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Lang J, McClure TD, Margolis DJA. MRI-Ultrasound Fused Approach for Prostate Biopsy-How It Is Performed. Cancers (Basel) 2024; 16:1424. [PMID: 38611102 PMCID: PMC11010881 DOI: 10.3390/cancers16071424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
The use of MRI-ultrasound image fusion targeted biopsy of the prostate in the face of an elevated serum PSA is now recommended by multiple societies, and results in improved detection of clinically significant cancer and, potentially, decreased detection of indolent disease. This combines the excellent sensitivity of MRI for clinically significant prostate cancer and the real-time biopsy guidance and confirmation of ultrasound. Both transperineal and transrectal approaches can be implemented using cognitive fusion, mechanical fusion with an articulated arm and electromagnetic registration, or pure software registration. The performance has been shown comparable to in-bore MRI biopsy performance. However, a number of factors influence the performance of this technique, including the quality and interpretation of the MRI, the approach used for biopsy, and experience of the practitioner, with most studies showing comparable performance of MRI-ultrasound fusion to in-bore targeted biopsy. Future improvements including artificial intelligence promise to refine the performance of all approaches.
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Affiliation(s)
- Jacob Lang
- Department of Urology, Weill Cornell Medicine, New York, NY 10068, USA
| | - Timothy Dale McClure
- Department of Urology, Weill Cornell Medicine, New York, NY 10068, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY 10068, USA
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Hu J, Zhu A, Vickers A, Allaf ME, Ehdaie B, Schaeffer A, Pavlovich C, Ross AE, Green DA, Wang G, Ginzburg S, Montgomery JS, George A, Graham JN, Ristau BT, Correa A, Shoag JE, Kowalczyk KJ, Zhang TR, Schaeffer EM. Protocol of a multicentre randomised controlled trial assessing transperineal prostate biopsy to reduce infectiouscomplications. BMJ Open 2023; 13:e071191. [PMID: 37208135 DOI: 10.1136/bmjopen-2022-071191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of postbiopsy infection is increasing due to increasing antibiotic resistance of rectal flora. Single-centre studies suggest that a clean, percutaneous transperineal approach to prostate biopsy may have a lower risk of infection. To date, there is no high-level evidence comparing transperineal versus transrectal prostate biopsy. We hypothesise that transperineal versus transrectal prostate biopsy under local anaesthesia has a significantly lower risk of infection, similar pain/discomfort levels and comparable detection of non-low-grade prostate cancer. METHODS AND ANALYSIS We will perform a multicentre, prospective randomised clinical trial to compare transperineal versus transrectal prostate biopsy for elevated prostate-specific antigen in the first biopsy, prior negative biopsy and active surveillance biopsy setting. Prostate MRI will be performed prior to biopsy, and targeted biopsy will be conducted for suspicious MRI lesions in addition to systematic biopsy (12 cores). Approximately 1700 men will be recruited and randomised in a 1:1 ratio to transperineal versus transrectal biopsy. A streamlined design to collect data and to determine trial eligibility along with the two-stage consent process will be used to facilitate subject recruitment and retention. The primary outcome is postbiopsy infection, and secondary outcomes include other adverse events (bleeding, urinary retention), pain/discomfort/anxiety and critically, detection of non-low-grade (grade group ≥2) prostate cancer. ETHICS AND DISSEMINATION The Institutional Review Board of the Biomedical Research Alliance of New York approved the research protocol (protocol number #18-02-365, approved 20 April 2020). The results of the trial will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT04815876.
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Affiliation(s)
- Jim Hu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Alec Zhu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Andrew Vickers
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Behfar Ehdaie
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christian Pavlovich
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David A Green
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Gerald Wang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Serge Ginzburg
- Einstein Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Arvin George
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - John N Graham
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Benjamin T Ristau
- Department of Surgery, Division of Urology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Andres Correa
- Department of Surgical Oncology, Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jonathan E Shoag
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Tenny R Zhang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - E M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Ono A, Hashimoto T, Shishido T, Hirasawa Y, Satake N, Namiki K, Saito K, Ohno Y. Clinical value of minimum apparent diffusion coefficient for prediction of clinically significant prostate cancer in the transition zone. Int J Clin Oncol 2023; 28:716-723. [PMID: 36961616 PMCID: PMC10119207 DOI: 10.1007/s10147-023-02324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND This study investigated the association between apparent diffusion coefficients in Prostate Imaging Reporting and Data System 4/5 lesions and clinically significant prostate cancer in the transition zone. METHODS We included 102 patients who underwent transperineal cognitive fusion targeted biopsy for Prostate Imaging Reporting and Data System 4/5 lesions in the transition zone between 2016 and 2020. The association between apparent diffusion coefficients and prostate cancers in the transition zone was analyzed. RESULTS The detection rate of prostate cancer was 49% (50/102), including clinically significant prostate cancer in 37.3% (38/102) of patients. The minimum apparent diffusion coefficients in patients with clinically significant prostate cancer were 494.5 ± 133.6 µm2/s, which was significantly lower than 653.8 ± 172.5 µm2/s in patients with benign histology or clinically insignificant prostate cancer. Age, prostate volume, transition zone volume, and mean and minimum apparent diffusion coefficients were associated with clinically significant prostate cancer. Multivariate analysis demonstrated that only the minimum apparent diffusion coefficient value (odds ratio: 0.994; p < 0.001) was an independent predictor of clinically significant prostate cancer. When the cutoff value of the minimum apparent diffusion coefficient was less than 595 µm2/s, indicating the presence of prostate cancer in the transition zone, the detection rate increased to 59.2% (29/49) in this cohort. CONCLUSION The minimum apparent diffusion coefficient provided additional value to indicate the presence of clinically significant prostate cancer in the transition zone. It may help consider the need for subsequent biopsies in patients with Prostate Imaging Reporting and Data System 4/5 lesions and an initial negative targeted biopsy.
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Affiliation(s)
- Ashita Ono
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Toshihide Shishido
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Yosuke Hirasawa
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Naoya Satake
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Kazunori Namiki
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
| | - Yoshio Ohno
- Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023 Japan
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Zhang K, Teoh J, Laguna P, Dominguez-Escrig J, Barret E, Ramon-Borja JC, Muir G, Bohr J, Pelechano Gómez P, Ng CF, Sanchez-Salas R, de la Rosette J. Effect of Focal vs Extended Irreversible Electroporation for the Ablation of Localized Low- or Intermediate-Risk Prostate Cancer on Early Oncological Control: A Randomized Clinical Trial. JAMA Surg 2023; 158:343-349. [PMID: 36723911 PMCID: PMC10099059 DOI: 10.1001/jamasurg.2022.7516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/09/2022] [Indexed: 02/02/2023]
Abstract
Importance Focal ablative irreversible electroporation (IRE) is a therapy that treats only the area of the tumor with the aim of achieving oncological control while reducing treatment-related functional detriment. Objective To evaluate the effect of focal vs extended IRE on early oncological control for patients with localized low- and intermediate-risk prostate cancer. Design, Setting, and Participants In this randomized clinical trial conducted at 5 centers in Europe, men with localized low- to intermediate-risk prostate cancer were randomized to receive either focal or extended IRE ablation. Data were collected at baseline and at regular intervals after the procedure from June 2015 to January 2020, and data were analyzed from September 2021 to July 2022. Main Outcomes and Measures Oncological outcome as indicated by presence of clinically significant prostate cancer (International Society of Urological Pathology grade ≥2) on transperineal template-mapping prostate biopsy at 6 months after IRE. Descriptive measures of results from that biopsy included the number and location of positive cores. Results A total of 51 and 55 patients underwent focal and extended IRE, respectively. Median (IQR) age was 64 years (58-67) in the focal ablation group and 64 years (57-68) in the extended ablation group. Median (IQR) follow-up time was 30 months (24-48). Clinically significant prostate cancer was detected in 9 patients (18.8%) in the focal ablation group and 7 patients (13.2%) in the extended ablation group. There was no significant difference in presence of clinically significant prostate cancer between the 2 groups. In the focal ablation group, 17 patients (35.4%) had positive cores outside of the treated area, 3 patients (6.3%) had positive cores in the treated area, and 5 patients (10.4%) had positive cores both in and outside of the treated area. In the extended group, 10 patients (18.9%) had positive cores outside of the treated area, 9 patients (17.0%) had positive cores in the treated area, and 2 patients (3.8%) had positive cores both in and outside of the treated area. Clinically significant cancer was found in the treated area in 5 of 48 patients (10.4%) in the focal ablation group and 5 of 53 patients (9.4%) in the extended ablation group. Conclusions and Relevance This study found that focal and extended IRE ablation achieved similar oncological outcomes in men with localized low- or intermediate-risk prostate cancer. Because some patients with intermediate-risk prostate cancer are still candidates for active surveillance, focal therapy may be a promising option for those patients with a high risk of cancer progression. Trial Registration ClinicalTrials.gov Identifier: NCT01835977.
