weltings S, Vis AN, Bekers E, van Leeuwen PJ, van der Poel HG. Histopathological concordance between prostate biopsies and radical prostatectomy specimens-implications of transrectal and transperineal biopsy approaches. Prostate Cancer Prostatic Dis 2024; 27:312-317. [PMID: 37660218 DOI: 10.1038/s41391-023-00714-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the histopathological concordance rates between prostate biopsies and radical prostatectomy specimens according to the applied biopsy approach (transrectal or transperineal). METHODS We studied patients who had been newly diagnosed with clinically significant prostate cancer and who underwent a radical prostatectomy between 2018 and 2022. Patients were included if they underwent a prebiopsy magnetic resonance imaging and if they had not been previously treated for prostate cancer. Histopathological grading on prostate biopsies was compared with that on radical prostatectomy specimens. Univariable and multivariable logistic regression analyses were performed to assess the effect of the applied biopsy approach on histopathological concordance. Additional analyses were performed to assess the effect of the applied biopsy approach on American Urological Association risk group migration, defined as any change in risk group after radical prostatectomy. RESULTS In total, 1058 men were studied, of whom 49.3% (522/1058) and 50.7% (536/1058) underwent transrectal and transperineal prostate biopsies, respectively. Histopathological disconcordance was observed in 37.8% (400/1058) of men while American Urological Association risk group migration was observed in 30.2% (320/1058) of men. A transperineal biopsy approach was found to be independently associated with higher histopathological concordance rates (OR 1.33 [95% CI 1.01-1.75], p = 0.04) and less American Urological Association risk group migration (OR 0.70 [95% CI 0.52-0.93], p = 0.01). CONCLUSIONS The use of a transperineal biopsy approach improved histopathological concordance rates compared to the use of a transrectal biopsy approach. A transperineal biopsy approach may provide more accurate risk stratification for clinical decision-making. Despite recent improvements, histopathologic concordance remains suboptimal and should be considered before initiating management.
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Affiliation(s)
- M J Hagens
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands.
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands.
| | - L L A Ribbert
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - A Jager
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - H Veerman
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - K Barwari
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Andros Clinics, Amsterdam, the Netherlands
| | - B Boodt
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Flevoziekenhuis, Almere, the Netherlands
| | - R E de Bruijn
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Ziekenhuis Amstelland, Amstelveen, the Netherlands
| | - A Claessen
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
| | - M R Leter
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - V van der Noort
- Department of Statistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Smeenge
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, St Jansdal Ziekenhuis, Harderwijk, the Netherlands
| | - T A Roeleveld
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - S P Rynja
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - M Schaaf
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, BovenIJ Ziekenhuis, Amsterdam, the Netherlands
| | - S Weltings
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
- Department of Urology, Zaans Medisch Centrum, Zaandam, the Netherlands
| | - A N Vis
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
| | - E Bekers
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - P J van Leeuwen
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
| | - H G van der Poel
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands
- Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands
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9
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Luining WI, Boevé LMS, Hagens MJ, Meijer D, de Weijer T, Ettema RH, Knol RJJ, Roeleveld TA, Srbljin S, Weltings S, Koppes JCC, van Moorselaar RJA, van Leeuwen PJ, Cysouw MCF, Oprea-Lager DE, Vis AN. A Comparison of Globally Applied Prognostic Risk Groups and the Prevalence of Metastatic Disease on Prostate-specific Membrane Antigen Positron Emission Tomography in Patients with Newly Diagnosed Prostate Cancer. Eur Urol Oncol 2024:S2588-9311(24)00097-X. [PMID: 38693019 DOI: 10.1016/j.euo.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/13/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Various risk classification systems (RCSs) are used globally to stratify newly diagnosed patients with prostate cancer (PCa) into prognostic groups. OBJECTIVE To compare the predictive value of different prognostic subgroups (low-, intermediate-, and high-risk disease) within the RCSs for detecting metastatic disease on prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) for primary staging, and to assess whether further subdivision of subgroups would be beneficial. DESIGN, SETTING, AND PARTICIPANTS Patients with newly diagnosed PCa, in whom PSMA-PET/CT was performed between 2017 and 2022, were studied retrospectively. Patients were stratified into risk groups based on four RCSs: European Association of Urology, National Comprehensive Cancer Network (NCCN), Cambridge Prognostic Group (CPG), and Cancer of the Prostate Risk Assessment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The prevalence of metastatic disease on PSMA-PET/CT was compared among the subgroups within the four RCSs. RESULTS AND LIMITATIONS In total, 2630 men with newly diagnosed PCa were studied. Any metastatic disease was observed in 35% (931/2630) of patients. Among patients classified as having intermediate- and high-risk disease, the prevalence of metastases ranged from approximately 12% to 46%. Two RCSs further subdivided these groups. According to the NCCN, metastatic disease was observed in 5.8%, 13%, 22%, and 62% for favorable intermediate-, unfavorable intermediate-, high-, and very-high-risk PCa, respectively. Regarding the CPG, these values were 6.9%, 13%, 21%, and 60% for the corresponding risk groups. CONCLUSIONS This study underlines the importance of nuanced risk stratification, recommending the further subdivision of intermediate- and high-risk disease given the notable variation in the prevalence of metastatic disease. PSMA-PET/CT for primary staging should be reserved for patients with unfavorable intermediate- or higher-risk disease. PATIENT SUMMARY The use of various risk classification systems in patients with prostate cancer helps identify those at a higher risk of having metastatic disease on prostate-specific membrane antigen positron emission tomography/computed tomography for primary staging.
