1
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Knight AS, Sharma P, de Riese WTW. MRI determined prostate volume and the incidence of prostate cancer on MRI-fusion biopsy: a systemic review of reported data for the last 20 years. Int Urol Nephrol 2022; 54:3047-3054. [PMID: 36040649 DOI: 10.1007/s11255-022-03351-w] [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: 07/13/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) is a precise, systemic and advantageous imaging technique when compared to transrectal ultrasound (TRUS) which is very operator dependent. The negative correlation between prostate volume and the incidence of prostate cancer (PCa) obtained by TRUS biopsy has been well documented in the literature. The purpose of this systemic review is analyzing the reported MRI-fusion study results on prostate biopsies regarding any correlation between prostate volume and the incidence of PCa. METHODS After defining the inclusion and exclusion criteria an in-depth review were performed between 01.01.2000 and 02.08.2022 using the PubMed database and applying the "PRISMA" guidelines. RESULTS Twelve studies qualified, and all showed an inverse/negative relationship between prostate volume and incidence of PCa. Sample sizes ranged from 33 to 2767 patients in single and multi-institutional studies. All studies showed a statistically significant inverse relationship with a p value < 0.05. The graph summarizing all of studies and using Fisher's method revealed a highly significant combined p level of 0.00001. Additionally, not one single study was found showing the contrary (a positive correlation between prostate size and the incidence of PCa). CONCLUSION To our knowledge, this is the first systemic review of reported MRI-Fusion data on the incidence of PCa in correlation with prostate volume. This MRI review confirms previous TRUS-biopsy studies which demonstrated an inverse relationship between prostate volume and the incidence of PCa, and thus further supports the hypothesis that large prostates size may be protective against PCa when compared to smaller prostates.
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Affiliation(s)
- Andrew S Knight
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, 3601-4th Street STOP 7260, Lubbock, TX, 79430-7260, USA
| | - Pranav Sharma
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, 3601-4th Street STOP 7260, Lubbock, TX, 79430-7260, USA
| | - Werner T W de Riese
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, 3601-4th Street STOP 7260, Lubbock, TX, 79430-7260, USA.
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2
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Ali A, Du Feu A, Oliveira P, Choudhury A, Bristow RG, Baena E. Prostate zones and cancer: lost in transition? Nat Rev Urol 2022; 19:101-115. [PMID: 34667303 DOI: 10.1038/s41585-021-00524-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 12/16/2022]
Abstract
Localized prostate cancer shows great clinical, genetic and environmental heterogeneity; however, prostate cancer treatment is currently guided solely by clinical staging, serum PSA levels and histology. Increasingly, the roles of differential genomics, multifocality and spatial distribution in tumorigenesis are being considered to further personalize treatment. The human prostate is divided into three zones based on its histological features: the peripheral zone (PZ), the transition zone (TZ) and the central zone (CZ). Each zone has variable prostate cancer incidence, prognosis and outcomes, with TZ prostate tumours having better clinical outcomes than PZ and CZ tumours. Molecular and cell biological studies can improve understanding of the unique molecular, genomic and zonal cell type features that underlie the differences in tumour progression and aggression between the zones. The unique biology of each zonal tumour type could help to guide individualized treatment and patient risk stratification.
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Affiliation(s)
- Amin Ali
- Prostate Oncobiology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Alexander Du Feu
- Prostate Oncobiology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Pedro Oliveira
- The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,The University of Manchester, Manchester Cancer Research Centre, Manchester, UK.,Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Robert G Bristow
- The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,The University of Manchester, Manchester Cancer Research Centre, Manchester, UK.,Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Esther Baena
- Prostate Oncobiology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK. .,Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.
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3
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van Riel LAMJG, Swaan A, Mannaerts CK, van Kollenburg RAA, Savci Heijink CD, de Reijke TM, de Bruin DM, Freund JE. Image-guided in-Vivo Needle-Based Confocal Laser Endomicroscopy in the Prostate: Safety and Feasibility Study in 2 Patients. Technol Cancer Res Treat 2022; 21:15330338221093149. [PMID: 35790459 PMCID: PMC9272180 DOI: 10.1177/15330338221093149] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose: To assess the safety and technical feasibility of in-vivo needle-based forward-looking confocal laser endomicroscopy in prostate tissue. Methods: For this feasibility study, 2 patients with a suspicion of prostate cancer underwent transperineal needle-based confocal laser endomicroscopy during ultrasound-guided transperineal template mapping biopsies. After intravenous administration of fluorescein, needle-based confocal laser endomicroscopy imaging was performed with a forward-looking probe (outer diameter 0.9 mm) in 2 trajectories during a manual push-forward and pullback motion. A biopsy was taken in a coregistered parallel adjacent trajectory to the confocal laser endomicroscopy trajectory for histopathologic comparison. Peri- and postprocedural adverse events, confocal laser endomicroscopy device malfunction and procedural failures were recorded. Needle-based confocal laser endomicroscopy image quality assessment, image interpretation, and histology were performed by an experienced confocal laser endomicroscopy rater and uro-pathologist, blinded to any additional information. Results: In both patients, no peri- and post-procedural adverse events were reported following needle-based confocal laser endomicroscopy. No confocal laser endomicroscopy device malfunction nor procedural failures were reported. Within 1.5 min after intravenous administration of fluorescein, needle-based confocal laser endomicroscopy image quality was sufficient for interpretation for at least 14 min, yielding more than 5000 confocal laser endomicroscopy frames per patient. The pullback confocal laser endomicroscopy recordings and most of the push-forward recordings almost only visualized erythrocytes, being classified as non-representative. During the push-forward recordings, prostate tissue was occasionally visualized in single frames, insufficient for histopathologic comparison. Prostate carcinoma was identified by biopsy in one patient (Gleason score 4 + 3 = 7, >50%), while the biopsy from the other patient showed no malignancy. Conclusion: Needle-based confocal laser endomicroscopy imaging of in-vivo prostate tissue with a forward-looking confocal laser endomicroscopy probe is safe without device malfunctions or procedural failures. Needle-based confocal laser endomicroscopy is technically feasible, but the acquired confocal laser endomicroscopy datasets are non-representative. The confocal laser endomicroscopy images’ non-representative nature is possibly caused by bleeding artifacts, movement artifacts and a lack of contact time with the tissue of interest. A different confocal laser endomicroscopy probe or procedure might yield representative images of prostatic tissue.
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Affiliation(s)
- Luigi A M J G van Riel
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Abel Swaan
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Christophe K Mannaerts
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Rob A A van Kollenburg
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - C Dilara Savci Heijink
- Department of Pathology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Theo M de Reijke
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniel M de Bruin
- Department of Urology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Erik Freund
- Department of Pathology, 26066Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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4
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Bodar YJL, Zwezerijnen BGJC, van der Voorn PJ, Jansen BHE, Smit RS, Kol SQ, Meijer D, de Bie K, Yaqub M, Windhorst BAD, Hendrikse HNH, Vis AN, Oprea-Lager DE. Prospective analysis of clinically significant prostate cancer detection with [ 18F]DCFPyL PET/MRI compared to multiparametric MRI: a comparison with the histopathology in the radical prostatectomy specimen, the ProStaPET study. Eur J Nucl Med Mol Imaging 2021; 49:1731-1742. [PMID: 34725727 PMCID: PMC8940822 DOI: 10.1007/s00259-021-05604-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/22/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Multiparametric magnetic resonance imaging (mpMRI) is a well-established imaging method for localizing primary prostate cancer (PCa) and for guiding targeted prostate biopsies. [18F]DCFPyL positron emission tomography combined with MRI (PSMA-PET/MRI) might be of additional value to localize primary PCa. The aim of this study was to assess the diagnostic performance of [18F]DCFPyL-PET/MRI vs. mpMRI in tumour localization based on histopathology after robot-assisted radical-prostatectomy (RARP), also assessing biopsy advice for potential image-guided prostate biopsies. METHODS Thirty prospectively included patients with intermediate to high-risk PCa underwent [18F]DCFPyL-PET/MRI and mpMRI prior to RARP. Two nuclear medicine physicians and two radiologists assessed tumour localization on [18F]DCFPyL-PET/MRI and on mpMRI respectively, and gave a prostate biopsy advice (2 segments) using a 14-segment model of the prostate. The uro-pathologist evaluated the RARP specimen for clinically significant PCa (csPCa) using the same model. csPCa was defined as any PCa with Grade Group (GG) ≥ 2. The biopsy advice based on imaging was correlated with the final histology in the RARP specimen for a total-agreement analysis. An additional near-agreement correlation was performed to approximate clinical reality. RESULTS Overall, 142 of 420 (33.8%) segments contained csPCa after pathologic examination. The segments recommended for targeted biopsy contained the highest GG PCa segment in 27/30 patients (90.0%) both for [18F]DCFPyL-PET/MRI and mpMRI. Areas under the receiver operating characteristics curves (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the total-agreement detection of csPCa per segment using [18F]DCFPyL-PET/MRI were 0.70, 50.0%, 89.9%, 71.7%, and 77.9%, respectively. These results were 0.75, 54.2%, 94.2%, 82.8%, and 80.1%, respectively, for mpMRI only. CONCLUSION Both [18F]DCFPyL-PET/MRI and mpMRI were only partly able to detect csPCa on a per-segment basis. An accurate detection (90.0%) of the highest GG lesion at patient-level was observed when comparing both [18F]DCFPyL-PET/MRI and mpMRI biopsy advice with the histopathology in the RARP specimen. So, despite the finding that [18F]DCFPyL-PET/MRI adequately detects csPCa, it does not outperform mpMRI.