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Affiliation(s)
- Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Gordon Muir
- Department of Urology, King’s College Hospital, London, United Kingdom
| | - Julia Bohr
- Department of Urology, Kliniken Essen-Mitte, Ev. Huyssens-Stiftung, Essen, Germany
| | - Paula Pelechano Gómez
- Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | | | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
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Handke AE, Albers P, Schimmöller L, Bonekamp D, Asbach P, Schlemmer HP, Hadaschik BA, Radtke JP. [Systematic or targeted fusion-guided biopsy]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:464-472. [PMID: 36941382 DOI: 10.1007/s00120-023-02062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Early detection of prostate cancer (PCa) is associated with a high risk for detecting low-risk disease. In the primary biopsy indication, systematic biopsy leads to an increased detection of clinically insignificant PCa, and significant prostate cancers are not detected with sufficient sensitivity, especially without prior magnetic resonance imaging (MRI). Similar data have recently become available for PCa screening. OBJECTIVES In light of the current literature, this article aims to discuss the data on systematic and combined targeted and systematic multiparametric MRI (mpMRI)-guided fusion biopsy to improve PCa diagnosis in clinically suspected cancer even in screening using multivariable risk stratification. MATERIALS AND METHODS Literature review on mpMRI and MRI/TRUS fusion biopsy (TRUS: transrectal ultrasonography) for tumor detection in suspected prostate cancer and PCa screening was performed. RESULTS Multiparametric MRI as a reflex test after prostate-specific antigen (PSA) determination (PSA cut-off 4 ng/ml) in combination with targeted biopsy alone reduces the detection of clinically nonsignificant tumors in early detection by half. On the other hand, in the form of a target saturation or in combination with a systematic biopsy, the sensitivity for the detection of cancers of International Society of Urogenital Pathology (ISUP) grade groups 2 or higher can be improved. Similar results are also shown in PCa screening with a PSA cut-off of 3 ng/ml. CONCLUSIONS The evidence for performing a targeted fusion biopsy alone is currently insufficient. Therefore, the combination of mpMRI-guided targeted and systematic biopsy continues to be the recommended standard for prostate cancer diagnosis.
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Affiliation(s)
- Analena Elisa Handke
- Urologische Klinik, Universitätsklinikum Essen, Essen, Deutschland
- Deutsches Konsortium für Translationale Krebsforschung, Essen, Deutschland
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Abteilung für Personalisierte Früherkennung des Prostatakarzinoms, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Lars Schimmöller
- Medizinische Fakultät, Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - David Bonekamp
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Patrick Asbach
- Klinik für Radiologie, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Heinz-Peter Schlemmer
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Boris A Hadaschik
- Urologische Klinik, Universitätsklinikum Essen, Essen, Deutschland
- Deutsches Konsortium für Translationale Krebsforschung, Essen, Deutschland
| | - Jan Philipp Radtke
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland.
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Wu S, Feldman AS, Kim MM, Lin SX, Cornejo KM, Harisinghani MG, Dahl DM, Wu CL. Gleason Grade Group Concordance between Systematic Template Combining Magnetic Resonance Imaging Fusion Targeted Biopsy and Radical Prostatectomy Specimens: A Comparison of Transperineal and Transrectal Approaches. Urology 2023:S0090-4295(23)00150-4. [PMID: 36828261 DOI: 10.1016/j.urology.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To evaluate the Gleason grade (GG) discrepancy between biopsy (Bx) techniques (transperineal [TP] /transrectal [TR] approaches or multiparametric magnetic resonance imaging [mpMRI] targeted biopsy [TBx] / standard template biopsies [SBx]) and radical prostatectomy (RP) specimens. PATIENTS AND METHODS We identified 310 prostate cancer (PCa) patients who underwent RP following either TP TBx combining SBx (20-core) (n = 105) or TR TBx combining SBx (12-core) (n = 205) from September 2019 to February 2021. The Bx GG was based on the core with the highest GG and clinically significant PCa (csPCa) was defined as grade group 2 or greater prostate adenocarcinoma. RESULTS TP combined TBx and SBx (CBx) showed a better GG concordance (63.8% vs 57.1%) than the TR approach, but did not reach a statistical significance. TBx demonstrated a significantly higher csPCa detection than SBx in all patients including both approaches (70.2% vs 63.9%, P < .001). TR TBx showed a significantly higher concordance than TR SBx (52.2% vs 41.5%, P = .0.002) while TP TBx did not differ from TP SBx. TP CBx showed the highest Kappa coefficient (κ =0.48) followed by TR CBx (κ = 0.39). Thirty-eight of 69 (55.1%) cases with a GG1 diagnosis in CBx were upgraded to csPCa in RP. TR approach showed a trend of 2.8-fold risk to upgrade to RP csPCa than TP approach (P = .0.065). CONCLUSION The combination of SBx and TBx led to a better pathological concordance and lower upgrading rate for both TP and TR approaches to RP. With more SBx cores, TP CBx showed a better performance than TR CBx.
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Affiliation(s)
- Shulin Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michelle M Kim
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mukesh G Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Is There an Impact of Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsy on the Risk of Upgrading in Final Pathology in Prostate Cancer Patients Undergoing Radical Prostatectomy? An European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Eur Urol Focus 2023:S2405-4569(23)00032-9. [PMID: 36746729 DOI: 10.1016/j.euf.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND The concordance rates of transperineal (TP) versus transrectal (TR) prostate biopsies with radical prostatectomy (RP) specimen have been assessed poorly in men diagnosed with magnetic resonance imaging (MRI)-targeted biopsy (TBx). OBJECTIVE To evaluate International Society of Urological Pathology (ISUP) concordance rates between the final pathology at RP and MRI-TBx or MRI-TBx + random biopsy (RB) according to the biopsy approach. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional database included patients diagnosed with TP or TR treated with RP. INTERVENTION TP-TBx or TR-TBx of the prostate. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The ISUP grade at biopsy was compared with the final pathology. A multivariable logistic regression analysis (MVA) was performed to assess the association between the biopsy approach (TP-TBx vs TR-TBx) and ISUP upgrading, downgrading, concordance, and clinically relevant increase (CRI). RESULTS AND LIMITATIONS Overall, 752 (59%) versus 530 (41%) patients underwent TR versus TP. At the MVA, TP-TBx was an independent predictor of upgrading (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.9, p < 0.01) and improved concordance relative to the final pathology (OR 1.7, 95% CI 1.2-2.5, p < 0.01) after adjusting for age, cT stage, Prostate Imaging Reporting and Data System, number of targeted cores, prostate-specific antigen, and prostate volume. Moreover, TP-TBx was associated with a lower risk of CRI than TR-TBx (OR 0.7, p < 0.01). This held true when considering patients who underwent MRI-TBx + RB (OR 0.6, p < 0.01). The inclusion of men who had RP represents a potential selection bias. CONCLUSIONS The adoption of TP-TBx compared with TR-TBx may reduce the risk of upgrading and improve the concordance of biopsy grade with the final pathology. The TP approach decreases the odds of CRI with improved patient selection for the correct active treatment. PATIENT SUMMARY In this report, we evaluated whether transperineal (TP) targeted biopsy (TBx) may improve the concordance of clinically significant prostate cancer with the final pathology in comparison with transrectal (TR) TBx in a large worldwide population. We found that TP-TBx might increase concordance compared with TR-TBx. Adding random biopsies to target one increases accuracy; however, concordance with the final pathology is overall suboptimal even with the TP approach.