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Affiliation(s)
- Wietske I Luining
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands.
| | | | - Marinus J Hagens
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands
| | - Tessa de Weijer
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rosemarijn H Ettema
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Ton A Roeleveld
- Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department Urology, Northwest Clinics, Alkmaar, The Netherlands
| | - Sandra Srbljin
- Department of Nuclear Medicine, Zaans Medical Center, Zaandam, The Netherlands
| | - Saskia Weltings
- Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Zaans Medical Center, Zaandam, The Netherlands
| | - Jose C C Koppes
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Reindert J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Matthijs C F Cysouw
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands
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10
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Diamand R, Guenzel K, Mjaess G, Lefebvre Y, Ferriero M, Simone G, Fourcade A, Fournier G, Bui AP, Taha F, Oderda M, Gontero P, Rysankova K, Bernal-Gomez A, Mastrorosa A, Roche JB, Fiard G, Abou Zahr R, Ploussard G, Windisch O, Novello Q, Benamran D, Delavar G, Anract J, Barry Delongchamps N, Halinski A, Dariane C, Benijts J, Assenmacher G, Roumeguère T, Peltier A. Transperineal or Transrectal Magnetic Resonance Imaging-targeted Biopsy for Prostate Cancer Detection. Eur Urol Focus 2024:S2405-4569(24)00047-6. [PMID: 38508895 DOI: 10.1016/j.euf.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND OBJECTIVE A notable paradigm shift has emerged in the choice of prostate biopsy approach, with a transition from transrectal biopsy (TRBx) to transperineal biopsy (TPBx) driven by the lower risk of severe urinary tract infections. The impact of this change on detection of clinically significant prostate cancer (csPCa) remains a subject of debate. Our aim was to compare the csPCa detection rate of TRBx and TPBx. METHODS Patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies for clinically localized PCa at 15 European referral centers from 2016 to 2023 were included. A propensity score matching (PSM) analysis was performed to minimize selection biases. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). KEY FINDINGS AND LIMITATIONS Of 3949 patients who met the study criteria, 2187 underwent TRBx and 1762 underwent TPBx. PSM resulted in 1301 matched pairs for analysis. Patient demographics and tumor characteristics were comparable in the matched cohorts. TPBx versus TRBx was associated with greater detection of csPCa, whether defined as International Society of Urological Pathology grade group ≥2 (51% vs 45%; OR 1.37, 95% CI 1.15-1.63; p = 0.001) or grade group ≥3 (29% vs 23%; OR 1.38, 95% CI 1.13-1.67; p = 0.001). Similar results were found when considering MRI-targeted biopsy alone and after stratifying patients according to tumor location, Prostate Imaging-Reporting and Data System score, and clinical features. Limitations include the retrospective nature of the study and the absence of centralized MRI review. CONCLUSIONS Our findings bolster existing understanding of the additional advantages offered by TPBx. Further randomized trials to fully validate these findings are awaited. PATIENT SUMMARY We compared the rate of detection of clinically significant prostate cancer with magnetic resonance imaging (MRI)-guided biopsies in which the sample needle is passed through the perineum or the rectum. Our results suggest that the perineal approach is associated with better detection of aggressive prostate cancer.
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Affiliation(s)
- Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - Karsten Guenzel
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | - Georges Mjaess
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Yolène Lefebvre
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | | | - Fayek Taha
- Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Marco Oderda
- Department of Urology, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Katerina Rysankova
- Department of Urology, University Hospital Ostrava, Ostrava, Czechia; Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava, Czechia
| | | | | | | | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France
| | - Rawad Abou Zahr
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Quentin Novello
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Gina Delavar
- Departement of Urology, Hôpital Cochin, Paris, France
| | - Julien Anract
- Departement of Urology, Hôpital Cochin, Paris, France
| | | | - Adam Halinski
- Department of Urology, Klinika Wisniowa, Zielona Góra, Poland
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Jan Benijts
- Department of Urology, Cliniques de l'Europe-Saint Elisabeth, Brussels, Belgium
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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11
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Yang Y, He X, Zeng Y, Lu Q, Li Y. The learning curve and experience of a novel multi-modal image fusion targeted transperineal prostate biopsy technique using electromagnetic needle tracking under local anesthesia. Front Oncol 2024; 14:1361093. [PMID: 38529371 PMCID: PMC10962208 DOI: 10.3389/fonc.2024.1361093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
Background Prostate cancer is the most common malignant tumor of male genitourinary system, and the gold standard for its diagnosis is prostate biopsy. Focusing on the methods and skills of prostate biopsy, we explored the learning curve and experience of a novel magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) image fusion transperineal biopsy (TPB) technique using electromagnetic needle tracking under local anesthesia. Methods The clinical and pathological data of 92 patients who underwent targeted TPB from January 2023 to July 2023 in our center were prospectively collected. The cumulative sum (CUSUM) analysis method and the best fitting curve were used to analyze the learning curve of this novel technique, and the clinical characteristics, perioperative data and tumor positive rate of prostate biopsy of patients at different stages of the learning curve were compared. Results With the increase of the number of surgical cases, the overall operative time showed a downward trend. The best fitting curve of CUSUM reached its peak at the twelfth case, which is the minimum cumulative number of surgical cases needed to cross the learning curve of the operation. Taking this as the boundary, the learning curve is divided into two stages: learning improvement stage (group A, 12 cases) and proficiency stage (group B, 80 cases). The surgical time and visual analog scale score during prostate biopsy in group A were significantly higher than those in group B. The visual numerical scale score during prostate biopsy in group A was significantly lower than that in group B. There was no statistically significant difference between group A and group B in the detection rate of csPCa and the incidence of perioperative complications. Conclusion The novel targeted TPB technique is divided into learning improvement stage and proficiency stage, and 12 cases may be the least cumulative number.
