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Piccinelli ML, Luzzago S, Marvaso G, Laukhtina E, Miura N, Schuettfort VM, Mori K, Colombo A, Ferro M, Mistretta FA, Fusco N, Petralia G, Jereczek-Fossa BA, Shariat SF, Karakiewicz PI, de Cobelli O, Musi G. Association between previous negative biopsies and lower rates of progression during active surveillance for prostate cancer. World J Urol 2022; 40:1447-1454. [PMID: 35347414 PMCID: PMC9166841 DOI: 10.1007/s00345-022-03983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/27/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose To test any-cause discontinuation and ISUP GG upgrading rates during Active Surveillance (AS) in patients that underwent previous negative biopsies (PNBs) before prostate cancer (PCa) diagnosis vs. biopsy naive patients. Methods Retrospective analysis of 961 AS patients (2008–2020). Three definitions of PNBs were used: (1) PNBs status (biopsy naïve vs. PNBs); (2) number of PNBs (0 vs. 1 vs. ≥ 2); (3) histology at last PNB (no vs. negative vs. HGPIN/ASAP). Kaplan–Meier plots and multivariable Cox models tested any-cause and ISUP GG upgrading discontinuation rates. Results Overall, 760 (79.1%) vs. 201 (20.9%) patients were biopsy naïve vs. PNBs. Specifically, 760 (79.1%) vs. 138 (14.4%) vs. 63 (6.5%) patients had 0 vs. 1 vs. ≥ 2 PNBs. Last, 760 (79.1%) vs. 134 (13.9%) vs. 67 (7%) patients had no vs. negative PNB vs. HGPIN/ASAP. PNBs were not associated with any-cause discontinuation rates. Conversely, PNBs were associated with lower rates of ISUP GG upgrading: (1) PNBs vs. biopsy naïve (HR:0.6, p = 0.04); (2) 1 vs. 0 PNBs (HR:0.6, p = 0.1) and 2 vs. 0 PNBs, (HR:0.5, p = 0.1); (3) negative PNB vs. biopsy naïve (HR:0.7, p = 0.3) and HGPIN/ASAP vs. biopsy naïve (HR:0.4, p = 0.04). However, last PNB ≤ 18 months (HR:0.4, p = 0.02), but not last PNB > 18 months (HR:0.8, p = 0.5) were associated with lower rates of ISUP GG upgrading. Conclusion PNBs status is associated with lower rates of ISUP GG upgrading during AS for PCa. The number of PNBs and time from last PNB to PCa diagnosis (≤ 18 months) appear also to be critical for patient selection. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-03983-8.
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Affiliation(s)
- Mattia Luca Piccinelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, Milan, Italy. .,Università degli Studi di Milano, Milan, Italy.
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Giulia Marvaso
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Noriyoshi Miura
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Victor M Schuettfort
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Nicola Fusco
- Department of Pathology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Shahrokh F Shariat
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Research Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,European Association of Urology Research Foundation, Arnhem, Netherlands
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, Milan, Italy.,Department of Oncology and Haemato-Oncology, Università Degli Studi Di Milano, 20122, Milan, Italy
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Rosenbaum CM, Mandel P, Tennstedt P, Preisser F, Marks P, Chun FKH, Graefen M, Tilki D, Salomon G. Effect of repeat prostate biopsies on functional outcomes after radical prostatectomy. Urol Oncol 2018; 36:91.e17-91.e22. [DOI: 10.1016/j.urolonc.2017.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/03/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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3
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The Influence of Serum Prostate-Specific Antigen on the Accuracy of Magnetic Resonance Imaging Targeted Biopsy versus Saturation Biopsy in Patients with Previous Negative Biopsy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7617148. [PMID: 29159180 PMCID: PMC5660748 DOI: 10.1155/2017/7617148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/17/2017] [Accepted: 09/10/2017] [Indexed: 12/16/2022]
Abstract
Objective We compared the prostate cancer (PCa) detection rates of targeted biopsy (TB) and saturation biopsy (SB) in patients with previous negative biopsy and the accuracy of TB and SB stratified by different serum prostate-specific antigen (PSA) levels. Materials and Methods Overall 185 patients were enrolled. In the magnetic resonance imaging (MRI) group, 65 men underwent TB and SB. In the control group, 120 men underwent SB alone. The primary outcome was the difference in PCa detection rate between the MRI group and control group. The secondary outcome was the difference in accuracy between TB and SB in detecting clinically significant PCa by stratifying the patients in the MRI group into those with PSA < 10 ng/ml and PSA ≥ 10 ng/ml. Results The detection rates for overall and clinically significant PCa were higher in the MRI group than in the control group (46.2% versus 20.9% and 43.1% versus 16.7%, both p < 0.001). In the MRI group, the accuracy of TB was higher than SB (94.7% versus 84.2%, p = 0.001) for the patients with PSA ≥ 10 ng/mL. Conclusions Combining TB and SB achieved the best cancer detection rate. The accuracy of TB was better than SB in the patients with serum PSA ≥ 10 ng/mL.