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Affiliation(s)
- Yves J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands. .,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands. .,Prostate Cancer Network, Amsterdam, the Netherlands.
| | - Ben G J C Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Patrick J van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Bernard H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Ruth S Smit
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Sabrine Q Kol
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Katelijne de Bie
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Bert A D Windhorst
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - Harry N H Hendrikse
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
| | - André N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands.,Prostate Cancer Network, Amsterdam, the Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres (VU University Medical Center), Amsterdam, the Netherlands
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5
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Altok M, Demirel C, Kang HC, Choi H, John D, Inguillo IA, Davis JW, Ward JF. Impact of MRI/US fusion‐guided prostate biopsy on biopsy‐naïve patients: A single urologist’s experience. BJUI COMPASS 2021; 3:19-25. [PMID: 35475153 PMCID: PMC8988783 DOI: 10.1002/bco2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/30/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To report our experience with imaging‐guided targeted prostate biopsy (IGTpBx) for patients undergoing initial prostate biopsy in a clinical setting. Materials and methods From July 2014 to February 2020, 305 men who had IGTpBx performed as their first prostate biopsy were enrolled. Two dedicated magnetic resonance imaging (MRI) radiologists segmented at least 1 region of interest (ROI) for each of these men using screening 1.5T MRI images. A single urologist employed the robotic‐assisted Artemis MRI/ultrasonography (US) fusion platform to obtain 2‐3 targeted samples from each ROI and additional random samples from the zones of the prostate outside the ROIs (a total of 12 zonal samples). Biopsy outcomes were categorized based on the Gleason score (GS) grade group (GG) as no cancer, favorable (GG < 3 or GS < 4 + 3), or clinically significant (GG ≥ 3 or GS ≥ 4 + 3) cancer. Results The overall cancer detection rate was 75%:31% clinically significant, 44% favorable, and 25% no cancer. These findings triggered active interventions in 176 (58%) patients. A prostate‐specific antigen (PSA) level of 0–4 ng/mL was detected in 39 (66%) of 59 patients (32 favorable, 7 significant), 4–10 ng/mL in 147 (77%) of 190 patients (85 favorable, 62 significant), and 10 ng/mL and over in 44 (80%) of 55 patients (17 favorable, 27 significant). Conclusions The tumor detection rate was 75% with IGTpBx in patients without a previous biopsy. In addition, about 42% of detected cancers were deemed clinically significant and led to active interventions. IGTpBx as a patient’s first prostate biopsy improves the detection of clinically significant prostate cancer when compared with historical data for random systematic prostate biopsy.
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Affiliation(s)
- Muammer Altok
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Cihan Demirel
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Hyunseon C. Kang
- Department of Abdominal Imaging Division of Diagnostic Imaging The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Haesun Choi
- Department of Abdominal Imaging Division of Diagnostic Imaging The University of Texas MD Anderson Cancer Center Houston TX USA
| | - David John
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Irene A. Inguillo
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - John W. Davis
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - John F. Ward
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
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6
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Bodar YJL, Jansen BHE, van der Voorn JP, Zwezerijnen GJC, Meijer D, Nieuwenhuijzen JA, Boellaard R, Hendrikse NH, Hoekstra OS, van Moorselaar RJA, Oprea-Lager DE, Vis AN. Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: is PSMA-targeted biopsy feasible? The DeTeCT trial. World J Urol 2020; 39:2439-2446. [PMID: 33079250 PMCID: PMC8332599 DOI: 10.1007/s00345-020-03490-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 11/01/2022] Open
Abstract
PURPOSE In primary prostate cancer (PCa) patients, accurate staging and histologic grading are crucial to guide treatment decisions. 18F-DCFPyL (PSMA)-PET/CT has been successfully introduced for (re)staging PCa, showing high accuracy to localise PCa in lymph nodes and/or osseous structures. The diagnostic performance of 18F-DCFPyL-PET/CT in localizing primary PCa within the prostate gland was assessed, allowing for PSMA-guided targeted-prostate biopsy. METHODS Thirty patients with intermediate-/high-risk primary PCa were prospectively enrolled between May 2018 and May 2019 and underwent 18F-DCFPyL-PET/CT prior to robot-assisted radical prostatectomy (RARP). Two experienced and blinded nuclear medicine physicians assessed tumour localisation within the prostate gland on PET/CT, using a 12-segment mapping model of the prostate. The same model was used by a uro-pathologist for the RARP specimens. Based on PET/CT imaging, a potential biopsy recommendation was given per patient, based on the size and PET-intensity of the suspected PCa localisations. The biopsy recommendation was correlated to final histopathology in the RARP specimen. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for clinically significant PCa (csPCa, Gleason score ≥ 3 + 4 = 7) were assessed. RESULTS The segments recommended for potential targeted biopsy harboured csPCA in 28/30 patients (93%), and covered the highest Gleason score PCa segment in 26/30 patient (87%). Overall, 122 of 420 segments (29.0%) contained csPCa at final histopathological examination. Sensitivity, specificity, PPV and NPV for csPCa per segment using 18F-DCFPyL-PET/CT were 61.4%, 88.3%, 68.1% and 84.8%, respectively. CONCLUSIONS When comparing the PCa-localisation on 18F-DCFPyL-PET/CT with the RARP specimens, an accurate per-patient detection (93%) and localisation of csPCa was found. Thus, 18F-DCFPyL-PET/CT potentially allows for accurate PSMA-targeted biopsy.
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Affiliation(s)
- Y J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands. .,Prostate Cancer Network, Amsterdam, The Netherlands.
| | - B H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J P van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - D Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - N H Hendrikse
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - D E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - A N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
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7
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D'Agostino D, Romagnoli D, Giampaoli M, Bianchi FM, Corsi P, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. "In-Bore" MRI-Guided Prostate Biopsy for Prostate Cancer Diagnosis: Results from 140 Consecutive Patients. Curr Urol 2020; 14:22-31. [PMID: 32398993 DOI: 10.1159/000499264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022] Open
Abstract
Objectives Transrectal ultrasound-guided biopsy (TRUS-GB) is the current reference standard procedure for diagnosis of prostate cancer (PCa) but this procedure has limitations related to the low detection rate (DR) described in the literature. The aim of the study was to evaluate the DR efficiency, and complication rate in a pure "in-bore" magnetic resonance imaging-guided biopsy (MRI-GB) series according to the Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2). Materials and Methods From July 2015 to April 2018, a series of 142 consecutive patients undergoing MRI-GB were prospectively enrolled. According to the European Society of Urogenital Radiology guidelines, the presence of clinically significant PCa (csPCa) on multiparametric magnetic resonance imaging was defined as equivocal, likely, or highly likely according to a PI-RADS v2, score of 3, 4, or 5, respectively. Results Of 142 patients, 76 (53.5%) were biopsy naive and 66 (46.5%) had ≤ 1 previous negative set of random TRUS-GB findings. The MRI-GB findings were positive in 75 of 142 patients with a DR of 52.8%. Of the 76 patients with ≤ 1 previous set of TRUS-GB, 43 had PCa found by MRI-GB, with a DR of 57.3%. The DR in the 66 biopsy-naive patients was 48% (32/66). Of the 75 patients with positive biopsy findings, 54 (80.5%) were found to have csPCa on histological examination. Of these 54 patients, 28 had an International Society of Urological Pathology grade 2; 5 had grade 3, 19 had grade 4, and 2 had grade 5. Considering the anatomic distribution of the index lesions using the PI-RADS v2 scheme, the probability of PCa was greater for lesions located in the peripheral zone (55 of 75, 73.3%) than for those in the central zone (20 of 75, 26.7%). Conclusions Our study conducted on 142 patients confirmed the greater DR of csPCa by MRI-GB, with a very low number of cores needed and a negligible incidence of complications, especially in patients with a previous negative biopsy. MRI-GB is optimal for the diagnosis of anterior and central lesions.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
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8
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Woodrum DA, Kawashima A, Gorny KR, Mynderse LA. Magnetic Resonance-Guided Prostate Ablation. Semin Intervent Radiol 2019; 36:351-366. [PMID: 31798208 PMCID: PMC6887527 DOI: 10.1055/s-0039-1697001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade "localized" prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.
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9
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Goel S, Shoag JE, Gross MD, Al Hussein Al Awamlh B, Robinson B, Khani F, Baltich Nelson B, Margolis DJ, Hu JC. Concordance Between Biopsy and Radical Prostatectomy Pathology in the Era of Targeted Biopsy: A Systematic Review and Meta-analysis. Eur Urol Oncol 2019; 3:10-20. [PMID: 31492650 DOI: 10.1016/j.euo.2019.08.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/01/2019] [Indexed: 02/01/2023]
Abstract
CONTEXT Multiparametric magnetic resonance imaging (mpMRI)-targeted transrectal prostate biopsy (TBx) may better predict pathology at radical prostatectomy than systematic transrectal prostate biopsy (SBx). OBJECTIVE To assess concordance between biopsy and radical prostatectomy pathology in men undergoing a TBx as compared with those undergoing an SBx. EVIDENCE ACQUISITION Four electronic databases (Ovid MEDLINE, Ovid EMBASE, the Cochrane Library [Wiley], and EBSCHOHost) were searched from inception until July 2018. Studies were included if they were published after 2012, conducted both SBx and TBx, and compared the biopsy results with final pathology after radical prostatectomy for ≥50 patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized. Bias was appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. EVIDENCE SYNTHESIS Our search yielded 10 studies including 1215 men. However, our inclusion criteria applied only to a proportion of men included in these studies. The median age was 65 yr and the median prostate-specific antigen level was 7.2 ng/ml. In the eight studies examining upgrading at prostatectomy, pathology from SBx was significantly more likely to be upgraded relative to TBx (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.48-4.14, p = 0.001). We found no significant difference in downgrading (OR 1.13, 95% CI 0.48-2.67, p = 0.783) between TBx and SBx. For both biopsy-naïve men and men with a prior negative biopsy, results from SBx were more likely to be upgraded than TBx at prostatectomy (OR 1.6 [95% CI 1.02-2.27, p < 0.001] and OR 4.23 [95% CI 1.68-8.48, p = 0.003], respectively). CONCLUSIONS Pathologic upgrading at prostatectomy was less likely with mpMRI-targeted biopsy versus systematic biopsy alone, without concurrent increase in downgrading. This increased accuracy should improve confidence in management decisions based on MRI-targeted biopsy pathology. PATIENT SUMMARY We reviewed the ability of multiparametric magnetic resonance imaging -targeted biopsy to predict cancer grade at radical prostatectomy. We found that targeted biopsy provides more accurate assessment of Gleason score at prostatectomy than systematic biopsy.