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Choi YH, Lee CU, Song W, Chang Jeong B, Seo SI, Jeon SS, Lee HM, Jeon HG, Lee SJ. Combination of multiparametric magnetic resonance imaging and transperineal template-guided mapping prostate biopsy to determine potential candidates for focal therapy. Prostate Int 2022. [DOI: 10.1016/j.prnil.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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9
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Detection of clinically significant prostate cancer by transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in smaller prostates. Urol Oncol 2022; 40:451.e9-451.e14. [DOI: 10.1016/j.urolonc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/20/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
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Value of magnetic resonance imaging/ultrasound fusion prostate biopsy to select patients for focal therapy. World J Urol 2022; 40:2689-2694. [PMID: 36152071 DOI: 10.1007/s00345-022-04157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To investigate the role of transrectal MRI fusion biopsy to select patients for prostate cancer focal therapy. METHODS Patients with suspected prostate cancer underwent transrectal MRI fusion biopsy with the Koelis trinity device. Two focal therapy eligibility criteria were subsequently defined: Group 1: PSA ≤ 15 ng/ml, unilateral csPCa, ISUP grade ≤ 2, no contralateral PIRADS 3-5 lesion; Group 2: same criteria but ISUP grade 3. These subgroups were correlated with histopathological post-prostatectomy parameters for stage pT2, unilateral csPCa, no ISUP upgrading. In addition, parameters of csPCa detection were analyzed for patients undergoing primary and re-biopsy. RESULTS Four hundred fourteen consecutive patients were analyzed (314 for primary biopsy, 100 for re-biopsy). Post-prostatectomy whole mount section analysis was available from 155 patients. 39 and 62 of these patients met focal therapy inclusion criteria for group 1 and group 2, respectively. A correlation with final pathology parameters following radical prostatectomy (stage pT2, unilateral csPCa, no ISUP upgrading) revealed a positive predictive value of only 53.8% and 64.5% for Group 1 and 2, respectively. The overall csPCa detection rate was 73.7%. In the re-biopsy group 20% additional patients with csPCa were detected by targeted biopsy. CONCLUSION Despite high csPCa detection rates following MRI fusion biopsy our study demonstrated that, using final pathology to confirm locally advanced tumor stage, presence of bilateral csPCa and ISUP upgrading, between 35.5 and 46.2% of patients would have been incorrectly selected for focal therapy.
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11
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Sidana A, Blank F, Wang H, Patil N, George AK, Abbas H. Schema and cancer detection rates for transperineal prostate biopsy templates: a review. Ther Adv Urol 2022; 14:17562872221105019. [PMID: 35783921 PMCID: PMC9243579 DOI: 10.1177/17562872221105019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer (PCa) is the most common noncutaneous malignancy in men and is
the second leading cause of cancer mortality in men in the United States.
Current practice requires histopathological confirmation of cancer achieved
through biopsy for diagnosis. The transrectal approach for prostate biopsy has
been the standard for several decades. However, the risks and limitations of
transrectal biopsies have led to a recent resurgence of transperineal prostatic
biopsies. Recent studies have demonstrated the transperineal approach for
prostate biopsies to be effective, associated with minimal complications and
superior in several aspects to traditional transrectal biopsies. While sextant
and extended sextant templates are widely accepted templates for transrectal
biopsy, there are a diverse set of transperineal biopsy templates available for
use, without consensus on the optimal sampling strategy. We aim to critically
appraise the salient features of established transperineal biopsy templates.
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Affiliation(s)
- Abhinav Sidana
- Associate Professor of Surgery, Director of Urologic Oncology, Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Fernando Blank
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hannah Wang
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nilesh Patil
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Arvin K. George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Hasan Abbas
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Görtz M, Nyarangi-Dix JN, Pursche L, Schütz V, Reimold P, Schwab C, Stenzinger A, Sültmann H, Duensing S, Schlemmer HP, Bonekamp D, Hohenfellner M, Radtke JP. Impact of Surgeon's Experience in Rigid versus Elastic MRI/TRUS-Fusion Biopsy to Detect Significant Prostate Cancer Using Targeted and Systematic Cores. Cancers (Basel) 2022; 14:cancers14040886. [PMID: 35205634 PMCID: PMC8870088 DOI: 10.3390/cancers14040886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary For the transfer of suspicious lesions in magnetic resonance imaging (MRI) to ultrasound in prostate fusion biopsy, biopsy platforms can be distinguished by rigid or elastic image registration. This study evaluates the detection rate of these different platforms for transperineal fusion-guided prostate biopsy to detect clinically significant prostate cancer under consideration of the surgeon’s learning curve. In our cohort, rigid and elastic registration systems showed a similar prostate cancer detection rate in experienced surgeons, whereas novices seem to benefit from rigid fusion. In the total cohort, targeted fusion biopsy with a rigid registration system outperformed elastic registration target biopsy with a superior significant prostate cancer detection rate, each compared to systematic saturation biopsy. Thus, rigid target biopsy aided in reducing targeting errors that result in missing MRI-visualized significant prostate cancer. These results can provide valuable decision support in selecting a biopsy fusion platform to increase the detection rate and risk stratification of prostate cancer, especially at the beginning of the surgeon’s learning curve. Abstract Multiparametric magnetic resonance imaging (mpMRI) and MRI/ultrasound fusion-targeted prostate biopsy (FB) have excellent sensitivity in detecting significant prostate cancer (sPC). FB platforms can be distinguished by rigid (RTB) or elastic image registration (ETB). We compared RTB and ETB by analyzing sPC detection rates of both RTB and ETB at different stages of the surgeons’ learning curve. Patients undergoing RTB between 2015–2017 (n = 502) were compared to patients undergoing ETB from 2017–2019 (n = 437). SPC detection rates were compared by Chi-square-test on patient-basis. Combination of transperineal systematic biopsy and each TB served as reference and sub-analyses were performed for different grades of surgeon’s experience. In the RTB subgroup, 233 men (46%) had sPC, compared to 201 (46%) in the ETB subgroup. RTB alone detected 94% of men with sPC and ETB 87% (p = 0.02). However, for at least intermediate-experienced surgeons (>100 FB), no differences occurred between RTB and ETB. In the total cohort, at least intermediate-experienced surgeons detected significantly more sPC (10%, p = 0.008) than novices. Thus, targeted transperineal MRI/TRUS-FB with a RTB registration system showed a similar sPC detection rate to ETB in experienced surgeons but a superior sPC detection rate to ETB in the total cohort. Low-experienced surgeons seem to benefit from RTB.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Helmholtz Young Investigator Group ‘Multiparametric Methods for Early Detection of Prostate Carcinoma’, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: or ; Tel.: +49-62-2156-8820
| | - Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Lars Pursche
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Constantin Schwab
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Albrecht Stenzinger
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Holger Sültmann
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany;
| | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, 69120 Heidelberg, Germany;
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
- Department of Urology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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13
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Hogan D, Kanagarajah A, Yao HH, Wetherell D, Dias B, Dundee P, Chu K, Zargar H, O'Connell HE. Local versus general anesthesia transperineal prostate biopsy: Tolerability, cancer detection, and complications. BJUI COMPASS 2021; 2:428-435. [PMID: 35474705 PMCID: PMC8988812 DOI: 10.1002/bco2.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/05/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods A prospective pilot cohort study of patients undergoing transperineal biopsy was performed. Patients were excluded if they had concurrent flexible cystoscopy or language barriers. Patients had a choice of GA or LA. A prospective questionnaire on Days 0, 1, 7, and 30 was applied. The primary outcome was patient tolerability. Secondary outcomes were cancer detection rate, complication rate, and theater utilization. Results This study included 80 patients (40 GA TPTB and 40 LA PPTAS). Baseline characteristics including age, prostate‐specific antigen (PSA), digital rectal examination (DRE), findings, and prostate volume were comparable between the groups (p = 0.3790, p = 0.9832, p = 0.444, p = 0.3939, respectively). Higher median prostate imaging‐reporting and data system (PI‐RADS) score of 4 (interquartile range [IQR] 2) versus 3 (IQR 1) was noted in the LA group (p = 0.0326). Pain was higher leaving recovery in the GA group however not significantly (p = 0.0555). Median pain score at LA infiltration was 5/10 (IQR 3), with no difference in pain at Days 1, 7, or 30 (p = 0.2722, 0.6465, and 0.8184, respectively). For GA versus LA, the overall cancer detection rate was 55% versus 55% (p = 1.000) with clinically significant cancer in 22.5% versus 35% (p = 0.217). Acute urinary retention (AUR) occurred in 5% of GA and 2.5% of LA patients (p = 1.000). The GA cohort spent longer in theater and in recovery with a median of 93.5 min versus 57 min for the LA group (p = <0.0001). Conclusion This study demonstrates that transperineal biopsy is safely performed under LA with no difference between the cohorts in relation cancer detection or AUR. LA biopsy also consumed less theater and recovery resources. A further larger prospective randomized controlled trial is required to confirm the findings of this study.