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Olvera-Posada D, Welk B, McClure JA, Winick-Ng J, Izawa JI, Pautler SE. The Impact of Multiple Prostate Biopsies on Risk for Major Complications Following Radical Prostatectomy: A Population-based Cohort Study. Urology 2017; 106:125-132. [DOI: 10.1016/j.urology.2017.03.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
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Rosenbaum CM, Mandel P, Tennstedt P, Boehm K, Chun FKH, Graefen M, Heinzer H, Tilki D, Salomon G. The Impact of Repeat Prostate Biopsies on Oncologic, Pathological and Perioperative Outcomes after Radical Prostatectomy. J Urol 2016; 197:103-108. [PMID: 27506693 DOI: 10.1016/j.juro.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The impact of repeat biopsy sessions on radical prostatectomy remains controversial regarding perioperative, pathological and oncologic outcome. MATERIALS AND METHODS We analyzed the records of 12,624 patients who underwent radical prostatectomy from 2007 to 2013. The association of the number of biopsy sessions (range 1 to 3 or more) with pathological outcomes and perioperative complications was analyzed using the Wilcoxon matched pair test. To test the association between biopsy sessions and biochemical recurrence-free survival we used Kaplan-Meier curves and multivariable Cox regression analysis. RESULTS Of the patients 89.2% had 1 biopsy session, 7.4% had 2 sessions and 3.4% had 3 or more sessions. Median followup was 36.6 months. In patients with 1, 2 and 3 or more biopsy sessions prostate volume (38, 44 and 45 ml) and prostate specific antigen (6.7, 7.6 and 10.1 ng/ml, respectively) were greater (each p <0.001). The perioperative outcome was more favorable. Patients with 1, 2 and 3 or more biopsy sessions more often had organ confined tumors (67.6%, 72.1% and 72.9%, p = 0.003) and higher tumor volume (3.1, 3.0 and 3.6 ml, p <0.001) but a lower tumor percent (7.5%, 3.7% and 2.4%, respectively, p <0.001). More biopsy sessions were associated with fewer lymph node metastases (1, 2 and 3 sessions 0.23, 0.13 and 0.17, respectively, p <0.001). Gleason score and surgical margin status did not differ. The overall biochemical recurrence rate was 18.9% and it was comparable among the biopsy groups. No association was found between the number of biopsies and biochemical recurrence. CONCLUSIONS Patients with multiple biopsy sessions experience a slightly more favorable pathological outcome without an impact on the oncologic outcome. The perioperative outcome was more favorable in patients with multiple biopsies.
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Affiliation(s)
- Clemens M Rosenbaum
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - Philipp Mandel
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Boehm
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Mendhiratta N, Meng X, Rosenkrantz AB, Wysock JS, Fenstermaker M, Huang R, Deng FM, Melamed J, Zhou M, Huang WC, Lepor H, Taneja SS. Prebiopsy MRI and MRI-ultrasound Fusion-targeted Prostate Biopsy in Men With Previous Negative Biopsies: Impact on Repeat Biopsy Strategies. Urology 2015; 86:1192-8. [PMID: 26335497 DOI: 10.1016/j.urology.2015.07.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/24/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report outcomes of magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy (MRF-TB) and 12-core systematic biopsy (SB) over a 26-month period in men with prior negative prostate biopsy. MATERIALS AND METHODS Between June 2012 and August 2014, 210 men presenting to our institution for prostate biopsy with ≥1 prior negative biopsy underwent multiparametric MRI followed by MRF-TB and SB and were entered into a prospective database. Clinical characteristics, maximum mpMRI suspicion scores (mSS), and biopsy results were queried from the database, and the detection rates of Gleason ≥7 prostate cancer (PCa) and overall PCa were compared between biopsy techniques using McNemar's test. RESULTS Forty seven (29%) of 161 men meeting inclusion criteria (mean age, 65 ± 8 years; mean prostate-specific antigen, 8.9 ± 8.9) were found to have PCa. MRF-TB and SB had overall cancer detection rates (CDRs) of 21.7% and 18.6% (P = .36), respectively, and CDR for Gleason score (GS) ≥7 disease of 14.9% and 9.3% (P = .02), respectively. Of 26 men with GS ≥7 disease, MRF-TB detected 24 (92.3%) whereas SB detected 15 (57.7%; P < .01). Using UCSF-CAPRA criteria, only 1 man was restratified from low risk to higher risk based on SB results compared to MRF-TB alone. Among men with mSS <4, 72% of detected cancers were low risk by UCSF-CAPRA criteria. CONCLUSION In men with previous negative biopsies and persistent suspicion of PCa, SB contributes little to the detection of GS ≥7 disease by MRF-TB, and avoidance of SB bears consideration. Based on the low likelihood of detecting GS ≥7 cancer and overall low-risk features of PCa in men with mSS <4, limiting biopsy to men with mSS ≥4 warrants further investigation.