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Affiliation(s)
- Shokhi Goel
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | | | - Becky Baltich Nelson
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Jim C Hu
- Weill Cornell Medical College, New York, NY, USA.
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Xue W, Huang Y, Li T, Tan P, Liu L, Yang L, Wei Q. Magnetic resonance imaging-guided targeted biopsy in risk classification among patients on active surveillance: A diagnostic meta-analysis. Medicine (Baltimore) 2019; 98:e16122. [PMID: 31261530 PMCID: PMC6617438 DOI: 10.1097/md.0000000000016122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the sensitivity and accuracy of magnetic resonance imaging-guided targeted biopsy (MRI-TB) in patients undergoing active surveillance (AS) procedure. METHODS We searched databases to identify relevant studies which compared MRI-TB with systemic biopsy for diagnosing prostate cancer in patients on AS. Outcomes included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the curve (AUC) and publication bias of AS group, confirmatory biopsy group and follow-up biopsy group. RESULTS Fourteen articles involving 1693 patients were included. In AS group, the sensitivity was 0.62 (95% confidence interval [CI], 0.57-0.68), specificity was 0.89 (95% CI, 0.87-0.90), NLR was 0.43 (0.31-0.60), PLR was 4.90 (3.50-6.86), DOR was 12.75 (7.22-22.51), and AUC was 0.8645. In confirmatory biopsy group, the sensitivity was 0.67 (0.59-0.74), specificity was 0.89 (0.86-0.91), NLR was 0.42 (0.27-0.65), PLR was 4.94 (3.88-6.30), DOR was 14.54 (9.60-22.02), and AUC was 0.8812. In follow-up biopsy group, the sensitivity was 0.35 (0.22-0.51), specificity was 0.88 (0.82-0.92), NLR was 0.76 (0.52-1.11), PLR was 3.06 (1.71-5.50), DOR was 4.41 (2.15-9.03), and AUC was 0.8367. CONCLUSION MRI-TB has a moderate-to-high diagnostic accuracy for diagnosing and reclassifying patients on AS with high specificity and AUC value under the SROC curve.
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Affiliation(s)
- Wenbin Xue
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Yu Huang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Ping Tan
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu
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11
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Dal Moro F, Zecchini G, Morlacco A, Gardiman MP, Lacognata CS, Lauro A, Rugge M, Prayer Galetti T, Zattoni F. Does 1.5 T mpMRI play a definite role in detection of clinically significant prostate cancer? Findings from a prospective study comparing blind 24-core saturation and targeted biopsies with a novel data remodeling model. Aging Clin Exp Res 2019; 31:115-123. [PMID: 29616473 DOI: 10.1007/s40520-018-0939-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Multiparametric-magnetic resonance imaging (mpMRI) can accurately detect high-grade and larger prostate cancers (PC). AIMS To evaluate the ability of 1.5 T magnetic field mpMRI-targeted Prostate Biopsies (PBx) in predicting PC in comparison with blind 24-core saturation PBx (sPBx). METHODS We prospectively collected data from patients undergoing transrectal sPBx and, if needed, targeted PBx of suspected lesions based on the 16-'region-of-interest' (ROI) PI-RADS graph. Data remodeling: for each 'target' (each suspected lesion at mpMRI), we identified all the 16 'ROIs' into which the lesion extended: these single 'ROIs' were identified as 'macro-targets'. For each 'ROI' and 'macro-target', we compared the mpMRI result with that of a saturation and targeted biopsy (if performed). RESULTS 1.5T mpMRI showed a PI-RADS value ≥ 3 in 101 patients (82.1%). We found a PC in 50 (40.6%). Negative-positive predictive values for mpMRI were 82-45%, respectively. Of the 22 patients with normal mpMRI, four had a PC, but none had a clinically significant cancer. After the data remodeling, we demonstrated the presence of PC in 228 'ROIs': (a) only in targeted biopsies in 15 'ROIs'/'macro-targets' (6.6%); (b) only in sPBx in 177 'ROIs' (77.6%); (c) in both targeted and sPBx in 36 'ROIs' (15.8%). DISCUSSION 81.8% of patients with normal 1.5T mpMRI were negative at PBx. Performing only targeted PBx may lead to lack of PC diagnosis in about 50% of patients. CONCLUSIONS In patients with suspected PC and a previous negative PBx, a normal mpMRI may exclude a clinically significant PC, avoiding sPBx.
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Affiliation(s)
- Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - Giovanni Zecchini
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Alessandro Morlacco
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | | | | | - Alberto Lauro
- Department of Radiology, Azienda Ospedaliera di Padova, Padua, Italy
| | - Massimo Rugge
- Department of Pathology, Azienda Ospedaliera di Padova, Padua, Italy
| | - Tommaso Prayer Galetti
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Filiberto Zattoni
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive treatment of the whole gland, including radical prostatectomy, radiation therapy, and cryosurgery. Active surveillance is a growing alternative option for patients with documented low-volume and low-grade prostate cancer. However, many patients are wanting a less morbid focal treatment alternative. With recent advances in software and hardware of magnetic resonance imaging (MRI), multiparametric MRI of the prostate has been shown to improve the accuracy in detecting and characterizing clinically significant prostate cancer. Targeted biopsy is increasingly utilized to improve the yield of MR detected, clinically significant prostate cancer and to decrease in detection of indolent prostate cancer. MR-guided targeted biopsy techniques include cognitive MR fusion transrectal ultrasound (TRUS) biopsy, in-bore transrectal targeted biopsy using robotic transrectal device, and in-bore direct MR-guided transperineal biopsy with a software based transperineal grid template. In addition, advances in MR-compatible thermal ablation technology allow accurate focal or regional delivery of thermal ablative energy to the biopsy-proved, MRI-detected tumor. MR-guided ablative treatment options include cryoablation, laser ablation, and high-intensity focused ultrasound with real-time or near simultaneous monitoring of the ablation zone. We present a contemporary review of MR-guided techniques for prostatic interventions.
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Tu X, Qiu S, Chang T, Jin K, Bao Y, Yang L, Wei Q. The role of real-time elastography-targeted biopsy in the detection and diagnosis of prostate cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e0220. [PMID: 29561450 PMCID: PMC5895328 DOI: 10.1097/md.0000000000010220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The role of real-time elastography (RTE)-targeted biopsy in the detection and diagnosis of prostate cancer (PCa) remains controversial. METHODS We searched Medline, Embase, and Cochrane Library from inception to July 31, 2017 and used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess the quality of the identified studies. We applied the relative sensitivity value to assess the diagnostic accuracy of RTE-targeted biopsy using the 10-core systematic biopsy as the reference standard. RESULTS Seven studies comprising 5 cohorts and 2 randomized controlled trials (RCTs) were included. Of the 5 cohorts that encompassed 698 participants, we found that RTE-targeted biopsy did not outperform systematic biopsy in either overall PCa detection (69.5% vs 80.5%, relative sensitivity 0.92, 95% CI 0.80-1.06) or for the initial biopsy (56.8% vs 64.0%, relative sensitivity 0.93, 95% CI 0.79-1.11). For the core-by-core analysis, more positive cores were detected by RTE-targeted biopsy than systematic biopsy (21% vs 11%, relative sensitivity 2.17, 95% CI 1.61-2.95). The 2 RCTs showed a favorable trend toward greater PCa detection when a combination of systematic biopsies and RTE-targeted biopsies was used than when systematic biopsy alone was used (45.5% vs 39.5%, risk ratio (RR) 1.18, 95% CI 0.98-1.43). CONCLUSION Currently, there is not enough evidence to demonstrate that RTE-targeted biopsy can outperform systematic biopsy, but the combination of systematic and RTE-targeted biopsy may be a promising approach for improving PCa detection.
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Affiliation(s)
- Xiang Tu
- Department of Urology, Institute of Urology
| | - Shi Qiu
- Department of Urology, Institute of Urology
| | - Tiancong Chang
- West China School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Kun Jin
- West China School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yige Bao
- Department of Urology, Institute of Urology
| | - Lu Yang
- Department of Urology, Institute of Urology
| | - Qiang Wei
- Department of Urology, Institute of Urology
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14
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The impact of prostate cancer diagnosis and treatment decision-making on health-related quality of life before treatment onset. Support Care Cancer 2017; 26:1297-1304. [PMID: 29127529 PMCID: PMC5847026 DOI: 10.1007/s00520-017-3953-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 10/30/2017] [Indexed: 11/21/2022]
Abstract
Objective The objective of this study is to test if patients’ health-related quality of life (HRQoL) declines after prostate biopsy to detect Pca, and after subsequent treatment decision-making in case Pca is confirmed, and to test whether personality state and traits are associated with these potential changes in HRQoL. Methods Patients who were scheduled for prostate biopsy to detect Pca (N = 377) filled out a baseline questionnaire about HRQoL (EORTC QLQ-C30 and PR25), “big five” personality traits (BFI-10), optimism (LOT-r), and self-efficacy (Decision Self-efficacy Scale) (t0). Patients with confirmed Pca (N = 126) filled out a follow-up questionnaire on HRQoL within 2 weeks after treatment was chosen but had not yet started (t1). Results HRQoL declined between t0 and t1, reflected in impaired role and cognitive functioning, and elevated fatigue, constipation, and prostate-specific symptoms. Sexual activity and functioning improved. Baseline HRQoL scores were unrelated to the selection of a particular treatment, but for patients who chose a curative treatment, post-decision HRQoL showed a greater decline compared to patients who chose active surveillance. Optimism was associated with HRQoL at baseline; decisional self-efficacy was positively associated with HRQoL at follow-up. No associations between HRQoL and the “big five” personality traits were found. Conclusion Patients who have undergone prostate biopsy and treatment decision-making for Pca experience a decline in HRQoL. Choosing treatment with a curative intent was associated with greater decline in HRQoL. Interventions aimed at optimism and decision self-efficacy could be helpful to reduce HRQoL impairment around the time of prostate biopsy and treatment decision-making.