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Affiliation(s)
- Donnacha Hogan
- Department of Urology Western Health Melbourne Victoria Australia
- School of Medicine University College Cork Cork Ireland
| | - Abbie Kanagarajah
- Department of Urology Western Health Melbourne Victoria Australia
- Melbourne Medical School The University of Melbourne Melbourne Victoria Australia
| | - Henry H. Yao
- Department of Urology Western Health Melbourne Victoria Australia
| | - David Wetherell
- Department of Urology Western Health Melbourne Victoria Australia
- Department of Urology Monash Health Melbourne Victoria Australia
| | - Brendan Dias
- Department of Urology Western Health Melbourne Victoria Australia
| | - Phil Dundee
- Department of Urology Western Health Melbourne Victoria Australia
| | - Kevin Chu
- Department of Urology Western Health Melbourne Victoria Australia
- Department of Urology Monash Health Melbourne Victoria Australia
| | - Homayoun Zargar
- Department of Urology Western Health Melbourne Victoria Australia
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14
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Ferraro DA, Becker AS, Kranzbühler B, Mebert I, Baltensperger A, Zeimpekis KG, Grünig H, Messerli M, Rupp NJ, Rueschoff JH, Mortezavi A, Donati OF, Sapienza MT, Eberli D, Burger IA. Diagnostic performance of 68Ga-PSMA-11 PET/MRI-guided biopsy in patients with suspected prostate cancer: a prospective single-center study. Eur J Nucl Med Mol Imaging 2021; 48:3315-3324. [PMID: 33620559 PMCID: PMC8426229 DOI: 10.1007/s00259-021-05261-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/11/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Ultrasound-guided biopsy (US biopsy) with 10-12 cores has a suboptimal sensitivity for clinically significant prostate cancer (sigPCa). If US biopsy is negative, magnetic resonance imaging (MRI)-guided biopsy is recommended, despite a low specificity for lesions with score 3-5 on Prostate Imaging Reporting and Data System (PIRADS). Screening and biopsy guidance using an imaging modality with high accuracy could reduce the number of unnecessary biopsies, reducing side effects. The aim of this study was to assess the performance of positron emission tomography/MRI with 68Ga-labeled prostate-specific membrane antigen (PSMA-PET/MRI) to detect and localize primary sigPCa (ISUP grade group 3 and/or cancer core length ≥ 6 mm) and guide biopsy. METHODS Prospective, open-label, single-center, non-randomized, diagnostic accuracy study including patients with suspected PCa by elevation of prostate-specific antigen (PSA) level and a suspicious lesion (PIRADS ≥3) on multiparametric MRI (mpMRI). Forty-two patients underwent PSMA-PET/MRI followed by both PSMA-PET/MRI-guided and section-based saturation template biopsy between May 2017 and February 2019. Primary outcome was the accuracy of PSMA-PET/MRI for biopsy guidance using section-based saturation template biopsy as the reference standard. RESULTS SigPCa was found in 62% of the patients. Patient-based sensitivity, specificity, negative and positive predictive value, and accuracy for sigPCa were 96%, 81%, 93%, 89%, and 90%, respectively. One patient had PSMA-negative sigPCa. Eight of nine false-positive lesions corresponded to cancer on prostatectomy and one in six false-negative lesions was negative on prostatectomy. CONCLUSION PSMA-PET/MRI has a high accuracy for detecting sigPCa and is a promising tool to select patients with suspicion of PCa for biopsy. TRIAL REGISTRATION This trial was retrospectively registered under the name "Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) Guided Biopsy in Men with Elevated PSA" (NCT03187990) on 06/15/2017 ( https://clinicaltrials.gov/ct2/show/NCT03187990 ).
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Affiliation(s)
- Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anton S Becker
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Benedikt Kranzbühler
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Iliana Mebert
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Anka Baltensperger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Konstantinos G Zeimpekis
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hannes Grünig
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan H Rueschoff
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Olivio F Donati
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcelo T Sapienza
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
- Department of Nuclear Medicine, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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15
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Wu CL, Kim M, Wu S, Lin SX, Crotty RK, Harisinghani M, Feldman AS, Dahl DM. Transperineal multiparametric magnetic resonance imaging-ultrasound fusion-targeted prostate biopsy combined with standard template improves perineural invasion detection. Hum Pathol 2021; 117:101-107. [PMID: 34461132 DOI: 10.1016/j.humpath.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/07/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Perineural invasion (PNI) on biopsy is associated with adverse features in prostate cancer (PCa). Transrectal multiparametric magnetic resonance imaging (MRI)-targeted biopsy (TBx) has shown to detect higher presence of PNI than standard template biopsy (SBx). Transperineal biopsy provides effective cancer detection with lower complications than the transrectal approach. We compared PNI detection efficiency between SBx and TBx through transperineal approach. We identified patients with PCa who underwent transperineal TBx and concomitant standard 20-core template SBx from September 2019 to February 2021. Clinical, MRI imaging and biopsy characteristics were evaluated and compared between TBx and SBx. Two hundred thirty-eight patients with PCa underwent concomitant transperineal SBx and TBx procedures. Combined PNI+ (SBxPNI+ and/or TBxPNI+) was identified in 77 of 238 (32.4%) patients. SBx detected 23.9% PNI-positive patients and TBx detected 19.3% PNI-positive patients of all patients with PCa. Patients with PNI were with significantly different clinicopathological characteristics than patients without PNI. Although significantly more positive PCa cores and higher positive PCa core rate were found in the SBx method, patients with SBxPNI+ only shared similar features as TBxPNI+only patients. Of 176 cases with both SBxPCa and TBxPCa, TBx could detect 19 (15.1%) more PNI cases than SBx while SBx could detect 24 (18.3%) more PNI cases than TBx. Multiparametric MRI fusion-targeted biopsy in combination with template biopsy through transperineal approach achieved PNI detection rate over 30% of PCa cases. The increased PNI detection may improve the model to select active surveillance candidates in clinical practice.
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Affiliation(s)
- Chin-Lee Wu
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Shulin Wu
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Rory K Crotty
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mukesh Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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16
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MRI-Targeted Prostate Biopsy Techniques: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:1263-1281. [PMID: 34259038 DOI: 10.2214/ajr.21.26154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prostate cancer is the second most common malignancy in men worldwide. Systematic transrectal prostate biopsy is commonly used to obtain tissue to establish the diagnosis. However, in recent years, MRI-targeted biopsy (based on an MRI examination performed prior to consideration of biopsy) has been shown to detect more clinically significant cancer and less clinically insignificant cancer compared to systematic biopsy. This approach of performing MRI prior to biopsy has become, or is becoming, a standard of practice in centers throughout the world. This growing use of an MRI-directed pathway is leading to performance of a larger volume of MRI-targeted prostate biopsies. The three common MRI-targeted biopsy techniques are cognitive biopsy, MRI-ultrasound software fusion biopsy, and MRI in-bore guided biopsy. These techniques for using MRI information at the time of biopsy can be performed via a transrectal or transperineal approach. This narrative review presents the three MRI-targeted biopsy techniques along with their advantages and shortcomings. Comparisons among the techniques are summarized based on the available evidence. Studies to date have provided heterogeneous results, and the preferred technique remains debated.