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Affiliation(s)
| | | | | | - Qiang Lu
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Yuanwei Li
- Department of Urology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
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12
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Chung Y, Hong SK. Shifting to transperineal prostate biopsy: A narrative review. Prostate Int 2024; 12:10-14. [PMID: 38523899 PMCID: PMC10960089 DOI: 10.1016/j.prnil.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 03/26/2024] Open
Abstract
To address the limitations and challenges associated with transrectal (TR) biopsy and to present transperineal (TP) biopsy as a viable and potentially safer alternative to TR biopsy. Prostate cancer (PCa) is a significant global health concern. The prevalence of advanced-stage prostate cancer in Asia is higher than that in the United States, emphasizing the need for effective screening and diagnosis methods. The gold standard of diagnosis is a TR biopsy. However, it has limitations due to the risk of infection and potential complications, such as injury to the rectal artery. Efforts have been made to address issues such as false-negative biopsies, under-sampling, and over-sampling through MRI-guided biopsies. However, the TR approach makes it difficult to access the apical and anterior regions of the prostate. TP biopsy has emerged as an alternative to address the limitations of TR biopsy. Nevertheless, a TP biopsy is a painful procedure, requiring the use of general anesthesia and expensive equipment. As a result, it has been perceived as costly and time-consuming. In addition, it requires a steep learning curve. The introduction of local anesthesia such as pudendal nerve block and the adoption of freehand techniques have contributed to the feasibility of performing TP biopsy. Recent research indicates that freehand TP biopsy can yield comparable diagnostic results to template-guided approaches. The diagnostic performance, cancer detection rates, and complication rates of TP biopsy have demonstrated its potential as a safe and effective diagnostic method.
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Affiliation(s)
- Younsoo Chung
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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13
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Mukherjee S, Papadopoulos D, Chari N, Ellis D, Charitopoulos K, Charitopoulos I, Bishara S. High-grade prostate cancer demonstrates preferential growth in the cranio-caudal axis and provides discrimination of disease grade in an MRI parametric model. Br J Radiol 2024; 97:574-582. [PMID: 38276882 PMCID: PMC11027337 DOI: 10.1093/bjr/tqad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To determine if multiparametric MRI prostate cancer (PC) lesion dimensions in different axes could distinguish between PC, grade group (GG) >2, and GG >3 on targeted transperineal biopsy and create and validate a predictive model on a separate cohort. METHODS The maximum transverse, anterio-posterior, and cranio-caudal lesion dimensions were assessed against the presence of any cancer, GG >2, and GG >3 on biopsy by binary logistic regression. The optimum multivariate models were evaluated on a separate cohort. RESULTS One hundred and ninety-three lesions from 148 patients were evaluated. Increased lesion volume, Prostate Specific Antigen (PSA), Prostate Imaging Reporting and Data System score, and decreased Apparent Diffusion Coefficient (ADC) were associated with increased GG (P < .001). The ratio of cranio-caudal to anterior-posterior lesion dimension increased from 1.20 (95% CI, 1.14-1.25) for GG ≤ 3 to 1.43 (95% CI, 1.28-1.57) for GG > 3 (P = .0022). The cranio-caudal dimension of the lesion was the strongest predictor of GG >3 (P = .000, area under the receiver operator characteristic curve [AUC] = 0.81). The best multivariate models had an AUC of 0.84 for cancer, 0.88 for GG > 2, and 0.89 for GG > 3. These models were evaluated on a separate cohort of 40 patients with 61 lesions. They demonstrated an AUC, sensitivity, and specificity of 0.82, 82.3%, and 55.5%, respectively, for the detection of cancer. For GG > 2, the models achieved an AUC of 0.84, sensitivity of 91.7%, and specificity of 69.4%. Additionally, for GG > 3, the models showed an AUC of 0.92, sensitivity of 88.9%, and specificity of 98.1%. CONCLUSIONS Cranio-caudal lesion dimension when used in conjunction with other parameters can create a model superior to the Prostate Imaging Reporting and Data Systems score in predicting cancer. ADVANCES IN KNOWLEDGE Higher-grade PC has a propensity to grow in the cranio-caudal direction, and this could be factored into MRI-based predictive models of prostate biopsy grade.
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Affiliation(s)
- Subhabrata Mukherjee
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Dimitrios Papadopoulos
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Natasha Chari
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - David Ellis
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Konstantinos Charitopoulos
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Ivo Charitopoulos
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
| | - Samuel Bishara
- Department of Urology, West Middlesex Hospital, Chelsea and Westminster NHS Trust, Twickenham Road, London, TW7 6AF, United Kingdom
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14
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Turchi B, Lombardo R, Franco A, Tema G, Nacchia A, Cicione A, Pastore AL, Carbone A, Fuschi A, Franco G, Tubaro A, De Nunzio C. Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial. Curr Oncol 2024; 31:747-758. [PMID: 38392049 PMCID: PMC10887997 DOI: 10.3390/curroncol31020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient's discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients' experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Cosimo De Nunzio
- Department of Urology, Sapienza University of Rome, 00100 Rome, Italy; (B.T.); (R.L.); (A.F.); (G.T.); (A.N.); (A.C.); (A.L.P.); (A.C.); (A.F.); (G.F.); (A.T.)