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15
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Tang Y, Liu Z, Tang L, Zhang R, Lu Y, Liang J, Zou Z, Zhou C, Wang Y. Significance of MRI/Transrectal Ultrasound Fusion Three-Dimensional Model-Guided, Targeted Biopsy Based on Transrectal Ultrasound-Guided Systematic Biopsy in Prostate Cancer Detection: A Systematic Review and Meta-Analysis. Urol Int 2017; 100:57-65. [PMID: 29084410 DOI: 10.1159/000484144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/10/2017] [Indexed: 09/19/2023]
Abstract
PURPOSE To assess MRI/Transrectal Ultrasound (TRUS) fusion three-dimensional model-guided targeted biopsy (3D-Tb) versus TRUS-guided systematic biopsy (Sb) in detecting overall and high-Gleason-score (≥7) prostate cancer (PCa). METHODS Pubmed and Web of science were searched. Studies with men having a suspicious lesion on MRI were included, which were divided into initial biopsy, previous negative biopsy, and mixed groups in meta-analysis. RESULTS Totally 13 cohorts in 12 studies, with 3,225 men were included. In total population, 3D-Tb and Sb did not differ significantly in the PCa detection rate (43.1 vs. 42.6%, p = 0.36), but after excluding initial biopsy group, the superiority of 3D-Tb became significant (p = 0.01); 3D-Tb had a significantly higher detection rate of high-Gleason-score PCa compared to Sb (30.0 vs. 24.1%, p < 0.05); 3D-Tb plus Sb significantly improved the PCa detection rate based on Sb alone (52.7 vs. 42.6%, p < 0.05). CONCLUSIONS In men with increased serum PSA and/or abnormal DRE and suspicious lesion on MRI but non-previous evidence of PCa, 3D-Tb plus Sb improves the PCa detection rate based on Sb alone. 3D-Tb alone has better performance in detecting high-Gleason-score PCa, and tends to have a higher PCa detection rate in population with previous negative biopsy compared to Sb.
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Affiliation(s)
- Yongquan Tang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Zhihong Liu
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Liangyou Tang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Ruochen Zhang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yiping Lu
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Liang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Zijun Zou
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Chuan Zhou
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yujie Wang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
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Woodrum D, Kawashima A, Gorny K, Mynderse L. Prostate cancer: state of the art imaging and focal treatment. Clin Radiol 2017; 72:665-679. [DOI: 10.1016/j.crad.2017.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/26/2017] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
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17
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Prospective Evaluation of PI-RADS™ Version 2 Using the International Society of Urological Pathology Prostate Cancer Grade Group System. J Urol 2017; 198:583-590. [PMID: 28373133 DOI: 10.1016/j.juro.2017.03.131] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The PI-RADS™ (Prostate Imaging Reporting and Data System), version 2 scoring system, introduced in 2015, is based on expert consensus. In the same time frame ISUP (International Society of Urological Pathology) introduced a new pathological scoring system for prostate cancer. Our goal was to prospectively evaluate the cancer detection rates for each PI-RADS, version 2 category and compare them to ISUP group scores in patients undergoing systematic biopsy and magnetic resonance imaging-transrectal ultrasound fusion guided biopsy. MATERIALS AND METHODS A total of 339 treatment naïve patients prospectively underwent multiparametric magnetic resonance imaging evaluated with PI-RADS, version 2 with subsequent systematic and fusion guided biopsy from May 2015 to May 2016. ISUP scores were applied to pathological specimens. An ISUP score of 2 or greater (ie Gleason 3 + 4 or greater) was defined as clinically significant prostate cancer. Cancer detection rates were determined for each PI-RADS, version 2 category as well as for the T2 weighted PI-RADS, version 2 categories in the peripheral zone. RESULTS The cancer detection rate for PI-RADS, version 2 categories 1, 2, 3, 4 and 5 was 25%, 20.2%, 24.8%, 39.1% and 86.9% for all prostate cancer, and 0%, 9.6%, 12%, 22.1% and 72.4% for clinically significant prostate cancer, respectively. On T2-weighted magnetic resonance imaging the cancer detection rate in the peripheral zone was significantly higher for PI-RADS, version 2 category 4 than for overall PI-RADS, version 2 category 4 in the peripheral zone (all prostate cancer 36.6% vs 48.1%, p = 0.001, and clinically significant prostate cancer 22.9% vs 32.6%, p = 0.002). CONCLUSIONS The cancer detection rate increases with higher PI-RADS, version 2 categories.
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Heterogeneous patterns of DNA methylation-based field effects in histologically normal prostate tissue from cancer patients. Sci Rep 2017; 7:40636. [PMID: 28084441 PMCID: PMC5233981 DOI: 10.1038/srep40636] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/09/2016] [Indexed: 12/26/2022] Open
Abstract
Prostate cancer (PC) diagnosis is based on histological evaluation of prostate needle biopsies, which have high false negative rates. Here, we investigated if cancer-associated epigenetic field effects in histologically normal prostate tissue may be used to increase sensitivity for PC. We focused on nine genes (AOX1, CCDC181 (C1orf114), GABRE, GAS6, HAPLN3, KLF8, MOB3B, SLC18A2, and GSTP1) known to be hypermethylated in PC. Using quantitative methylation-specific PCR, we analysed 66 malignant and 134 non-malignant tissue samples from 107 patients, who underwent ultrasound-guided prostate biopsy (67 patients had at least one cancer-positive biopsy, 40 had exclusively cancer-negative biopsies). Hypermethylation was detectable for all genes in malignant needle biopsy samples (AUC: 0.80 to 0.98), confirming previous findings in prostatectomy specimens. Furthermore, we identified a four-gene methylation signature (AOX1xGSTP1xHAPLN3xSLC18A2) that distinguished histologically non-malignant biopsies from patients with vs. without PC in other biopsies (AUC = 0.65; sensitivity = 30.8%; specificity = 100%). This signature was validated in an independent patient set (59 PC, 36 adjacent non-malignant, and 9 normal prostate tissue samples) analysed on Illumina 450 K methylation arrays (AUC = 0.70; sensitivity = 40.6%; specificity = 100%). Our results suggest that a novel four-gene signature may be used to increase sensitivity for PC diagnosis through detection of epigenetic field effects in histologically non-malignant prostate tissue samples.
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19
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Jelidi A, Ohana M, Labani A, Alemann G, Lang H, Roy C. Prostate cancer diagnosis: Efficacy of a simple electromagnetic MRI-TRUS fusion method to target biopsies. Eur J Radiol 2017; 86:127-134. [DOI: 10.1016/j.ejrad.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022]
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20
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Tadtayev S, Hussein A, Carpenter L, Vasdev N, Boustead G. The association of level of practical experience in transrectal ultrasonography guided prostate biopsy with its diagnostic outcome. Ann R Coll Surg Engl 2016; 99:218-223. [PMID: 27659356 DOI: 10.1308/rcsann.2016.0308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The diagnostic yield of transrectal ultrasonography (TRUS) guided prostate biopsy is influenced by many patient and procedure specific factors. However, the role of operator specific factors remains inadequately defined. This study investigated the association of diagnostic outcome of TRUS guided biopsy with operator skill level. METHODS This study looked at a consecutive cohort of 690 men undergoing their first extended pattern TRUS guided prostate biopsy by 27 operators over a 24-month period in a single institution. Logistic regression was used for statistical analysis. RESULTS Biopsies performed by consultants (odds ratio [OR]: 2.35, p=0.004) and senior trainees (OR: 2.37, p=0.002) in patients with prostate specific antigen levels of <10ng/ml were more likely to be positive than those performed by junior trainees (cancer detection rate 50.0%, 50.3% and 29.9% respectively). Furthermore, biopsies performed by junior trainees yielded a significantly higher proportion of prostate cancers with a Gleason score of ≥3+4 than those performed by senior trainees (OR: 2.11, p=0.031) and consultants (OR: 2.40, p=0.013) (81.4%, 67.5% and 64.6% respectively). No significant differences emerged between operator skill groups for complications, rebiopsy rates or the number of prostate cancers found during the follow-up period (median: 34 months) of patients with a negative biopsy. CONCLUSIONS Level of operator experience is associated with the diagnostic outcome of extended pattern TRUS guided biopsy. The findings of this study imply that case selection, self-audit and expert supervision for the duration of the learning curve should form the basis of biopsy training.
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Affiliation(s)
- S Tadtayev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK
| | - A Hussein
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK
| | | | - N Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK.,University of Hertfordshire , UK
| | - G Boustead
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK
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Woodrum DA, Gorny KR, Greenwood B, Mynderse LA. MRI-Guided Prostate Biopsy of Native and Recurrent Prostate Cancer. Semin Intervent Radiol 2016; 33:196-205. [PMID: 27582607 DOI: 10.1055/s-0036-1586151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive, curative treatment of the whole gland with either radical prostatectomy or radiation therapy. However, many men are reluctant to take the definitive step due to potential morbidity associated with either therapy. A growing interest in active surveillance or focal therapy has emerged as realistic alternatives for many patients. With each of these management strategies, it is critical to accurately quantify and stage the cancer with improved biopsy targeting and more precise imaging with magnetic resonance imaging (MRI). Furthermore, having dependable prostate imaging allows for targeted biopsies to improve the yield of clinically significant prostate cancer and decrease detection of indolent prostate cancer. MRI-guided targeted biopsy techniques include cognitive MRI/transrectal ultrasound fusion biopsy, in-bore transrectal targeted biopsy using a calibrated guidance device, and in-bore direct MR-guided transperineal biopsy with a software-based transperineal grid template. Herein we present a contemporary review of MRI-guided targeted biopsy techniques for new and recurrent cancerous foci of the prostate.