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18
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Vural M, Coskun B, Kilic M, Durmaz S, Gumus T, Cengiz D, Onay A, Saglican Y, Colakoglu B, Akpek S, Yildirim H, Esen T, Rozanes I. In-bore MRI-guided prostate biopsy in a patient group with PI-RADS 4 and 5 targets: A single center experience. Eur J Radiol 2021; 141:109785. [PMID: 34091134 DOI: 10.1016/j.ejrad.2021.109785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the diagnostic yield of magnetic resonance imaging (MRI) guided in-bore biopsy in patients with high likelihood multiparametric MRI (mpMRI) findings, regarding overall and clinically significant prostate cancer (csPCa) detection rates and concordance of biopsy and radical prostatectomy (RP) Gleason scores (GS). METHODS This retrospective study consisted of 277 Prostate Imaging Reporting and Data System (PI-RADS) assessment category 4 and 5 targets in 246 patients (mean age, 65.7 years; median prostate specific antigen value, 7.75 ng/mL) who had undergone in-bore biopsy at our institution between 2012 and 2020. Eighty-one patients who underwent RP were eligible for the concordance analysis of biopsy and RP specimen GS. RESULTS Overall PCa detection rates were 80.5 % per patient (198/246) and 78 % per target (216/277) and 83.5 % and 67.4 % in primary (biopsy naive) and secondary (at least one negative prior biopsy) settings. csPCa was found in 63 % overall, 66 % of patients (132/200) in the primary, and 50 % of patients (23/46) in the secondary biopsy settings (p < 0.001). The prostate cancer detection rate was 68 % and 92 % in PI-RADS 4 and 5, respectively (p < 0.001). In the radical prostatectomy subcohort, 27.2 % of patients were upgraded, 8.6 % of patients were downgraded from needle biopsy. Significant complications occurred in 1.2 % of patients. CONCLUSIONS MRI-guided in-bore prostate biopsy has a high detection rate of csPCa in primary and secondary biopsy cohorts. Biopsy results were satisfactory in terms of the number of positive cores, cancer percentage in positive cores, and concordance of GS in needle biopsy and RP specimen.
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Affiliation(s)
- Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Bilgen Coskun
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Mert Kilic
- Department of Urology, VKF American Hospital, Istanbul, Turkey.
| | - Selahattin Durmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Terman Gumus
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey.
| | - Duygu Cengiz
- Department of Radiology, University of Koc School of Medicine, Istanbul, Turkey.
| | - Aslihan Onay
- Department of Radiology, TOBB University of Economics and Technology, Faculty of Medicine, Ankara, Turkey.
| | - Yesim Saglican
- Department of Pathology, Acibadem Maslak Hospital, Istanbul, Turkey.
| | - Bulent Colakoglu
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Sergin Akpek
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Hakan Yildirim
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
| | - Tarik Esen
- Department of Urology, VKF American Hospital, Istanbul, Turkey.
| | - Izzet Rozanes
- Department of Radiology, VKF American Hospital, Istanbul, Turkey.
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19
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Sigle A, Jilg CA, Kuru TH, Binder N, Michaelis J, Grabbert M, Schultze-Seemann W, Miernik A, Gratzke C, Benndorf M, Suarez-Ibarrola R. Evaluation of the Ginsburg Scheme: Where Is Significant Prostate Cancer Missed? Cancers (Basel) 2021; 13:cancers13102502. [PMID: 34065418 PMCID: PMC8160743 DOI: 10.3390/cancers13102502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Systematic biopsy according to the Ginsburg scheme is widely used to complement MRI-targeted biopsy for the diagnosis of prostate cancer. This is the first study to evaluate the distribution of cancerous lesions that were missed by the Ginsburg scheme. We found that significant prostate cancer lesions were missed in 3.6% of patients. The majority of the missed lesions (17/39, 43.6%) were localized within the anterior region of the prostate. Complementing the Ginsburg scheme by adding biopsy cores to this region may be considered in certain patients who were extensively pre-biopsied without a conclusive diagnosis or when targeted biopsy was not possible. Moreover, based on Ginsburg scheme sectors and newly defined blind sectors, we developed a new sector map of the prostate that can be applied to focal therapy planning and for the follow-up management of patients under active surveillance. Abstract Background: Systematic biopsy (SB) according to the Ginsburg scheme (GBS) is widely used to complement MRI-targeted biopsy (MR-TB) for optimizing the diagnosis of clinically significant prostate cancer (sPCa). Knowledge of the GBS’s blind sectors where sPCa is missed is crucial to improve biopsy strategies. Methods: We analyzed cancer detection rates in 1084 patients that underwent MR-TB and SB. Cancerous lesions that were missed or underestimated by GBS were re-localized onto a prostate map encompassing Ginsburg sectors and blind-sectors (anterior, central, basodorsal and basoventral). Logistic regression analysis (LRA) and prostatic configuration analysis were applied to identify predictors for missing sPCa with the GBS. Results: GBS missed sPCa in 39 patients (39/1084, 3.6%). In 27 cases (27/39, 69.2%), sPCa was missed within a blind sector, with 17/39 lesions localized in the anterior region (43.6%). Neither LRA nor prostatic configuration analysis identified predictors for missing sPCa with the GBS. Conclusions: This is the first study to analyze the distribution of sPCa missed by the GBS. GBS misses sPCa in few men only, with the majority localized in the anterior region. Adding blind sectors to GBS defined a new sector map of the prostate suited for reporting histopathological biopsy results.
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Affiliation(s)
- August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Cordula A. Jilg
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | | | - Nadine Binder
- Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, 79110 Freiburg, Germany;
| | - Jakob Michaelis
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Markus Grabbert
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Wolfgang Schultze-Seemann
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
| | - Matthias Benndorf
- Department of Radiology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany;
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79110 Freiburg, Germany; (A.S.); (C.A.J.); (J.M.); (M.G.); (W.S.-S.); (A.M.); (C.G.)
- Correspondence: ; Tel.: +49-761-270-25820; Fax: +49-761-270-28960
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20
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Klotz L, Chin J, Black PC, Finelli A, Anidjar M, Bladou F, Mercado A, Levental M, Ghai S, Chang SD, Milot L, Patel C, Kassam Z, Moore C, Kasivisvanathan V, Loblaw A, Kebabdjian M, Earle CC, Pond GR, Haider MA. Comparison of Multiparametric Magnetic Resonance Imaging-Targeted Biopsy With Systematic Transrectal Ultrasonography Biopsy for Biopsy-Naive Men at Risk for Prostate Cancer: A Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 7:534-542. [PMID: 33538782 DOI: 10.1001/jamaoncol.2020.7589] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Magnetic resonance imaging (MRI) with targeted biopsy is an appealing alternative to systematic 12-core transrectal ultrasonography (TRUS) biopsy for prostate cancer diagnosis, but has yet to be widely adopted. Objective To determine whether MRI with only targeted biopsy was noninferior to systematic TRUS biopsies in the detection of International Society of Urological Pathology grade group (GG) 2 or greater prostate cancer. Design, Setting, and Participants This multicenter, prospective randomized clinical trial was conducted in 5 Canadian academic health sciences centers between January 2017 and November 2019, and data were analyzed between January and March 2020. Participants included biopsy-naive men with a clinical suspicion of prostate cancer who were advised to undergo a prostate biopsy. Clinical suspicion was defined as a 5% or greater chance of GG2 or greater prostate cancer using the Prostate Cancer Prevention Trial Risk Calculator, version 2. Additional criteria were serum prostate-specific antigen levels of 20 ng/mL or less (to convert to micrograms per liter, multiply by 1) and no contraindication to MRI. Interventions Magnetic resonance imaging-targeted biopsy (MRI-TB) only if a lesion with a Prostate Imaging Reporting and Data System (PI-RADS), v 2.0, score of 3 or greater was identified vs 12-core systematic TRUS biopsy. Main Outcome and Measures The proportion of men with a diagnosis of GG2 or greater cancer. Secondary outcomes included the proportion who received a diagnosis of GG1 prostate cancer; GG3 or greater cancer; no significant cancer but subsequent positive MRI results and/or GG2 or greater cancer detected on a repeated biopsy by 2 years; and adverse events. Results The intention-to-treat population comprised 453 patients (367 [81.0%] White, 19 [4.2%] African Canadian, 32 [7.1%] Asian, and 10 [2.2%] Hispanic) who were randomized to undergo TRUS biopsy (226 [49.9%]) or MRI-TB (227 [51.1%]), of which 421 (93.0%) were evaluable per protocol. A lesion with a PI-RADS score of 3 or greater was detected in 138 of 221 men (62.4%) who underwent MRI, with 26 (12.1%), 82 (38.1%), and 30 (14.0%) having maximum PI-RADS scores of 3, 4, and 5, respectively. Eighty-three of 221 men who underwent MRI-TB (37%) had a negative MRI result and avoided biopsy. Cancers GG2 and greater were identified in 67 of 225 men (30%) who underwent TRUS biopsy vs 79 of 227 (35%) allocated to MRI-TB (absolute difference, 5%, 97.5% 1-sided CI, -3.4% to ∞; noninferiority margin, -5%). Adverse events were less common in the MRI-TB arm. Grade group 1 cancer detection was reduced by more than half in the MRI arm (from 22% to 10%; risk difference, -11.6%; 95% CI, -18.2% to -4.9%). Conclusions and Relevance Magnetic resonance imaging followed by selected targeted biopsy is noninferior to initial systematic biopsy in men at risk for prostate cancer in detecting GG2 or greater cancers. Trial Registration ClinicalTrials.gov Identifier: NCT02936258.