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15
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Uleri A, Baboudjian M, Tedde A, Gallioli A, Long-Depaquit T, Palou J, Basile G, Gaya JM, Sanguedolce F, Lughezzani G, Rajwa P, Pradere B, Roupret M, Briganti A, Ploussard G, Breda A. Is There an Impact of Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsy in Clinically Significant Prostate Cancer Detection Rate? A Systematic Review and Meta-analysis. Eur Urol Oncol 2023; 6:621-628. [PMID: 37634971 DOI: 10.1016/j.euo.2023.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
CONTEXT It is unclear whether a magnetic resonance imaging (MRI)-targeted transperineal (TP) biopsy can improve the detection of clinically significant prostate cancer (csPCa). OBJECTIVE To compare the MRI-targeted TP and transrectal (TR) approaches for csPCa detection. EVIDENCE ACQUISITION A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify reports published until February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was the detection of csPCa (Gleason grade group ≥2). Sensitivity analyses were performed to investigate csPCa detection rates according to tumor location, Prostate Imaging Reporting and Data System (PI-RADS) score, and type of fusion (cognitive or software based). EVIDENCE SYNTHESIS Eleven studies met our inclusion criteria, and data from 3522 and 5140 patients who underwent, respectively, TR and TP MRI-targeted biopsies were reviewed. No statistically significant difference in the detection of csPCa was observed between the TR and TP approaches (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.98-1.25; p = 0.1). When stratifying patients according to lesion location, the TP approach was associated with higher csPCa detection in case of anterior (OR 2.17, 95% CI 1.46-3.22; p < 0.001) and apical (OR 1.86, 95% CI 1.14-3.03; p = 0.01) lesions. In the subgroup analysis based on PI-RADS score, the TP approach was associated with higher csPCa detection (OR 1.57, 95% CI 1.07-2.29; p = 0.02) in PI-RADS 4 lesions. Conversely, no difference was found in PI-RADS 3 and 5 lesions (p > 0.05). The main limitation was the retrospective design of most included studies. CONCLUSIONS No significant association was found between the prostate biopsy approach and csPCa detection rate when we considered all biopsy indications. The TP approach provides a detection advantage in anterior and apical tumors, arguing for a preferred use of the TP approach in these lesion locations. PATIENT SUMMARY The transperineal magnetic resonance imaging-targeted prostate biopsy approach appears to be more effective only for selected lesions. No clear benefit was seen for the transperineal approach in the overall population.
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Affiliation(s)
- Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology IRCCS Humanitas Research Hospital Rozzano Milan Italy
| | - Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Morgan Roupret
- GRC 5 Predictive Onco-Uro, Department of Urology, AP-HP, Pitié Salpétrière Hospital, Sorbonne University, Paris, France
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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16
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Ito M, Yonese I, Toide M, Ikuta S, Kobayashi S, Koga F. Superior detection of significant prostate cancer by transperineal prostate biopsy using MRI-transrectal ultrasound fusion image guidance over cognitive registration. Int J Clin Oncol 2023; 28:1545-1553. [PMID: 37606785 DOI: 10.1007/s10147-023-02404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The BioJet system allows the fusion of magnetic resonance imaging (MRI) images with real-time transrectal ultrasonography to accurately direct biopsy needles to the target lesions. To date, the superiority of targeted biopsy using the BioJet system over cognitive registration remains unknown. METHODS This retrospective study included 171 biopsy-naïve men with elevated prostate-specific antigen (2.5-20 ng/mL) and MRI-positive lesions; 74 and 97 men underwent a four-core targeted biopsy per MRI-positive target lesion and a 14-core systematic biopsy transperineally using the BioJet system and cognitive registration, respectively. Detection rates of significant cancer, defined as grade group ≥ 2 or maximum cancer length ≥ 5 mm, were compared between the BioJet system and cognitive registration using propensity score matching and a multivariate logistic regression model. RESULTS After propensity score matching (67 men for each group), the detection rates of significant cancer were significantly higher in the BioJet group than in the cognitive group for both targeted (76% vs. 46%, P = 0.002) and systematic (70% vs. 46%, P = 0.018) biopsy. Multivariate analysis of the entire cohort also showed that the BioJet system was independently associated with significant cancer detection by targeted and systematic biopsy (P < 0.01), along with a higher prostate-specific antigen density and a higher prostate imaging reporting and data system score. CONCLUSIONS Transperineal prostate biopsy using the BioJet system is superior to cognitive registration in detecting significant cancer for targeted and systematic biopsies.
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Affiliation(s)
- Masaya Ito
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan.
| | - Ichiro Yonese
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Shuzo Ikuta
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shuichiro Kobayashi
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
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17
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Hogenhout R, Remmers S, van Leenders GJLH, Roobol MJ. The transition from transrectal to transperineal prostate biopsy without antibiotic prophylaxis: Cancer detection rates and complication rates. Prostate Cancer Prostatic Dis 2023; 26:581-587. [PMID: 36631536 DOI: 10.1038/s41391-022-00641-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Currently, transperineal prostate biopsy (TPB) is preferred over transrectal biopsy (TRB) because of less infectious complications and improved clinically significant prostate cancer (csPCa) detection. However, literature on omitting antibiotic prophylaxis (AP) is limited. Furthermore, previous studies did not include invasive cribriform growth/intraductal carcinoma (CR/IDC) in the definition of csPCa. Therefore, we compared the infectious complication rates between TPB without AP and TRB with AP, and we compared the csPCa detection rates between TPB and TRB including CR/IDC in the definition of csPCa. METHODS We included 729 men who were referred to Erasmus MC Cancer Institute between 2013-2019 for MRI/TRUS fusion-guided prostate biopsy. Up to 2019, TRB was performed with AP, thereafter TPB was performed without AP. Data on complications were collected prospectively. We compared csPCa detection rates between the biopsy routes using multivariable logistic regressions for men without previous PCa diagnosis and mixed logistic regression for men on active surveillance. To compare the csPCa detection rates in anterior and apical lesions, and the complications rates between the biopsy routes, we used the chi-square test. RESULTS Overall, we found no difference in csPCa detection between TPB and TRB (odds ratio 1.0, 95%-confidence interval (CI) 0.62-1.76, p = 0.9; for men on active surveillance: odds ratio 1.05, 95%-CI 0.58-1.88, p = 0.9). This was confirmed in anterior and apical lesions although absolute numbers were low. TPB reduced infectious complications with fever compared to TRB (1.1% vs 5.1%, difference = 4.0%, 95%-CI 1.0-7.9, p = 0.010). CONCLUSIONS TPB has no different csPCa detection rate from TRB taking CR/IDC into account. TPB is, however, preferable because of less infectious complications, even if AP is omitted.