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Predictors of prostate cancer in ultrasound-guided transperineal saturation biopsy in Turkish men with multiple prior negative biopsies. Urologia 2016; 83:71-6. [PMID: 26743593 DOI: 10.5301/uro.5000159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transperineal prostate biopsy (STPB) is associated with an improved cancer detection rate and an increase in anterior and apical prostate cancers compared to standard transrectal biopsy. PATIENTS AND METHODS A total of 48 men with at least two sets of prior prostate biopsies underwent transrectal ultrasound-guided STPB. Prostate rebiopsy indications were serum prostate-specific antigen (PSA) levels greater than 2.5 ng/mL and/or abnormal digital rectal examination and/or presence of high-grade prostatic intraepithelial neoplasia (HGPIN; ≥2 cores) or atypical small acinar proliferation (ASAP) at previous biopsies. The procedure was performed at dorsal lithotomy position under general anesthesia using a perineal 0.5 cm brachytherapy template attached to the transrectal ultrasound probe. Specimens from each zone were sent separately for pathological examination. RESULTS Mean PSA level at STPB was 15.9 ng/mL (range 4.03 to 59.57). An average of 54.5 cores was obtained. Prostate adenocarcinoma was detected in 15 of 48 (31%) patients. Mean percentage of malignant cores was 11.9%. Multivariate logistic regression analysis revealed that age and presence of ASAP or HGPIN at previous biopsies were independent predictors of prostate cancer (p<0.05). No major complications, including sepsis and severe urinary or rectal bleeding, were observed in any of the patients. Five patients (10%) developed acute urinary retention after the procedure requiring urethral catheterization. CONCLUSIONS Considerable number of patients with negative multiple biopsies were diagnosed with prostate cancer. STPB is a well-tolerated procedure with minimal morbidity, which can be considered for the diagnosis of prostate cancer in patients with previous negative biopsies.
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Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive treatment of the whole gland including radical prostatectomy, radiation therapy, and cryosurgery. Active surveillance is a growing alternative option for patients with documented low-volume, low-grade prostate cancer. With recent advances in software and hardware of MRI, multiparametric MRI of the prostate has been shown to improve the accuracy in detecting and characterizing clinically significant prostate cancer. Targeted biopsy is increasingly utilized to improve the yield of MR-detected, clinically significant prostate cancer and to decrease in detection of indolent prostate cancer. MR-guided targeted biopsy techniques include cognitive MR fusion TRUS biopsy, in-bore transrectal targeted biopsy using robotic transrectal device, and in-bore direct MR-guided transperineal biopsy with a software-based transperineal grid template. In addition, advances in MR compatible thermal ablation technology allow accurate focal or regional delivery of optimal thermal energy to the biopsy-proved, MRI-detected tumor, utilizing cryoablation, laser ablation, high-intensity focused ultrasound ablation under MR guidance and real-time or near simultaneous monitoring of the ablation zone. Herein we present a contemporary review of MR-guided targeted biopsy techniques of MR-detected lesions as well as MR-guided focal or regional thermal ablative therapies for localized naïve and recurrent cancerous foci of the prostate.
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High Grade Prostatic Intraepithelial Neoplasia and Atypical Glands. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MM. Magnetic Resonance Imaging–targeted Biopsy May Enhance the Diagnostic Accuracy of Significant Prostate Cancer Detection Compared to Standard Transrectal Ultrasound-guided Biopsy: A Systematic Review and Meta-analysis. Eur Urol 2015; 68:438-50. [DOI: 10.1016/j.eururo.2014.11.037] [Citation(s) in RCA: 413] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/19/2014] [Indexed: 12/13/2022]
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Choudry GA, Khan MH, Qayyum T. Role of transperineal template biopsy in prostate cancer. World J Clin Urol 2015; 4:21-26. [DOI: 10.5410/wjcu.v4.i1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/03/2014] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer is the most common neoplasm diagnosed in men. Whilst treatment modalities have progressed, diagnostic investigations in terms of biopsy methods have been assessed but there is no consensus of when the different diagnostic methods in terms of transrectal ultrasound (TRUS) or transperineal template (TPT) should be utilised. TPT biopsy has a higher diagnostic yield than TRUS in those with a primary biopsy, in those with previous negative biopsies with TRUS as well as those undergoing saturation biopsies. Despite the increased likelihood of diagnosing cancer with TPT than TRUS this maybe secondary to the increased number of biopsies being utilised. However there is no consensus regarding the ideal number of biopsies that should be utilised with TPT. Furthermore it is felt that the increased number of biopsies utilised with TPT is associated the higher complication rates with TPT. The role of TPT biopsy is recognised in those with previous negative biopsies with transrectal ultrasound but further work is required regarding the ideal number of biopsies. Furthermore, it is felt that TPT biopsy may have a role in primary biopsy.
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Lista F, Castillo E, Gimbernat H, Rodríguez-Barbero JM, Panizo J, Angulo JC. Multiparametric magnetic resonance imaging predicts the presence of prostate cancer in patients with negative prostate biopsy. Actas Urol Esp 2015; 39:85-91. [PMID: 25267460 DOI: 10.1016/j.acuro.2014.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the ability of multiparametric prostate magnetic resonance imaging (mpMRI) to detect prostate cancer in patients with prior negative transrectal prostate biopsy (TPB). MATERIAL AND METHODS mpMRI (TSE-T2-w, DWI and DCE sequences) was performed on 1.5T (Magnetom Avanto; Siemens Healthcare Solutions) in 150 patients suspicious of prostate cancer and with negative TPB. European Society of Urogenital Radiology (ESUR) criteria were used (score 1: clinically significant disease is highly unlikely to be present; score 2: clinically significant cancer is unlikely to be present; score 3: clinically significant cancer is equivocal; score 4: clinically significant cancer is likely to be present; score 5: clinically significant cancer is highly likely to be present). PSA measurement (total and free), digital rectal examination (DRE), transrectal ultrasound (TRU) and a second TPB (at least 14 cylinders) were performed in all patients. Variables were submitted for independent blind analysis. The accuracy of each test was measured. Stepwise selection model for prediction of prostate cancer in second TPB was developed. RESULTS Mean age was 66.2± 5 years (51-77), mean PSA 11.3± 9.6ng/mL (0.9-75) and mean prostatic volume 82.2±42 (20-250) cc. DRE was suspicious in 11 (7.3%) patients. The mean number of cylinders per patient sampled in second TRB was 17.6±2.7(14-22). Second TRB was positive in 28 patients (18.7%). mpMRI was positive (score 3-5) in 102 (68%), test sensibility was 92.9% and the NPV was 95.8%. The risk of prostate cancer diagnosis in second TPB is modified by: PSA velocity > 0.75 (OR 1.04 [0.99-1.08]; P=0.06), free/total ratio PSA <15% (OR 0.37 [0.13-1.05]; P=0.06), each cc. of prostate volume (OR 0.98 [0.97-1]; P=0.017) and mpMRI 3-5 (OR 7.87 [1.78-34.7]; P=0.006). Multivariate analysis reveals that mpMRI (OR 7.41 [1.65-33.28]; P=0.009) and prostatic volume (OR 0.31 [0.12-0.78]; P=0.01) are independent risk predictors of prostate cancer. CONCLUSIONS According to ESUR guidelines and in patients with prior negative prostate biopsy, mpMRI is a valuable tool for the prediction of prostate cancer in second TPB. Lower prostate volume, the higher reliability.
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Affiliation(s)
- F Lista
- Servicio de Urología, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, España.
| | - E Castillo
- Servicio de Radiodiagnóstico, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, España
| | - H Gimbernat
- Servicio de Urología, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, España
| | - J M Rodríguez-Barbero
- Servicio de Anatomía Patológica, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - J Panizo
- Servicio de Anatomía Patológica, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, España
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Comparison of re-biopsy with preceded MRI and re-biopsy without preceded MRI in patients with previous negative biopsy and persistently high PSA. ACTA ACUST UNITED AC 2014; 40:571-7. [DOI: 10.1007/s00261-014-0245-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chambó RC, Tsuji FH, de Oliveira Lima F, Yamamoto HA, Nóbrega de Jesus CM. What is the ideal core number for ultrasound-guided prostate biopsy? Korean J Urol 2014; 55:725-31. [PMID: 25405014 PMCID: PMC4231149 DOI: 10.4111/kju.2014.55.11.725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/26/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose We evaluated the utility of 10-, 12-, and 16-core prostate biopsies for detecting prostate cancer (PCa) and correlated the results with prostate-specific antigen (PSA) levels, prostate volumes, Gleason scores, and detection rates of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Materials and Methods A prospective controlled study was conducted in 354 consecutive patients with various indications for prostate biopsy. Sixteen-core biopsy specimens were obtained from 351 patients. The first 10-core biopsy specimens were obtained bilaterally from the base, middle third, apex, medial, and latero-lateral regions. Afterward, six additional punctures were performed bilaterally in the areas more lateral to the base, middle third, and apex regions, yielding a total of 16-core biopsy specimens. The detection rate of carcinoma in the initial 10-core specimens was compared with that in the 12- and 16-core specimens. Results No significant differences in the cancer detection rate were found between the three biopsy protocols. PCa was found in 102 patients (29.06%) using the 10-core protocol, in 99 patients (28.21%) using the 12-core protocol, and in 107 patients (30.48%) using the 16-core protocol (p=0.798). The 10-, 12-, and 16-core protocols were compared with stratified PSA levels, stratified prostate volumes, Gleason scores, and detection rates of HGPIN and ASAP; no significant differences were found. Conclusions Cancer positivity with the 10-core protocol was not significantly different from that with the 12- and 16-core protocols, which indicates that the 10-core protocol is acceptable for performing a first biopsy.