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Affiliation(s)
- Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Chin
- London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Antonio Finelli
- Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maurice Anidjar
- Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Franck Bladou
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Universite de Bordeaux, Bordeaux, France
| | - Ashley Mercado
- Vancouver Prostate Centre, Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Levental
- Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Sangeet Ghai
- Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurent Milot
- Body and VIR Radiology Department, Hospices Civils de Lyon, Hospital Edouard Herriot, Lyon, France
| | - Chirag Patel
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Zahra Kassam
- London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | | | | | - Andrew Loblaw
- Institute of Healthcare Policy and Management, Department of Radiation Oncology, Ontario Institute of Cancer Research, University of Toronto, Toronto, Ontario, Canada
| | - Marlene Kebabdjian
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- Ontario Institute of Cancer Research, Toronto, Ontario, Canada
| | - Greg R Pond
- Department of Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Masoom A Haider
- Toronto General Hospital, Department of Radiology, University of Toronto, Toronto, Ontario, Canada
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21
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Vėželis A, Platkevičius G, Kinčius M, Gumbys L, Naruševičiūtė I, Briedienė R, Petroška D, Ulys A, Jankevičius F. Systematic and MRI-Cognitive Targeted Transperineal Prostate Biopsy Accuracy in Detecting Clinically Significant Prostate Cancer after Previous Negative Biopsy and Persisting Suspicion of Malignancy. ACTA ACUST UNITED AC 2021; 57:medicina57010057. [PMID: 33435132 PMCID: PMC7827632 DOI: 10.3390/medicina57010057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 12/24/2022]
Abstract
Background and objectives: Overdiagnosis, overtreatment, and the need for repeated procedures caused by transrectal ultrasound guided prostate biopsies and their related complications places a heavy burden on healthcare systems. This was a prospective cohort validating study to access the clinical accuracy of systematic and MRI-cognitive targeted transperineal prostate biopsies in detecting clinically significant prostate cancer after a previous negative biopsy and persistent suspicion of malignancy. The primary goal was to assess the ability of multiparametric magnetic resonance imaging (mpMRI) to detect clinically significant prostate cancer with an additional goal to assess the diagnostic value of systematic and MRI-cognitive transperineal biopsies. Materials and Methods: In total, 200 patients were enrolled who had rising serum prostate specific antigen (PSA) levels for at least 4 months after a previous negative transrectal ultrasound (TRUS) biopsy. All eligible men underwent 1.5T prostate mpMRI, reported using the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), followed by a 20-region transperineal prostate systematic biopsy and additional targeted biopsies. Results: Systematic 20-core transperineal prostate biopsies (TPBs) were performed for 38 (19%) patients. Systemic 20-core TPB with additional cognitive targeted biopsies were performed for 162 (81%) patients. Clinically significant prostate cancer (csPC) was detected for 31 (15.5%) patients, of which 20 (64.5%) cases of csPC were detected by systematic biopsy, eight (25.8%) cases were detected by targeted biopsy, and three (9.7%) both by systematic and targeted biopsies. Conclusions: Cognitive mpMRI guided transperineal target biopsies increase the detection rate of clinically significant prostate cancer after a previously negative biopsy. However, in a repeat prostate biopsy setting, we recommend applying a cognitive targeted biopsy with the addition of a systematic biopsy.
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Affiliation(s)
- Alvydas Vėželis
- Department of Oncourology, National Cancer Institute, 08406 Vilnius, Lithuania; (A.V.); (M.K.); (A.U.)
| | - Gediminas Platkevičius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
- Correspondence:
| | - Marius Kinčius
- Department of Oncourology, National Cancer Institute, 08406 Vilnius, Lithuania; (A.V.); (M.K.); (A.U.)
| | - Liutauras Gumbys
- Department of Radiology, Nuclear Medicine and Physics of Medicine, Center for Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania;
| | - Ieva Naruševičiūtė
- Department of Diagnostic and Interventional Radiology, National Cancer Institute, 08660 Vilnius, Lithuania; (I.N.); (R.B.)
| | - Rūta Briedienė
- Department of Diagnostic and Interventional Radiology, National Cancer Institute, 08660 Vilnius, Lithuania; (I.N.); (R.B.)
| | - Donatas Petroška
- National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania;
| | - Albertas Ulys
- Department of Oncourology, National Cancer Institute, 08406 Vilnius, Lithuania; (A.V.); (M.K.); (A.U.)
| | - Feliksas Jankevičius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
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22
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Bhat Z, Bhat A, Mahmalji W. Consecutive transperineal prostatic template biopsies employing cognitive and systematic approach: a single center study. Aging Male 2020; 23:953-957. [PMID: 31318579 DOI: 10.1080/13685538.2019.1641796] [Citation(s) in RCA: 1] [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: 10/26/2022] Open
Abstract
INTRODUCTION The role of transperineal template biopsy for prostate cancer diagnosis is well established. Pre-biopsy multiparametric magnetic resonance imaging (MRI) is used in most centers for planning of prostate biopsies and staging. Cognitive and software fusion techniques are increasingly getting popular. METHODS We retrospectively reviewed patients who underwent transperineal template biopsies from January 2016 till December 2018. This included patients on active surveillance, previous negative transrectal ultrasonography biopsies with persistently raised prostate-specific antigen/abnormal prostate on digital rectal examination and de-novo template biopsies. Two specialist uro-radiologists reported all the scans and the biopsies were performed by one experienced urologist. The cognitive biopsies were performed for PIRADS 3-5 lesions on MRI. Total of 330 patients underwent transperineal template biopsies and cognitive target biopsies were carried out in 75 patients who were included in the study. We evaluated the results as positive/negative cognitive biopsies and also according to the PIRAD scoring. Only the patients with prostate cancer on template biopsy histology were included. RESULTS Fifty-seven (76%) of the cognitive biopsies were positive out of total 75.[Table: see text]. CONCLUSIONS Combined cognitive and systematic biopsies have excellent diagnostic rate especially for PIRAD 4-5 MRI areas.
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Affiliation(s)
- Zubair Bhat
- Department of Urology, Medway Maritime Hospital Hospital, Gillingham, Kent, United Kingdom
| | - Arshad Bhat
- Department of Urology, Medway Maritime Hospital Hospital, Gillingham, Kent, United Kingdom
| | - Wasim Mahmalji
- Department of Urology, Hereford County Hospital, Hereford, United Kingdom
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23
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Castellucci R, Linares Quevedo AI, Sánchez Gómez FJ, Cogollos Acuña I, Salmerón Béliz I, Muñoz Fernández de Legaría M, Salinas S, Martínez Piñeiro L. A non-randomized prospective study on the diagnostic performance of perineal prostatic biopsy, directed via diffusion nuclear resonance, in patients with suspected prostate cancer and previous negative transrectal prostate biopsy. Urologia 2020; 88:69-76. [PMID: 33054607 DOI: 10.1177/0391560320962888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A definition of the best strategy is necessary to optimize the follow-up of patients with previous negative transrectal guided ultrasound biopsy (TRUS-GB) and the persistence of raised prostate-specific antigen (PSA).The purpose of this study was to evaluate the prostate cancer (PCa) diagnostic rate of targeted transperineal ultrasound guided biopsy (TPUS-GB) with cognitive multiparametric magnetic resonance imaging (mpMRI) registration with concurrent systematic biopsy in patients with previous negative systematic TRUS-GB and persistently elevated PSA levels. MATERIALS AND METHODS In this prospective study conducted at the University Infanta Sofia Hospital from April 2016 to November 2017, patients with one previous negative systematic TRUS-GB and persistently high PSA levels were referred for mpMRI prostate scans. All patients underwent systematic TPUS-GB and those patients with suspicious findings on mpMRI scans, Pirads 3 and 4-5, underwent a subsequent cognitive guidance mpMRI-TPUS-GB. RESULTS In total, 71 patients were included in this study. Suspicious findings on mpMRI scans prior to TPUS-GB were found in 50 patients (70.4%). 16 patients were diagnosed with prostate cancer (22.5%), of whom 14 (87.5%) had a mpMRI scan with Pirads 3 or Pirads 4-5. Patients with Pirads 3, 4 or 5 showed negative results in almost all cores taken by concurrent systematic TPUS-GB. CONCLUSIONS Cognitive mpMRI-TPUS fusion biopsy is a useful tool to diagnose PCa in patients with previous negative prostate biopsy. The samples obtained from the suspicious areas in the mpMRI detect more cases of intermediate and high risk PCa compared to the samples obtained at random or from non-suspicious areas.