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Affiliation(s)
- Renée Hogenhout
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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18
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Wilson PFR, Gilany M, Jamzad A, Fooladgar F, To MNN, Wodlinger B, Abolmaesumi P, Mousavi P. Self-Supervised Learning With Limited Labeled Data for Prostate Cancer Detection in High-Frequency Ultrasound. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1073-1083. [PMID: 37478033 DOI: 10.1109/tuffc.2023.3297840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Deep learning-based analysis of high-frequency, high-resolution micro-ultrasound data shows great promise for prostate cancer (PCa) detection. Previous approaches to analysis of ultrasound data largely follow a supervised learning (SL) paradigm. Ground truth labels for ultrasound images used for training deep networks often include coarse annotations generated from the histopathological analysis of tissue samples obtained via biopsy. This creates inherent limitations on the availability and quality of labeled data, posing major challenges to the success of SL methods. However, unlabeled prostate ultrasound data are more abundant. In this work, we successfully apply self-supervised representation learning to micro-ultrasound data. Using ultrasound data from 1028 biopsy cores of 391 subjects obtained in two clinical centers, we demonstrate that feature representations learned with this method can be used to classify cancer from noncancer tissue, obtaining an AUROC score of 91% on an independent test set. To the best of our knowledge, this is the first successful end-to-end self-SL (SSL) approach for PCa detection using ultrasound data. Our method outperforms baseline SL approaches, generalizes well between different data centers, and scales well in performance as more unlabeled data are added, making it a promising approach for future research using large volumes of unlabeled data. Our code is publicly available at https://www.github.com/MahdiGilany/SSL_micro_ultrasound.
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19
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Kaneko M, Medina LG, Lenon MSL, Hemal S, Sayegh AS, Jadvar DS, Ramacciotti LS, Paralkar D, Cacciamani GE, Lebastchi AH, Salhia B, Aron M, Hopstone M, Duddalwar V, Palmer SL, Gill IS, Abreu AL. Transperineal vs transrectal magnetic resonance and ultrasound image fusion prostate biopsy: a pair-matched comparison. Sci Rep 2023; 13:13457. [PMID: 37596374 PMCID: PMC10439224 DOI: 10.1038/s41598-023-40371-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
The objective of this study was to compare transperineal (TP) versus transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (PBx). Consecutive men who underwent prostate MRI followed by a systematic biopsy. Additional target biopsies were performed from Prostate Imaging Reporting & Data System (PIRADS) 3-5 lesions. Men who underwent TP PBx were matched 1:2 with a synchronous cohort undergoing TR PBx by PSA, Prostate volume (PV) and PIRADS score. Endpoint of the study was the detection of clinically significant prostate cancer (CSPCa; Grade Group ≥ 2). Univariate and multivariable analyses were performed. Results were considered statistically significant if p < 0.05. Overall, 504 patients met the inclusion criteria. A total of 168 TP PBx were pair-matched to 336 TR PBx patients. Baseline demographics and imaging characteristics were similar between the groups. Per patient, the CSPCa detection was 2.1% vs 6.3% (p = 0.4) for PIRADS 1-2, and 59% vs 60% (p = 0.9) for PIRADS 3-5, on TP vs TR PBx, respectively. Per lesion, the CSPCa detection for PIRADS 3 (21% vs 16%; p = 0.4), PIRADS 4 (51% vs 44%; p = 0.8) and PIRADS 5 (76% vs 84%; p = 0.3) was similar for TP vs TR PBx, respectively. However, the TP PBx showed a longer maximum cancer core length (11 vs 9 mm; p = 0.02) and higher cancer core involvement (83% vs 65%; p < 0.001) than TR PBx. Independent predictors for CSPCa detection were age, PSA, PV, abnormal digital rectal examination findings, and PIRADS 3-5. Our study demonstrated transperineal MRI/TRUS fusion PBx provides similar CSPCa detection, with larger prostate cancer core length and percent of core involvement, than transrectal PBx.