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Affiliation(s)
- Renato Caretta Chambó
- Graduate in Base of Surgery Program, Botucatu Medical School, Sao Paulo State University, Botucatu, Sao Paulo, Brazil
| | - Fábio Hissachi Tsuji
- Graduate in Base of Surgery Program, Botucatu Medical School, Sao Paulo State University, Botucatu, Sao Paulo, Brazil
| | - Flávio de Oliveira Lima
- Department of Pathology, Hospital das Clinicas, Botucatu Medical School, Sao Paulo State University, Botucatu, Sao Paulo, Brazil
| | - Hamilto Akihissa Yamamoto
- Department of Urology, Hospital das Clinicas, Botucatu Medical School, Sao Paulo State University, Botucatu, Sao Paulo, Brazil
| | - Carlos Márcio Nóbrega de Jesus
- Department of Urology, Hospital das Clinicas, Botucatu Medical School, Sao Paulo State University, Botucatu, Sao Paulo, Brazil
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Abraham NE, Mendhiratta N, Taneja SS. Patterns of repeat prostate biopsy in contemporary clinical practice. J Urol 2014; 193:1178-84. [PMID: 25444971 DOI: 10.1016/j.juro.2014.10.084] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE The objectives of this study were to 1) describe the patterns of repeat prostate biopsy in men with a previous negative biopsy and 2) identify predictors of prostate cancer diagnosis on repeat biopsy in these men. MATERIALS AND METHODS From a university faculty group practice we identified 1,837 men who underwent prostate biopsy between January 1, 1995 and January 1, 2010. Characteristics of repeat biopsy were examined, including the indication for biopsy, the number of repeat biopsies performed, the number of cores obtained and total prostate specific antigen before biopsy. Features of prostate cancer diagnosed on repeat biopsy were examined, including Gleason score, number of positive cores, percent of tumor and treatment choice. Multivariable logistic regression was done to identify prostate cancer predictors. RESULTS Initial biopsy was negative in 1,213 men. In 255 men a total of 798 repeat biopsies were performed. Of the 63 men diagnosed with prostate cancer Gleason score was 6 or less in 33 (52%), 7 in 22 (35%) and 8-9 in 8 (13%). When categorized by Epstein criteria, the rate of clinically insignificant cancer diagnosis decreased substantially by the third and fourth repeat biopsies. Repeat biopsy in men older than 70 years, biopsies including more than 20 cores and the fourth repeat biopsy were associated with an increased likelihood of prostate cancer diagnosis. CONCLUSIONS In men selected for multiple repeat biopsies clinically significant cancer is found at each sampling round. Given the continued likelihood of cancer detection even by the fifth biopsy, early consideration of saturation or image guided biopsy may be warranted in the repeat biopsy population.
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Affiliation(s)
- Nitya E Abraham
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, New York
| | - Neil Mendhiratta
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, New York
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, New York.
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Scattoni V, Maccagnano C, Capitanio U, Gallina A, Briganti A, Montorsi F. Random biopsy: when, how many and where to take the cores? World J Urol 2014; 32:859-69. [PMID: 24908067 DOI: 10.1007/s00345-014-1335-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The optimal random prostate biopsy scheme (PBx) in the initial and repeated setting is still an issue of controversy. We performed an analysis of the recent literature about the prostate biopsy techniques. METHODS We performed a clinical and critical literature review by searching MEDLINE database from January 2005 up to January 2014. Electronic searches were limited to the English language, and the keywords prostate cancer, prostate biopsy, transrectal ultrasound, transperineal prostate biopsy were used. RESULTS Prostate biopsy strategy in initial setting. According to the literature and the major international guidelines, the recommended approach in initial setting is still the extended scheme (EPBx) (12 cores). However, there is now a growing evidence in the literature that (a) saturation PBx (>20 cores) (SPBx) might be indicated in patients with PSA <10 ng/ml or low PSA density or large prostate and (b) an individualized approach with more than 12 cores according to the clinical characteristics of the patients may optimize cancer detection in the single patient. Moreover, in the era of multi-parametric MRI (mpMRI), EPBx or SPBX may be substituted by mpMRI-targeted biopsies that have demonstrated superiority over systematic random biopsies for the detection of clinically significant disease and representation of disease burden, while deploying fewer cores. Prostate biopsy strategy in repeat setting. How and how many cores should be taken in the different scenarios in the repeated setting is still unclear. SPBx clearly improves cancer detection if clinical suspicion persists after previous biopsy with negative findings and is able to provide an accurate prediction of prostate tumour volume and grade. Nevertheless, international guidelines do not strongly recommended SPBx in all situations of repeated setting. In the active surveillance and in focal therapy protocols, the optimal schemes have to be defined. CONCLUSIONS The course of PBx has changed significantly from sextant biopsies to systematic and from extended to SPBx schemes. The issue about the number and location of the cores is still a matter of debate both in initial and in repeat setting. At present, EPBx is sufficient in most of the cases to provide adequate diagnosis and prostate cancer characterization in the initial setting, while SPBx seems to be necessary in repeat setting. The PBx schemes are evolving also because the scenario in which a PBx is necessary is changing. Random prostate PBx do not represent the future, while imaging target biopsy are becoming more popular.
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Affiliation(s)
- Vincenzo Scattoni
- Department of Urology, Scientific Institute H San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy,
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Abstract
A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection and avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. Magnetic resonance imaging-guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers. Hematuria, hematospermia, and rectal bleeding are common complications of prostate needle biopsy, but are generally self-limiting and well tolerated. All men should receive antimicrobial prophylaxis before biopsy.
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Salomon G, Drews N, Autier P, Beckmann A, Heinzer H, Hansen J, Michl U, Schlomm T, Haese A, Steuber T, Graefen M, Becker A. Incremental detection rate of prostate cancer by real-time elastography targeted biopsies in combination with a conventional 10-core biopsy in 1024 consecutive patients. BJU Int 2014; 113:548-53. [PMID: 24128330 DOI: 10.1111/bju.12517] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify the incremental detection rate (DR) of a targeted biopsy in addition to a randomized 10-core biopsy. PATIENTS AND METHODS This retrospective study analysed 1024 patients who consecutively underwent a four-core real-time elastography (RTE) targeted biopsies in addition to a randomized 10-core transrectal ultrasonography (TRUS)-guided biopsy in a primary or rebiopsy setting. The overall DR, the DR of a 10-core randomized, RTE targeted biopsy and the incremental DR were calculated. RESULTS Overall, randomized and RTE targeted biopsy DRs (for the combination, the 10-core and the four-core RTE biopsy scheme) were 46.2% (n = 473), 39.1% (n = 400) and 29.0% (n = 297), respectively. Four-core RTE targeted biopsies detected an additional 73 patients not detected by the 10-core randomized biopsies (increase in the overall DR of 7.1%). This represented a relative increase in DR of 18.3%. The incremental DR was better in rebiopsy patients (24.8%) than in patients having their first biopsy (14.7%). Within all patients diagnosed by RTE targeted biopsy only, 34 patients harboured significant Gleason 4 or 5 prostate cancer (PCa), diagnosed by four-core RTE biopsy only. Moreover, PCa with a Gleason grade of 4 or 5 was detected by four-core RTE biopsies in 30 patients, who showed low-grade PCa ≤ Gleason 3 only in the systematic 10-core biopsy. CONCLUSIONS Real-time elastography targeted biopsy seems to be an appropriate method for increasing the DR of PCa. Nevertheless, RTE targeted biopsies missed a high proportion of patients with PCa and should therefore be considered as an addition to randomized biopsies.
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Affiliation(s)
- Georg Salomon
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
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Preneoplasia in the prostate gland with emphasis on high grade prostatic intraepithelial neoplasia. Pathology 2013; 45:251-63. [PMID: 23478231 DOI: 10.1097/pat.0b013e32835f6134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are a variety of morphological patterns and processes that have been implicated in the pathogenesis of prostate cancer. Prostatic intraepithelial neoplasia (PIN), inflammation with or without atrophy, and adenosis (atypical adenomatous hyperplasia) have all been given candidate status as precursor lesions of prostatic adenocarcinoma. Based on decades of research, high grade prostatic intraepithelial neoplasia (HPIN), a proliferative lesion of prostatic secretory cells, has emerged as the most likely morphological pre-invasive lesion involved in the evolution of many but not all prostatic adenocarcinomas. In this manuscript, we briefly discuss other proposed precursors of prostatic adenocarcinoma and then focus on the history, diagnostic criteria and morphology of HPIN. The incidence of HPIN and its relationship to prostate cancer is reviewed. The differential diagnosis of large glandular patterns in the prostate is discussed in depth. Finally, we summarise the recent clinicopathological studies evaluating the clinical significance of HPIN and discuss follow-up strategies in men diagnosed with HPIN.