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Affiliation(s)
| | - Xiaosong Meng
- Department of Urology, NYU Langone Medical Center, New York, NY
| | | | - James S Wysock
- Department of Urology, NYU Langone Medical Center, New York, NY
| | | | - Richard Huang
- Department of Urology, NYU Langone Medical Center, New York, NY
| | - Fang-Ming Deng
- Department of Pathology, NYU Langone Medical Center, New York, NY
| | - Jonathan Melamed
- Department of Pathology, NYU Langone Medical Center, New York, NY
| | - Ming Zhou
- Department of Pathology, NYU Langone Medical Center, New York, NY
| | - William C Huang
- Department of Urology, NYU Langone Medical Center, New York, NY
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York, NY
| | - Samir S Taneja
- Department of Urology, NYU Langone Medical Center, New York, NY; Department of Radiology, NYU Langone Medical Center, New York, NY.
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Renard-Penna R, Mozer P, Cornud F, Barry-Delongchamps N, Bruguière E, Portalez D, Malavaud B. Prostate Imaging Reporting and Data System and Likert Scoring System: Multiparametric MR Imaging Validation Study to Screen Patients for Initial Biopsy. Radiology 2015; 275:458-68. [PMID: 25599415 DOI: 10.1148/radiol.14140184] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare the diagnostic performance of the magnetic resonance (MR) imaging-based Prostate Imaging Reporting and Data System (PI-RADS) and a Likert scale in the detection of prostate cancer in a cohort of patients undergoing initial prostate biopsy. MATERIALS AND METHODS This institutional review board-approved two-center prospective study included 118 patients with normal digital rectal examination (DRE) results but elevated prostate-specific antigen (PSA) levels (4-20 ng/mL) who were referred for initial prostate biopsies and had one suspicious (Likert scale score, ≥3) focus at prebiopsy 1.5-T multiparametric MR imaging performed with T2-weighted, diffusion-weighted [DW], and dynamic contrast material-enhanced imaging. Targeted core biopsies and random systematic core biopsies were performed. The elementary unit for analysis was the core. Relationships were assessed by using the Mann-Whitney U test. Yates corrected and Pearson χ(2) tests were used to evaluate categoric variables. A training set was randomly drawn to construct the receiver operating characteristic curves for the summed PI-RADS scores and for the Likert scale scores. The thresholds to recommend biopsy were obtained from the Youden J statistics and were tested in the remaining validation set in terms of predictive characteristics. Interobserver variability was analyzed by using weighed κ statistics in a random set of 50 patients. RESULTS Higher T2-weighted, DW, and dynamic contrast-enhanced imaging PI-RADS scores were observed in areas that yielded cancer-positive cores. The percentage of positive cores increased with the sum of scores aggregated in five classes as follows: For summed PI-RADS scores of 3-5, the percentage of positive cores was 2.3%; for scores of 6-8, it was 5.8%; for scores of 9 or 10, it was 24.7%; for scores of 11 or 12, it was 51.8%; and for scores of 13-15, it was 72.1% (P for trend, <.0001). For the threshold of summed PI-RADS scores of 9 or greater, sensitivity was 86.6%, specificity was 82.4%, the positive predictive value was 52.4%, the negative predictive value was 96.5%, and accuracy was 83.2%. The respective data for Likert scale scores of 3 or greater were 93.8%, 73.6%, 44.3%, 98.1%, and 73.3%. Good interobserver agreement was observed for the Likert scale (κ = 0.80) and the summed PI-RADS (κ = 0.73) scoring systems. CONCLUSION PI-RADS provided the site-specific stratified risk of cancer-positive cores in biopsy-naive men with normal DRE results and elevated PSA levels. There was no significant difference between summed PI-RADS scores of 9 or greater and Likert scale scores of 3 or greater in the detection of cancer in the peripheral zone.