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Affiliation(s)
- Masatomo Kaneko
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Luis G Medina
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Maria Sarah L Lenon
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sij Hemal
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Aref S Sayegh
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Donya S Jadvar
- Dornsife School of Letters and Science, University of Southern California, Los Angeles, CA, USA
| | - Lorenzo Storino Ramacciotti
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Divyangi Paralkar
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amir H Lebastchi
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle Hopstone
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Suzanne L Palmer
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Andre Luis Abreu
- Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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20
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Hu J, Zhu A, Vickers A, Allaf ME, Ehdaie B, Schaeffer A, Pavlovich C, Ross AE, Green DA, Wang G, Ginzburg S, Montgomery JS, George A, Graham JN, Ristau BT, Correa A, Shoag JE, Kowalczyk KJ, Zhang TR, Schaeffer EM. Protocol of a multicentre randomised controlled trial assessing transperineal prostate biopsy to reduce infectiouscomplications. BMJ Open 2023; 13:e071191. [PMID: 37208135 DOI: 10.1136/bmjopen-2022-071191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of postbiopsy infection is increasing due to increasing antibiotic resistance of rectal flora. Single-centre studies suggest that a clean, percutaneous transperineal approach to prostate biopsy may have a lower risk of infection. To date, there is no high-level evidence comparing transperineal versus transrectal prostate biopsy. We hypothesise that transperineal versus transrectal prostate biopsy under local anaesthesia has a significantly lower risk of infection, similar pain/discomfort levels and comparable detection of non-low-grade prostate cancer. METHODS AND ANALYSIS We will perform a multicentre, prospective randomised clinical trial to compare transperineal versus transrectal prostate biopsy for elevated prostate-specific antigen in the first biopsy, prior negative biopsy and active surveillance biopsy setting. Prostate MRI will be performed prior to biopsy, and targeted biopsy will be conducted for suspicious MRI lesions in addition to systematic biopsy (12 cores). Approximately 1700 men will be recruited and randomised in a 1:1 ratio to transperineal versus transrectal biopsy. A streamlined design to collect data and to determine trial eligibility along with the two-stage consent process will be used to facilitate subject recruitment and retention. The primary outcome is postbiopsy infection, and secondary outcomes include other adverse events (bleeding, urinary retention), pain/discomfort/anxiety and critically, detection of non-low-grade (grade group ≥2) prostate cancer. ETHICS AND DISSEMINATION The Institutional Review Board of the Biomedical Research Alliance of New York approved the research protocol (protocol number #18-02-365, approved 20 April 2020). The results of the trial will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT04815876.
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Affiliation(s)
- Jim Hu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Alec Zhu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Andrew Vickers
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Behfar Ehdaie
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christian Pavlovich
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David A Green
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Gerald Wang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Serge Ginzburg
- Einstein Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Arvin George
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - John N Graham
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Benjamin T Ristau
- Department of Surgery, Division of Urology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Andres Correa
- Department of Surgical Oncology, Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jonathan E Shoag
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Tenny R Zhang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - E M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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21
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Girometti R, Giannarini G, Peruzzi V, Amparore D, Pizzolitto S, Zuiani C. MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition. Eur J Radiol 2023; 164:110852. [PMID: 37167683 DOI: 10.1016/j.ejrad.2023.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Quality is currently recognized as the pre-requisite for delivering the clinical benefits expected by magnetic resonance imaging (MRI)-informed prostate biopsy (MRI-i-PB) in patients with a suspicion for clinically significant prostate cancer (csPCa). The "quality chain" underlying MRI-i-PB is multidisciplinary in nature, and depends on several factors related to the patient, imaging technique, image interpretation and biopsy procedure. This review aims at making the radiologist aware of biopsy-related factors impacting on MRI-i-PB quality, both in terms of biopsy planning (threshold for biopsy decisions, association with systematic biopsy and number of targeted cores) and biopsy acquisition (biopsy route, targeting technique, and operator's experience). While there is still space for improvement and better standardization of several biopsy-related procedures, current evidence suggests that high-quality MRI-i-PB can be delivered by acquiring and increased the number of biopsy cores targeted to suspicious imaging findings and perilesional area ("focal saturation biopsy"). On the other hand, uncertainty still exists as to whether software-assisted fusion of MRI and transrectal ultrasound images can outperform cognitive fusion strategy. The role for operator's experience and quality assurance/quality control procedures are also discussed.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Torino, Italy.
| | - Stefano Pizzolitto
- Unit of Pathology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
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22
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Wilcox Vanden Berg RN, George AK, Kaye DR. Should Transperineal Prostate Biopsy Be the Standard of Care? Curr Urol Rep 2023; 24:135-142. [PMID: 36512186 DOI: 10.1007/s11934-022-01139-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW We reviewed the advantages and disadvantages of transperineal prostate biopsy (TP-bx) to evaluate its potential role as the standard of care for prostate biopsy. RECENT FINDINGS Studies have suggested no difference in prostate cancer (PCa) detection rate between TP-bx and transrectal biopsy (TR-bx) but have suggested potentially increased detection of anterior prostate tumors. Advances in anesthetic technique have obviated the need for sedation thus allowing TP-bx to become an office-based procedure, which in turn can decrease the overall cost of TP-bx. Furthermore, given the low rate of infectious complications after TP-bx, some have foregone peri-procedural antibiotics without a change in the rate of infectious complications. Recent procedural advances have made TP-bx a tolerable, office-based procedure. Given the similar diagnostic performance and the benefits for the patient and community, TP-bx should become the standard of care for prostate biopsy for most patients. Future efforts should address the barriers for more universal adoption.
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Affiliation(s)
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Deborah R Kaye
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA. .,Duke-Margolis Center for Public Policy, Duke University, Durham, NC, USA. .,Duke Clinical Research Institute, Durham, NC, USA. .,Duke Cancer Institute, Duke Cancer Center/Clinic 5-1, 20 Duke Medicine Circle Durham, Durham, NC, 27710, USA.