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Bjurlin MA, Carter HB, Schellhammer P, Cookson MS, Gomella LG, Troyer D, Wheeler TM, Schlossberg S, Penson DF, Taneja SS. Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol 2013; 189:2039-46. [PMID: 23485507 DOI: 10.1016/j.juro.2013.02.072] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE An optimal prostate biopsy in clinical practice is based on a balance among adequate detection of clinically significant prostate cancers (sensitivity), assuredness regarding the accuracy of negative sampling (negative predictive value), limited detection of clinically insignificant cancers and good concordance with whole gland surgical pathology results to allow accurate risk stratification and disease localization for treatment selection. Inherent within this optimization is variation of the core number, location, labeling and processing for pathological evaluation. To date, there is no consensus in this regard. The purpose of this review is to 1) define the optimal number and location of biopsy cores during primary prostate biopsy among men with suspected prostate cancer, 2) define the optimal method of labeling prostate biopsy cores for pathological processing which will provide relevant and necessary clinical information for all potential clinical scenarios, and 3) determine the maximal number of prostate biopsy cores allowable within a specimen jar which would not preclude accurate histological evaluation of the tissue. MATERIALS AND METHODS A bibliographic search using PubMed® covering the period up to July 2012 yielded approximately 550 articles. Articles were reviewed and categorized based on which of the 3 objectives of this review was addressed. Data were extracted, analyzed and summarized. Recommendations are provided based on this literature review and our clinical experience. RESULTS The use of 10 to 12-core extended sampling protocols increases cancer detection rates compared to traditional sextant sampling methods and reduces the likelihood of repeat biopsy by increasing negative predictive value, ultimately allowing more accurate risk stratification without increasing the likelihood of detecting insignificant cancers. As the number of cores increases above 12, the increase in diagnostic yield becomes marginal. Only limited evidence supports the use of initial biopsy schemes involving more than 12 cores or saturation. Apical and laterally directed sampling of the peripheral zone increases cancer detection rate, reduces the need for repeat biopsies and predicts pathological features on prostatectomy while transition zone biopsies do not. There are little data to suggest that knowing the exact site of an individual positive biopsy core provides meaningful clinical information. However, determining laterality of cancer on biopsy may be helpful for predicting sites of extracapsular extension and therapeutic planning. Placement of multiple biopsy cores in a single container (greater than 2) appears to compromise pathological evaluation, which can reduce cancer detection rate and increase the likelihood of equivocal diagnoses. CONCLUSIONS A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoids repeat biopsy, and provides information adequate for identifying men who need therapy and planning that therapy while minimizing the detection of occult, indolent prostate cancers. This literature review does not provide compelling evidence that individual site specific labeling of cores benefits clinical decision making regarding the management of prostate cancer. Based on the available literature, we recommend packaging no more than 2 cores in each jar to avoid reduction of the cancer detection rate through inadequate tissue sampling.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York 10016, USA
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Abstract
High-grade prostatic intraepithelial neoplasia (PIN) is the only accepted precursor of prostatic adenocarcinoma, according to numerous studies of animal models and man; other proposed precursors include atrophy and malignancy-associated changes (with no morphologic changes). PIN is characterized by progressive abnormalities of phenotype and genotype that are intermediate between benign prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. The only method of detection of PIN is biopsy because it does not significantly elevate serum prostate-specific antigen concentration and cannot be detected by ultrasonography. The mean incidence of PIN in biopsies is 9% (range, 4%-16%), representing about 115,000 new cases of isolated PIN diagnosed each year in the United States. The clinical importance of PIN is its high predictive value as a marker for adenocarcinoma, and its identification warrants repeat biopsy for concurrent or subsequent carcinoma, especially when multifocal or observed in association with atypical small acinar proliferation (ASAP). Carcinoma develops in most patients with PIN within 10 years. Androgen deprivation therapy and radiation therapy decrease the prevalence and extent of PIN, suggesting that these forms of treatment may play a role in prevention of subsequent cancer. Multiple clinical trials to date of men with PIN have had modest success in delaying or preventing subsequent cancer.
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Fine SW, Reuter VE. Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer. Histopathology 2012; 60:142-52. [PMID: 22212083 DOI: 10.1111/j.1365-2559.2011.04004.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past 25 years, our understanding of prostatic disease has evolved secondary to the increased detection, treatment and study of both benign and neoplastic prostatic lesions. The advent of aggressive prostate-specific antigen screening and standardization of extended transrectal needle biopsy protocols has resulted in significant stage migration and earlier detection of prostate cancers, a growing proportion of which are lower-volume posterior peripheral zone tumours. Consequently, an increased incidence of anterior-predominant prostate cancers has been observed. Given the histomorphological complexity of the prostate, these developments have necessitated a reconsideration of prostatic anatomy, biopsy strategies in the detection of anterior tumours and the determination and relevance of zonal origin in prostate cancer. This review will provide a contemporary update of these topics, while highlighting specific areas in which a keen understanding of prostatic histoanatomy may influence biopsy interpretation.
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Affiliation(s)
- Samson W Fine
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Engehausen DG, Engelhard K, Schwab SA, Uder M, Wach S, Wullich B, Krause FS. Magnetic resonance image-guided biopsies with a high detection rate of prostate cancer. ScientificWorldJournal 2012; 2012:975971. [PMID: 22489209 PMCID: PMC3317570 DOI: 10.1100/2012/975971] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/15/2011] [Indexed: 12/21/2022] Open
Abstract
AIM To explore the potential of transrectal magnetic resonance image- (MRI-) guided biopsies of the prostate in a patient cohort with prior negative ultrasound guided biopsies. PATIENTS AND METHODS Ninety-six men with suspected prostate cancer underwent MRI-guided prostate biopsies under real-time imaging control in supine position. RESULTS Adenocarcinoma of the prostate was detected in 39 of 96 patients. For individual core biopsies, MRI yielded a sensitivity of 93.0% and a specificity of 94.4%. When stratifying patients according to the free-to-total prostate-specific antigen (PSA) ratio, the prostate cancer discovery rate was significantly higher in the group with ratios less than 0.15 (57.1%). CONCLUSION MRI-guided biopsy of the prostate is a diagnostic option for patients with suspected prostate cancer and a history of repeatedly negative transrectal ultrasound-guided biopsies. Combined with the free-to-total PSA ratio, it is a highly effective method for detecting prostate cancer.
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Affiliation(s)
- Dirk G Engehausen
- Department of Urology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
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Prospective evaluation of 3-T MRI performed before initial transrectal ultrasound-guided prostate biopsy in patients with high prostate-specific antigen and no previous biopsy. AJR Am J Roentgenol 2011; 197:W876-81. [PMID: 22021535 DOI: 10.2214/ajr.11.6829] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of our study was to prospectively evaluate whether MRI before an initial transrectal ultrasound-guided biopsy contributed to detection of prostate cancer in patients with high prostate-specific antigen (PSA) level and no previous biopsy. SUBJECTS AND METHODS Men with an abnormal digital rectal examination or high PSA level were enrolled in this prospective randomized study. Participants were randomly allocated into two groups; the MRI group underwent 3-T MRI and then a transrectal ultrasound-guided biopsy with knowledge of the cancer location. The non-MRI group did not undergo MRI before transrectal ultrasound-guided biopsy. The cancer detection rate and positive core rate were obtained to compare the MRI and non-MRI groups. RESULTS The MRI and non-MRI groups contained 44 and 41 patients, respectively. There was no significant difference between the two groups with respect to age, PSA, and prostate volume. The MRI group (13/44, 29.5%) had a significantly higher cancer detection rate than the non-MRI group (4/41, 9.8%) (p = 0.03). The MRI group (52/527, 9.9%) had a significantly higher positive core rate than the non-MRI group (11/432, 2.5%) (p = 0.00). Regarding cancer detection rate and positive core rate, odds ratios were 3.9 (95% CI, 1.1-13.1) and 4.2 (95% CI, 2.2-8.1), respectively. CONCLUSION In patients with PSA level and no previous biopsy, 3-T MRI that is performed before transrectal ultrasound-guided biopsy may contribute to the detection of prostate cancer.
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Using a Saturation Biopsy Scheme Increases Cancer Detection During Repeat Biopsy in Men With High-grade Prostatic Intra-epithelial Neoplasia. Urology 2011; 78:1115-9. [DOI: 10.1016/j.urology.2011.04.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 04/04/2011] [Accepted: 04/09/2011] [Indexed: 11/22/2022]
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Zaytoun OM, Jones JS. Prostate cancer detection after a negative prostate biopsy: lessons learnt in the Cleveland Clinic experience. Int J Urol 2011; 18:557-68. [PMID: 21692866 DOI: 10.1111/j.1442-2042.2011.02798.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Urologists are often faced with the dilemma of managing patients with a negative initial prostate biopsy in whom clinical or pathological risk for prostate cancer still exists. Such real-life challenging scenarios might raise questions such as: Who should undergo further biopsies? What are the optimal predictors for prostate cancer on subsequent biopsies? What is the optimal biopsy protocol that should be used? When to stop the biopsy cascade? The last decade has witnessed numerous studies that have analyzed factors conferring a significant risk for cancer discovered on repeat biopsies. We and others have developed predictive models to aid decision-making regarding pursuing further biopsies. For decades, high-grade prostatic intraepithelial neoplasia has been considered a strong risk indicator for subsequent cancer. However, it has been recently shown that only through segmentation of this heterogeneous population does the real risk profile emerge. Biopsy templates underwent modification regarding the number and location of cores with emergence of the transrectal or brachytherapy grid transperineal saturation biopsy. However, the best biopsy protocol remains controversial. We have refined the initial biopsy template to a 14 core initial biopsy template that optimizes cancer detection, and have shown that transrectal saturation biopsy significantly improves cancer detection for repeat biopsy. Another concern is the overdiagnosis of clinically insignificant cancer on repeat biopsies, so we explored ways to limit this, and to deal with its ramifications. Through carrying out a Medline literature search, we critically evaluated pertinent articles together with emphasis of our own journey in this arena to assist in the decision-making process for repeat biopsy population.
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Affiliation(s)
- Osama M Zaytoun
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Computerized transrectal ultrasound of the prostate in a multicenter setup (C-TRUS-MS): detection of cancer after multiple negative systematic random and in primary biopsies. World J Urol 2011; 29:573-9. [DOI: 10.1007/s00345-011-0713-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022] Open
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Haffner J, Lemaitre L, Puech P, Haber GP, Leroy X, Jones JS, Villers A. Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection. BJU Int 2011; 108:E171-8. [PMID: 21426475 DOI: 10.1111/j.1464-410x.2011.10112.x] [Citation(s) in RCA: 323] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE •To compare magnetic resonance imaging (MRI)-targeted biopsies with extended systematic biopsies for the detection of significant prostate cancer. METHODS •In all, 555 consecutive patients with suspicion of prostate cancer had pre-biopsy dynamic contrast-enhanced 1.5-tesla (T) MRI with pelvic coil, 10-12 transrectal ultrasound-guided extended systematic biopsies plus two targeted biopsies at any MRI area suspicious for malignancy. •Significant prostate cancer was defined as >5 mm total cancer length and/or any Gleason pattern >3. •Cancer length and grade at biopsy were reported and located on a 24-sector map. RESULTS •Median (range) prostate-specific antigen (PSA) was 6.75 (0.18-100) ng/mL. •MRI was positive in 351 (63%) patients and, overall, 302 (54%) had cancer at extended systematic biopsies and/or targeted biopsies. Of 302 cancers detected, 249 (82%) were significant prostate cancers and 53 (18%) were nonsignificant prostate cancers. •Extended systematic biopsies did not detect 12 significant prostate cancers and targeted biopsies did not detect 13 significant prostate cancers. For significant prostate cancer detection, sensitivity, specificity and accuracy of targeted biopsies were 0.95, 1.0 and 0.98. The values for extended systematic biopsies were 0.95, 0.83, and 0.88. •The detection accuracy of significant prostate cancer by targeted biopsies was higher than that by extended systematic biopsies (P < 0.001). Targeted biopsies also detected 16% more grade 4/5 cases and better quantified the cancer than extended systematic biopsies, with cancer length of 5.56 vs. 4.70 mm (P= 0.002). • A targeted biopsies-only strategy without extended systematic biopsies would have necessitated a mean of 3.8 cores performed in only 63% of patients with positive MRI and avoided the potentially unnecessary diagnosis of 13% (53/302) of nonsignificant prostate cancers. CONCLUSIONS • Strategy of targeted biopsies alone at pre-biopsy MRI-suspicious areas is an attractive potential alternative to extended systematic biopsies for detection of significant prostate cancer. •Further studies are necessary to validate the strategy of targeted biopsies alone.