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Affiliation(s)
- Roberto Castellucci
- Department of Urology, Azienda Sanitaria Locale, Chieti, Italy.,Urology Department, University Hospital "Infanta Sofia", European University of Madrid, Madrid, Spain
| | - Ana I Linares Quevedo
- Urology Department, University Hospital "Infanta Sofia", European University of Madrid, Madrid, Spain
| | - Francisco J Sánchez Gómez
- Urology Department, University Hospital "Infanta Sofia", European University of Madrid, Madrid, Spain
| | | | | | | | - Silvia Salinas
- Department of Pathology University Hospital "Infanta Sofia", Madrid, Spain
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25
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3-T Multiparametric MRI Followed by In-Bore MR-Guided Biopsy for Detecting Clinically Significant Prostate Cancer After Prior Negative Transrectal Ultrasound-Guided Biopsy. AJR Am J Roentgenol 2020; 215:660-666. [PMID: 32755166 DOI: 10.2214/ajr.19.22455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the rate of detection of clinically significant prostate cancer (csPCa), as assessed on the basis of Prostate Imaging Reporting and Data System version 2.1 (PI-RADSv2.1) guidelines, using 3-T in-bore MR-guided biopsy (MRGB) for a cohort of patients suspected of having csPCa despite having a history of recent negative transrectal ultrasound-guided biopsy results. MATERIALS AND METHODS. The cohort in this retrospective, single-center study was derived from a database of 330 patients who underwent multiparametric MRI (mpMRI) followed by in-bore transrectal 3-T MRGB. Seventy-nine patients (mean [± SD] age, 64.1 ± 8.6 years) with prior negative transrectal ultrasound-guided biopsy results and positive pre-MRGB mpMRI results (PI-RADS score ≥ 3) composed the final cohort. The rate of detection of PCa and csPCa (the latter of which was defined by a Gleason score of 3 + 4 or higher) was stratified according to updated PI-RADSv2.1 assessment. RESULTS. MRGB detected PCa in 36 patients (45.6%), 30 (83.3%) of whom had csPCa. The PI-RADSv2.1 score was a strong predictor (odds ratio, 3.97; 95% CI, 1.93-7.47) of csPCa detection. We found two benign transition zone target lesions that were downgraded from PI-RADSv2 category 3 to PI-RADSv2.1 category 2. PCa was detected in 18.4% (7/38), 65.2% (15/23), and 87.5% (14/16) of individuals with PI-RADSv2.1 category 3, 4, and 5 lesions, respectively, with 85.7% (6/7), 86.7% (13/15), and 78.6% (11/14) of these cases found to be csPCa, respectively. Of the seven PI-RADSv2.1 category 3 csPCa lesions, six had prostate-specific antigen density greater than 0.10 ng/mL/cc. CONCLUSION. With the use of 3-T in-bore MRGB, csPCa was detected in 38% of individuals with prior negative transrectal ultrasound-guided biopsy results. PI-RADSv2.1 was a strong predictor of csPCa detection. On the basis of our results, patients with PI-RADSv2.1 category 4 or 5 lesions and patients with PI-RADSv2.1 category 3 lesions and a prostate-specific antigen density greater than or equal to 0.10 ng/mL/cc may benefit from in-bore MRGB.
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26
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Tamhankar AS, El-Taji O, Vasdev N, Foley C, Popert R, Adshead J. The clinical and financial implications of a decade of prostate biopsies in the NHS: analysis of Hospital Episode Statistics data 2008-2019. BJU Int 2020; 126:133-141. [PMID: 32232966 DOI: 10.1111/bju.15062] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the clinical and financial implications of a decade of prostate biopsies performed in the UK National Health Service (NHS) through the transrectal (TR) vs the transperineal (TP) route. METHODS We conducted an evaluation of the TR vs the TP biopsy approach in the context of 28 days post-procedure complications and readmissions. A secondary evaluation of burden of expenditure in NHS hospitals over the entire decade (2008-2019) was conducted through examination of national Hospital Episode Statistics (HES) data. RESULTS In this dataset of 486 467 prostate biopsies (387 879 TR and 98 588 TP biopsies), rates of infection and sepsis were higher for the TR compared to the TP cohort (0.53% vs 0.31%; P < 0.001, confidence interval 99% ). Rates of sepsis have more than doubled for TR biopsies in the last 2 years compared to the previous decade (1.12% vs 0.53%). Infective complications were the main reasons for readmissions in the TR cohort, whereas urinary retention was the predominant reason for readmission in the TP cohort. Over the last decade, non-elective (NEL) readmissions seem higher for the TP group; however, in the last 2 years these have reduced compared to the TR group (3.54% vs 3.74%). The cost estimates for NEL readmissions for the entire decade were £33,589,527.00 and £7,179,926.00 respectively, for TR and TP cohorts (P < 0.001). Estimated costs per patient readmission were £2,225.00 and £1,758.00 in the TR and TP groups (P < 0.001). CONCLUSIONS Evaluation of nearly half a million prostate biopsies in the NHS over the entire decade gives sufficient evidence for the distinct advantages of the TP route over the TR route in terms of reduced infections and burden of expenditure. In addition, there is a potential for savings both in upstream and downstream costs if biopsy is performed under a local anaesthetic.
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Affiliation(s)
| | - Omar El-Taji
- Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Nikhil Vasdev
- Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Charlotte Foley
- Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Rick Popert
- Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Jim Adshead
- Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK
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27
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Zhang K, Zhang Z, Liu M, Zhu G, Roobol MJ. Comparison of clinically significant prostate cancer detection by MRI cognitive biopsy and in-bore MRI-targeted biopsy for naïve biopsy patients. Transl Androl Urol 2020; 9:243-249. [PMID: 32420129 PMCID: PMC7214969 DOI: 10.21037/tau.2020.02.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) targeted prostate biopsy increases the diagnostic accuracy of clinically significant prostate cancer (PCa). Currently there is no consensus on which type of MRI-targeted biopsy performs better in a given setting. In this study, we aimed to compare the detection rate of (clinically significant) PCa by MRI cognitive targeted biopsy (COG) and in-bore MRI-targeted biopsy (IB) techniques for naïve prostate biopsy patients in China. Methods Our study included 85 men from Beijing United Family Hospital and Clinics and 88 men from Beijing Hospital, National Center of Gerontology. All men had no history of prostate biopsy, undergoing mpMRI scan due to elevated PSA and/or abnormal DRE. The men in Beijing United Family Hospital group received COG plus systematic biopsy. The men in Beijing Hospital group only received IB. Results The median age in COG and IB group was 63.0 years and 70.0 years (P<0.01). The median PSA was 7.4 and 6.8 ng/mL in COG and IB group respectively (P=0.124). The detection rate of PCa was 36.5% by COG and 52.3% by IB (P=0.037). The detection rate of clinically significant PCa (Gleason score ≥7) was 23.5% and 29.5% by COG and IB (P=0.371) respectively. In COG group, combination biopsy (COG + systematic biopsy) achieved improved PCa (42.4%) and clinically significant PCa (28.2%) detection rate compared with COG alone. However, there was no difference in overall PCa and clinically significant PCa detection between combination biopsy and IB. Conclusions IB had a higher rate of overall PCa detection compared with COG, but the two approaches did not differ significantly in the detection of clinically significant PCa. There was no significant difference in detection rate of PCa and clinically significant PCa between the combination biopsy and IB.