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23
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Zhao CC, Rossi JK, Wysock JS. Systematic Review and Meta-Analysis of Free-Hand and Fixed-Arm Spatial Tracking Methodologies in Software-Guided MRI-TRUS Fusion Prostate Biopsy Platforms. Urology 2023; 171:16-22. [PMID: 36243143 DOI: 10.1016/j.urology.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the cancer detection rate (CDR) between the 2 dominant spatial tracking methodologies in software-guided MRI-transrectal ultrasound fusion prostate biopsy (SGF-Bx) platforms: fixed-arm and free-hand. METHODS We conducted a systematic review and meta-analysis on published primary analyses of prospective trials and cohort studies that enrolled biopsy-naïve patients for SFG-Bx. Inclusion criteria included the use of the Prostate Imaging Reporting & Data System (PI-RADS) v2.0 or later and the targeting of lesions graded as PI-RADS 3 or higher. Random effects models were used to assess the overall prostate cancer (PCa) CDR and the clinically significant prostate cancer (csPCa) CDR for both platforms. csPCa was standardized to a definition of Gleason Grade Group 2 or higher when possible. Subgroup analysis was performed by stratifying studies into the average number of cores taken per lesion. RESULTS The PCa CDR was 0.674 for free-hand systems and 0.681 for fixed-arm systems. The csPCa CDR was 0.492 for free-hand systems and 0.500 for fixed-hand systems. There was no significant difference between free-hand and fixed-arm cancer detection rates for both overall PCa (P = .88) and csPCa (P = .90). Subgroup analyses revealed significant PCa CDR and csPCa CDR differences (P < .001) between free-hand and fixed-arm platforms only when 2 cores per lesion were taken, in favor of fixed-arm platforms. CONCLUSIONS Fixed-arm platforms performed similarly in cancer detection to free-hand platforms but show a minor benefit on fewer samples. While tracking methodology differences appear subtle, further investigation into the clinical impact of platform-specific features are warranted.
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Affiliation(s)
- Calvin C Zhao
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA
| | - Juan Kochen Rossi
- Department of Urology, New York University Grossman School of Medicine, New York, NY
| | - James S Wysock
- Department of Urology, New York University Grossman School of Medicine, New York, NY.
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24
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Qi F, Xu W, Li L, Li X, Xu Z. Evaluation of the role of local therapy in patients with cN1M0 prostate cancer: A population-based study from the SEER database. Front Oncol 2022; 12:1050317. [PMID: 36544700 PMCID: PMC9760928 DOI: 10.3389/fonc.2022.1050317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/17/2022] [Indexed: 12/07/2022] Open
Abstract
Objective To investigate the prognostic value of local therapy (LT) in cN1M0 prostate cancer (PCa). Methods Patients diagnosed with cN1M0 PCa were extracted from the surveillance, epidemiology, and end results (SEER) database. Kaplan-Meier (KM) curve was used to compare the survival outcomes between patients treated with and without LT. Further, among patients receiving LT, KM analysis was also applied to investigate the survival differences in patients with radical prostatectomy (RP) and radiation therapy (RT). Propensity score matching (PSM) analysis was performed to balance the basic characteristics of patients in each group and make it comparable when exploring the survival impact of different treatment types. Finally, uni- and multivariable Cox proportional-hazards models were utilized to identify independent prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS) in this population. Results Patients treated with LT had significantly better OS (P<0.0001) and CSS (P<0.0001) than those without LT, as well as in most subgroups, except for non-White patients, or those with ISUP grade group 1 or T3 stage. Notably, patients receiving RP also had significantly better OS (P=0.00012) and CSS (P=0.0045) than those treated with RT alone, especially in those aged ≥75 years old, prostate-specific antigen (PSA) 10-20 ng/mL, ISUP grade 1-3 or non-white patients. Finally, clinical T stage, ISUP grade group and the administration of LT were identified to be independent prognostic factors for OS and CSS among cN1M0 PCa patients. Conclusion The cN1M0 PCa patients treated with LT were associated with significantly better survival. Among patients receiving LT, the combination of RP and PLND could lead to a better prognosis compared to RT alone in most subgroups. An individualized treatment strategy is warranted to be developed after weighing the benefits and risks of treatment.
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Affiliation(s)
- Feng Qi
- Department of Urologic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbo Xu
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Lu Li
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Xiao Li
- Department of Urologic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,Department of Scientific Research, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Zicheng Xu, ; Xiao Li,
| | - Zicheng Xu
- Department of Urologic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Zicheng Xu, ; Xiao Li,
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25
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Gandaglia G, Giannarini G, Stabile A, Montorsi F, Briganti A. Should we combine systematic with MRI-targeted biopsy? Implications for the management of patients with prostate cancer. Eur Radiol 2022; 32:7488-7490. [PMID: 36107203 DOI: 10.1007/s00330-022-09096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
| | - Armando Stabile
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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Touzani A, Fiard G, Barret E, Renard-Penna R, Salin A, Pradère B, Rozet F, Beauval JB, Malavaud B, Giannarini G, Colin P, Rouprêt M, Ploussard G. Clinical Trial Protocol for PERFECT: A Randomised Controlled Trial Comparing the Efficiency and Tolerance of Transperineal Fusion Versus Transrectal Imaging-targeted Prostate Biopsies (CCAFU-PR1 Study). EUR UROL SUPPL 2022; 45:76-80. [PMID: 36217451 PMCID: PMC9547228 DOI: 10.1016/j.euros.2022.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/18/2022] Open
Abstract
PERFECT is a multicentre randomised controlled clinical trial that evaluates the efficiency of fusion magnetic resonance imaging-targeted biopsies in the transperineal (TP) versus transrectal (TR) approach in terms of the detection of significant cancers. Our study builds on the hypothesis that the TP approach for prostate biopsies has at least the same diagnostic accuracy as the TR approach, with lower morbidity. Here, we describe the clinical protocol, study population, and primary and secondary outcomes.