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Affiliation(s)
- Jérémie Haffner
- Department of Urology, Université Lille Nord de France, F-59000 Lille, France
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Recommandations pour la bonne pratique des biopsies prostatiques. Prog Urol 2011; 21:18-28. [DOI: 10.1016/j.purol.2010.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 07/02/2010] [Indexed: 11/23/2022]
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Beyond diagnosis: evolving prostate biopsy in the era of focal therapy. Prostate Cancer 2010; 2011:386207. [PMID: 22110983 PMCID: PMC3216124 DOI: 10.1155/2011/386207] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/14/2010] [Indexed: 11/23/2022] Open
Abstract
Despite decades of use as the “gold standard” in the detection of prostate cancer, the optimal biopsy regimen is still not universally agreed upon. While important aspects such as the need for laterally placed biopsies and the importance of apical cancer are known, repeated studies have shown significant patients with cancer on subsequent biopsy when the original biopsy was negative and an ongoing suspicion of cancer remained. Attempts to maximise the effectiveness of repeat biopsies have given rise to the alternate approaches of saturation biopsy and the transperineal approach. Recent interest in focal treatment of prostate cancer has further highlighted the need for accurate detection of prostate cancer, and in response, the introduction of transperineal template-guided biopsy. While the saturation biopsy approach and the transperineal template approach increase the detection rate of cancer in men with a previous negative biopsy and appear to have acceptable morbidity, there is a lack of clinical trials evaluating the different biopsy strategies. This paper reviews the evolution of prostatic biopsy and current controversies.
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Aigner F, Pallwein L, Junker D, Schäfer G, Mikuz G, Pedross F, Mitterberger MJ, Jaschke W, Halpern EJ, Frauscher F. Value of real-time elastography targeted biopsy for prostate cancer detection in men with prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less. J Urol 2010; 184:913-7. [PMID: 20643432 DOI: 10.1016/j.juro.2010.05.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE We assessed the prostate cancer detection rate of real-time elastography targeted biopsy in men with total prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less. MATERIALS AND METHODS Real-time elastography using an EUB 8500 Hitachi ultrasound system (Hitachi Medical, Tokyo, Japan) was done in 94 men with a mean age of 57.4 years (range 35 to 77) with increased prostate specific antigen between 1.25 ng/ml or greater and 4.00 ng/ml or less (mean 3.20, range 1.30 to 4.00) and a free-to-total prostate specific antigen ratio of less than 18%. Real-time elastography was done to evaluate peripheral zone tissue elasticity and hard areas were defined as suspicious. Targeted biopsies with a maximum of 5 cores were done in suspicious areas, followed by 10-core systematic biopsy. We analyzed the cancer detection rate of real-time elastography and systematic biopsy. RESULTS Cancer was found in 27 of 94 patients (28.7%). Real-time elastography detected cancer in 20 patients (21.3%) and systematic biopsy detected it in 18 (19.1%). Positive cancer cores were found in real-time elastography targeted cores in 38 of 158 cases (24%) and in systematic cores in 38 of 752 (5.1%) (chi-square test p <0.0001). The cancer detection rate per core was 4.7-fold greater for targeted than for systematic biopsy. CONCLUSIONS Real-time elastography targeted biopsy allows prostate cancer detection in men with prostate specific antigen 1.25 ng/ml or greater and 4 ng/ml or less with a decreased number of cores compared with that of systematic biopsy.
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Affiliation(s)
- Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
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Chun FKH, Epstein JI, Ficarra V, Freedland SJ, Montironi R, Montorsi F, Shariat SF, Schröder FH, Scattoni V. Optimizing performance and interpretation of prostate biopsy: a critical analysis of the literature. Eur Urol 2010; 58:851-64. [PMID: 20884114 DOI: 10.1016/j.eururo.2010.08.041] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 08/26/2010] [Indexed: 12/12/2022]
Abstract
CONTEXT The number and location of biopsy cores and the interpretation of prostate biopsy in different clinical settings remain the subjects of continuing debate. OBJECTIVE Our aim was to review the current evidence regarding the performance and interpretation of initial, repeat, and saturation prostatic biopsy. EVIDENCE ACQUISITION A comprehensive Medline search was performed using the Medical Subject Heading search terms prostate biopsy, prostate cancer, detection, transrectal ultrasound (TRUS), nomogram, and diagnosis. Results were restricted to the English language, with preference given to those published within the last 3 yr. EVIDENCE SYNTHESIS At initial biopsy, a minimum of 10 but not >18 systematic cores are recommended, with 14-18 cores in glands ≥ 50 cm³. Biopsies should be directed laterally, and transition zone (TZ) cores are not recommended in the initial biopsy setting. Further biopsy sets, either as an extended repeat or as a saturation biopsy (≥ 20 cores) including the TZ, are warranted in young and fit men with a persistent suspicion of prostate cancer. An immediate repeat biopsy is not indicated for prior high-grade prostatic intraepithelial neoplasia diagnosis given an adequate extended initial biopsy. Conversely, biopsies with atypical glands that are suspicious but not diagnostic of cancer should be repeated within 3-6 mo. Overall recommendations for further biopsy sets (a third set or more) cannot be made. Transrectal ultrasound-guided systematic biopsies represent the standard-of-care method of prostate sampling. However, transperineal biopsies are an up-to-standard alternative. CONCLUSIONS The optimal prostatic biopsy regimen should be based on the individualized clinical setting of the patient and should follow the minimum standard requirements reported in this paper.
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Affiliation(s)
- Felix K-H Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
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Gupta A, Roobol MJ, Savage CJ, Peltola M, Pettersson K, Scardino PT, Vickers AJ, Schröder FH, Lilja H. A four-kallikrein panel for the prediction of repeat prostate biopsy: data from the European Randomized Study of Prostate Cancer screening in Rotterdam, Netherlands. Br J Cancer 2010; 103:708-14. [PMID: 20664589 PMCID: PMC2938258 DOI: 10.1038/sj.bjc.6605815] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Most men with elevated levels of prostate-specific antigen (PSA) do not have prostate cancer, leading to a large number of unnecessary biopsies. A statistical model based on a panel of four kallikreins has been shown to predict the outcome of a first prostate biopsy. In this study, we apply the model to an independent data set of men with previous negative biopsy but persistently elevated PSA. Methods: The study cohort consisted of 925 men with a previous negative prostate biopsy and elevated PSA (⩾3 ng ml−1), with 110 prostate cancers detected (12%). A previously published statistical model was applied, with recalibration to reflect the lower positive biopsy rates on rebiopsy. Results: The full-kallikrein panel had higher discriminative accuracy than PSA and DRE alone, with area under the curve (AUC) improving from 0.58 (95% confidence interval (CI): 0.52, 0.64) to 0.68 (95% CI: 0.62, 0.74), P<0.001, and high-grade cancer (Gleason ⩾7) at biopsy with AUC improving from 0.76 (95% CI: 0.64, 0.89) to 0.87 (95% CI: 0.81, 0.94), P=0.003). Application of the panel to 1000 men with persistently elevated PSA after initial negative biopsy, at a 15% risk threshold would reduce the number of biopsies by 712; would miss (or delay) the diagnosis of 53 cancers, of which only 3 would be Gleason 7 and the rest Gleason 6 or less. Conclusions: Our data constitute an external validation of a previously published model. The four-kallikrein panel predicts the result of repeat prostate biopsy in men with elevated PSA while dramatically decreasing unnecessary biopsies.
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Affiliation(s)
- A Gupta
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Eleven-Year Outcome of Patients with Prostate Cancers Diagnosed During Screening After Initial Negative Sextant Biopsies. Eur Urol 2010; 57:256-66. [DOI: 10.1016/j.eururo.2009.10.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 10/27/2009] [Indexed: 11/17/2022]
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50
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Candefjord S, Ramser K, Lindahl OA. Technologies for localization and diagnosis of prostate cancer. J Med Eng Technol 2010; 33:585-603. [PMID: 19848851 DOI: 10.3109/03091900903111966] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The gold standard for detecting prostate cancer (PCa), systematic biopsy, lacks sensitivity as well as grading accuracy. PSA screening leads to over-treatment of many men, and it is unclear whether screening reduces PCa mortality. This review provides an understanding of the difficulties of localizing and diagnosing PCa. It summarizes recent developments of ultrasound (including elastography) and MRI, and discusses some alternative experimental techniques, such as resonance sensor technology and vibrational spectroscopy. A comparison between the different methods is presented. It is concluded that new ultrasound techniques are promising for targeted biopsy procedures, in order to detect more clinically significant cancers while reducing the number of cores. MRI advances are very promising, but MRI remains expensive and MR-guided biopsy is complex. Resonance sensor technology and vibrational spectroscopy have shown promising results in vitro. There is a need for large prospective multicentre trials that unambiguously prove the clinical benefits of these new techniques.
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Affiliation(s)
- S Candefjord
- Department of Computer Science and Electrical Engineering, Luleå University of Technology, Luleå, Sweden.
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