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Affiliation(s)
- Raphaëlle Renard-Penna
- From the Departments of Radiology (R.R.) and Urology (P.M.), Hôpital Pitié-Salpétrière, Paris, France; Department of Radiology, Hôpital Cochin, Paris, France (F.C., N.B.); and Departments of Radiology (E.B., D.P.) and Urology (B.M.), Institut Universitaire du Cancer, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex 9, France
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Bentley TGK, Schroeder BE, Schnabel CA, Erlander MG, Hsiao WC, Ortendahl JD, Broder MS. Cost effectiveness of a 92-gene assay for the diagnosis of metastatic cancer. J Med Econ 2014; 17:527-37. [PMID: 24689556 DOI: 10.3111/13696998.2014.909817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the 92-gene assay can be used to standardize the diagnostic process and costs for clinicians, patients, and payers. METHODS Four decision-analytic models were developed to project the lifetime clinical and economic impact of incorporating the 92-gene assay compared with standard care alone. For each model, total and incremental costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and the proportion of patients treated correctly versus incorrectly were projected from the payer perspective. Model inputs were based on published literature, analyses of SEER (Surveillance Epidemiology and End RESULTS) data, publicly available data, and interviews with clinical experts. RESULTS In all four models, the 92-gene assay increased the proportion of patients treated correctly, decreased the proportion of patients treated with empiric therapy, and increased quality-adjusted survival. In the primary model, the ICER was $50,273/QALY; thus, the 92-gene assay is therefore cost effective when considering a societal willingness-to-pay threshold of $100,000/QALY. These findings were robust across sensitivity analyses. CONCLUSIONS Use of the 92-gene assay for diagnosing metastatic tumors of uncertain origin is associated with reduced misdiagnoses, increased survival, and improved quality of life. Incorporating the assay into current practice is a cost-effective approach to standardizing diagnostic methods while improving patient care. Limitations of this analysis are the lack of data availability and resulting modeling simplifications, although sensitivity analyses showed these to not be key drivers of results.
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Affiliation(s)
- Tanya G K Bentley
- Partnership for Health Analytic Research LLC , Beverly Hills, CA , USA
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9
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Linkage of Data from Diverse Data Sources (LDS): A Data Combination Model Provides Clinical Data of Corresponding Specimens in Biobanking Information System. J Med Syst 2013; 37:9975. [DOI: 10.1007/s10916-013-9975-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
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10
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Ploussard G, Nicolaiew N, Marchand C, Terry S, Allory Y, Vacherot F, Abbou CC, Salomon L, de la Taille A. Risk of repeat biopsy and prostate cancer detection after an initial extended negative biopsy: longitudinal follow-up from a prospective trial. BJU Int 2013; 111:988-96. [PMID: 23452046 DOI: 10.1111/j.1464-410x.2012.11607.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Even after a negative set of prostate biopsies, the risk of undetected prostate cancer remains clinically significant. Predictive markers of such a risk are undefined. In addition to PSA and PSAD, low prostate volume and %fPSA are interesting time-varying risk factors and are relevant in biopsy decision-making. OBJECTIVE To assess prospectively the time-varying risk of rebiopsy and of prostate cancer (PCa) detection after an initial negative biopsy protocol. PATIENTS AND METHODS Over a period of 10 years, 1995 consecutive patients with initially negative biopsies were followed. Rebiopsies were performed in patients who had a persistent suspicion of PCa. Predictive factors for rebiopsy and for PCa detection were tested using univariate, multivariate and time-dependent models. RESULTS A total of 617 men (31%) underwent at least one rebiopsy after a mean follow-up of 19 months. PCa detection rates during second, third, and fourth sets of biopsies were 16.7, 16.9 and 12.5%, respectively. The overall rate of detected PCa was 7.0%. The 5-year rebiopsy-free and PCa-free survival rates were 65.9 and 92.5%, respectively. Indications for rebiopsy were more frequently reported in patients having a high prostate-specific antigen (PSA) level (P = 0.006) or a high PSA density (PSAD; P < 0.001) and in younger patients (P = 0.008). The risk of PCa on rebiopsies was not correlated with age, but significantly increased more than twofold in cases of PSA >6 ng/mL, PSAD >0.15 ng/mL/g, free-to-total PSA ratio (%fPSA) <15, and/or prostate volume <50 mL. Time-dependent analyses were in line with these findings. The main study limitation was the lack of control of the absence of PCa and PSA kinetics in men not rebiopsied. CONCLUSIONS The overall risk of detected PCa after an initial negative biopsy was low. In addition to PSA and PSAD, which are well-used in rebiopsy indications, low prostate volume and %fPSA are interesting time-varying risk factors for PCa on rebiopsy and could be relevant in biopsy decision-making.
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Affiliation(s)
- Guillaume Ploussard
- Departments of Urology and Pathology, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France.
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