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Affiliation(s)
- Alae Touzani
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
- Corresponding author. La Croix du Sud Hospital, 52, Chemin de Ribaute, 31130 Quint Fonsegrives, France. Tel. +33 5 32027202; Fax: +33 5 32027203.
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
| | - Benjamin Pradère
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
| | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Baptiste Beauval
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer-Oncopole, Toulouse, France
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia Academic Medical Centre, Udine, Italy
| | - Pierre Colin
- Department of Urology, Clinique La Louvière, Lille, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Guillaume Ploussard
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
- IUCT-O, Toulouse, France
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Koparal MY, Sözen TS, Karşıyakalı N, Aslan G, Akdoğan B, Şahin B, Türkeri L. Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association. Prostate 2022; 82:425-432. [PMID: 34927740 DOI: 10.1002/pros.24288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. PATIENTS AND METHODS This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with ≥3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. RESULTS The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). CONCLUSION Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.
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Affiliation(s)
| | - Tevfik Sinan Sözen
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
| | - Nejdet Karşıyakalı
- Department of Urology, School of Medicine, Acıbadem University, İstanbul, Turkey
| | - Güven Aslan
- Department of Urology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bülent Akdoğan
- Department of Urology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bahadır Şahin
- Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Levent Türkeri
- Department of Urology, School of Medicine, Acıbadem University, İstanbul, Turkey
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Kotamarti S, George A, Zhu A, Polascik TJ. Transrectal Ultrasound-Guided Biopsy Should Continue to Be a Standard of Care for The Detection of Prostate Cancer. Urology 2022; 164:21-24. [PMID: 35038489 DOI: 10.1016/j.urology.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022]
Abstract
For men choosing to screen for prostate cancer (PCa), biopsy remains critical for diagnosis. While transrectal ultrasound-guided (TRUS) biopsy has been the standard of care for many years, recent concerns regarding post-procedural infection have led to increased interest in prostatic sampling via the transperineal (TP) approach. However, TRUS biopsy features important patient-related and physician/practice-related advantages compared to the TP method, and there are several useful strategies to effectively mitigate infectious concerns. The benefits associated with TRUS biopsy, particularly patient comfort and efficient clinical workflow, are further accentuated by several key shortcomings associated with switching to the TP approach. Herein, we present an argument in favor of maintaining TRUS biopsy as standard practice, discussing significant topics including infectious complications, practice workflow and cost, cancer detection rates, and patient experience.
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Affiliation(s)
| | - Arvin George
- Department of Urology, University of Michigan Hospital, Ann Arbor, MI
| | - Alex Zhu
- Department of Urology, University of Michigan Hospital, Ann Arbor, MI
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Devetzis K, Kum F, Popert R. Recent Advances in Systematic and Targeted Prostate Biopsies. Res Rep Urol 2021; 13:799-809. [PMID: 34805013 PMCID: PMC8598205 DOI: 10.2147/rru.s291963] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.
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Affiliation(s)
| | - Francesca Kum
- King's College School of Medicine, London, UK.,Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Richard Popert
- Department of Urology, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK
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Van Poppel H, Hogenhout R, Albers P, van den Bergh RCN, Barentsz JO, Roobol MJ. A European Model for an Organised Risk-stratified Early Detection Programme for Prostate Cancer. Eur Urol Oncol 2021; 4:731-739. [PMID: 34364829 DOI: 10.1016/j.euo.2021.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Overdiagnosis as the argument to stop prostate cancer (PCa) screening is less valid since the introduction of new technologies such as risk calculators (RCs) and magnetic resonance imaging (MRI). These new technologies result in fewer unnecessary biopsy procedures and fewer cases of both overdiagnosis and underdetection. Therefore, we can now adequately respond to the growing and urgent need for a structured risk assessment to detect PCa early. OBJECTIVE To provide expert discussion on the existing evidence for a previously published risk-stratified strategy regarding an organised population-based early detection programme for PCa. EVIDENCE ACQUISITION The proposed algorithm for early detection of PCa emerged from expert consensus by the authors based on available evidence derived from a nonsystematic review of the current literature using Medline/PubMed, Cochrane Library database, ClinicalTrials.gov, ISRCTN Registry, and the European Association of Urology guidelines on PCa. EVIDENCE SYNTHESIS Although not confirmed by the highest level of evidence, current literature and guidelines point towards an algorithm for early detection of PCa that starts with risk-based prostate-specific antigen (PSA) testing, followed by multivariable risk stratification with RCs. All men who are classified to be at intermediate and high risk are then offered prostate MRI. The combined data from RCs and MRI results can be used to select men for prostate biopsy. Low-risk men return to a risk-based safety net that includes individualised PSA-interval tests and, if necessary, repeated MRI. Depending on local availability, the use of the different risk stratification tools may be adapted. CONCLUSIONS We present a risk-stratified algorithm for an organised population-based early detection programme for clinically significant PCa. Although the proposed strategy has not yet been analysed prospectively, it exploits and may even improve the most important available benefits of "PSA-only" screening studies, while at the same time reduces unnecessary biopsies and overdiagnosis by using new risk stratification tools. PATIENT SUMMARY This paper presents a personalised strategy that enables selective early detection of prostate cancer by combining prostate-specific antigen (interval) testing' prediction models (risk calculators), and magnetic resonance imaging scans. This will likely lead to reduced prostate cancer-related morbidity and mortality, while reducing the need for prostate biopsy and limiting overdiagnosis.
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Affiliation(s)
- Hendrik Van Poppel
- Department of Development and Regeneration, University Hospital KU Leuven, Leuven, Belgium.
| | - Renée Hogenhout
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter Albers
- Department of Urology, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany; Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jelle O Barentsz
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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