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Affiliation(s)
- Kai Zhang
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Urology, Beijing United Family Hospital and Clinics, Beijing 100015, China
| | - Zhipeng Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Gang Zhu
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing 100015, China
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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28
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Donato P, Morton A, Yaxley J, Ranasinghe S, Teloken PE, Kyle S, Coughlin G, Esler R, Dunglison N, Gardiner RA, Roberts MJ. 68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future? Eur J Nucl Med Mol Imaging 2020; 47:1843-1851. [PMID: 31912257 DOI: 10.1007/s00259-019-04620-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND 68Ga prostate specific membrane antigen PET/CT (68Ga-PSMA PET/CT) may be superior to multiparametric MRI (mpMRI) for localisation of prostate cancer tumour foci, however the concordance and differences between 68Ga-PSMA PET/CT and mpMRI when applied to all biopsied patients and potential benefit in patients with negative mpMRI is unclear. METHODS Retrospective analysis of patients undergoing mpMRI, prostate biopsy and 68Ga-PSMA PET/CT over a 3-year period. Diagnostic performance of 68Ga-PSMA PET/CT and mpMRI were assessed using biopsy histopathology for the entire cohort and radical prostatectomy specimen in a subset of patients. Lesion concordance and additional detection of each modality were determined, including in a dedicated cohort of patients with mpMRI PIRADS 2 scans. RESULTS A total of 144 patients were included in the study. Index lesion/foci detection was similar between 68Ga-PSMA PET/CT and mpMRI (sensitivity 83.1% vs 90.1%; p = 0.267), however lesions missed by mpMRI were larger (1.66 cm3 vs 0.72 cm3; p = 0.034). Lesion detection rates were similar across the biopsy histopathology and radical prostatectomy specimen subset, with a high concordance for index (80.1%) and a moderate concordance for total (67%) lesions between the 2 imaging modalities. The additional detection yield favoured 68Ga-PSMA PET/CT over mpMRI for index (13.5% vs 4.3%) and total (18.2% vs 5.4%) lesions; both modalities missed 2.1% and 12.3% of index and total lesions, respectively. 68Ga-PSMA PET/CT identified 9 of 11 patients with PIRADS 2 mpMRI but subsequently diagnosed with Gleason ≥ 3 + 4 disease. CONCLUSIONS Despite high concordance rates, 68Ga-PSMA PET/CT incrementally improved tumour localisation compared with mpMRI. These results suggest that 68Ga-PSMA PET/CT may have an incremental value to that of mpMRI in the diagnostic process for prostate.
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Affiliation(s)
- Peter Donato
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia.
| | - Andrew Morton
- Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - John Yaxley
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Sachinka Ranasinghe
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Patrick E Teloken
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Samuel Kyle
- Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia.,Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Geoff Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rachel Esler
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nigel Dunglison
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robert A Gardiner
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia.,Griffith University, Brisbane, Queensland, Australia.,Edith Cowan University, Joondalup, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia. .,Nepean Urology Research Group, Kingswood, Penrith, New South Wales, Australia. .,Discipline of Surgery, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
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29
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Cattarino S, Forte V, Salciccia S, Drudi FM, Cantisani V, Sciarra A, Fasulo A, Ciccariello M. MRI ultrasound fusion biopsy in prostate cancer detection: Are randomized clinical trials reproducible in everyday clinical practice? Urologia 2019; 86:9-16. [PMID: 30890102 DOI: 10.1177/0391560319834490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION: The aim of this study was to evaluate the performance of multiparametric magnetic resonance imaging (mpMRI)-ultrasound (US) fusion-targeted biopsies (TB) in men with primary and repeated biopsies comparing the cancer detection rate (CDR) of random biopsies (RB) + TB versus only TB. METHODS: The present study is a real-life study on patients with primary and prior negative prostate biopsies with suspicious PCa. A total of 130 men with prostate-specific antigen (PSA) value >2.5 ng/dL and/or abnormal digital rectal examination (DRE) were included in the study and subjected to mpMRI. Patients with >2 previous biopsies and/or with ⩾3 suspected lesions on MRI and/or prostate imaging-reporting and data system (PIRADS) value ⩾4 (n:30 pts) were subjected only to TB on the areas indicated by mpMRI. All the other patients (n:70 pts) were subjected to standard random laterally directed 10-core plus TB on the areas indicated by mpMRI. RESULTS: The overall CDR was 53% (53/100). In relation to PIRADS score, the overall CDR was 0, 40% (12/30), 56.83% (29/51), and 84% (11/13) for PIRADS 2, 3, 4, and 5, respectively. According to biopsy modality, CDR for RB + TB was 50% (35/70) and CDR for TB was 60% (18/30) with a p-value of 0.3632. DISCUSSION: MRI-US fusion biopsy is associated with a high CDR of clinically significant PCa (csPCa). MRI-US fusion biopsy could be a reasonable approach in patients with previous negative biopsy and high PIRADS score on MRI, to ensure a high CDR of csPCa and to reduce the diagnosis of clinically insignificant tumors.
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Affiliation(s)
| | - Valerio Forte
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Maria Drudi
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Valerio Cantisani
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Mauro Ciccariello
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
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Bae JH, Kim SH. Transrectal ultrasound-guided prostate biopsy versus combined magnetic resonance imaging-ultrasound fusion and systematic biopsy for prostate cancer detection in routine clinical practice. Ultrasonography 2019; 39:137-143. [PMID: 31995858 PMCID: PMC7065986 DOI: 10.14366/usg.19036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/26/2019] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The goal of this study was to retrospectively compare systematic ultrasound-guided prostate biopsy (US-PB) and multiparametric magnetic resonance imaging-ultrasound fusion prostate biopsy (MRI-PB) in men undergoing primary or repeated biopsies. METHODS A population of 2,200 patients with a prostate-specific antigen (PSA) level >4.0 ng/ dL and/or an abnormal rectal examination was divided into two groups. All patients underwent US-PB (n=1,021) or MRI-PB (n=1,179) between April 2015 and April 2019. Population demographics, including age, PSA level, digital rectal examination results, prostate volume, number of previous negative biopsies, Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) score, and biopsy results, were acquired and compared with respect to these variables. Univariate regression analysis of the risk factors for a higher Gleason score (GS) was performed. RESULTS The cancer detection rate (CDR) was 23.8% (243 of 1,021) in the US-PB group and 31.3% (399 of 1,179) in the MRI-PB group. Of those, 225 patients (22.0%) in the US-PB group and 374 patients (31.7%) in the MRI-PB group had clinically significant prostate cancer (csPCa). The patients with csPCa in the MRI-PB group included 10 (40%), 50 (62.5%), 184 (94.8%), and 32 (94.1%) patients with PI-RADS V2 scores of 2, 3, 4, and 5, respectively. Of the patients with csPCa, 155 (91.7%) in the US-PB group were diagnosed on the basis of the primary biopsy, compared to 308 (94.4%) in the MRI-PB group. We found the PI-RADS V2 score to be the best predictor of a higher GS. CONCLUSION MRI-PB showed a high CDR for csPCa. MRI-PB could be a reasonable approach in patients with high PI-RADS V2 scores at primary biopsy.
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Affiliation(s)
- Jae Heung Bae
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
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[Importance of magnetic resonance imaging/ultrasound-guided fusion biopsy for the detection and monitoring of prostate cancer]. Urologe A 2019; 58:1499-1510. [PMID: 31741003 DOI: 10.1007/s00120-019-01069-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The use of multiparametric magnetic resonance imaging (mpMRI) is becoming increasingly more important for the primary diagnostics of prostate cancer (PCa) and for monitoring under active surveillance. Current studies confirmed that the use of mpMRI can increase the detection of clinically significant PCa and reduce the detection rate of insignificant PCa as well as the rate of unnecessary biopsies. The information from mpMRI can be cognitively used for in-bore biopsy and using fusion biopsy systems. There are no clear recommendations on the access approach for fusion biopsy (e. g. transrectal or perineal), whereby higher rates of rectal bleeding and infections have been described for transrectal access compared to perineal access. The increasing rate of antibiotic resistance as well as restricted indications for the use of quinolones are a major challenge for transrectal biopsy.
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Kasivisvanathan V, Stabile A, Neves JB, Giganti F, Valerio M, Shanmugabavan Y, Clement KD, Sarkar D, Philippou Y, Thurtle D, Deeks J, Emberton M, Takwoingi Y, Moore CM. Magnetic Resonance Imaging-targeted Biopsy Versus Systematic Biopsy in the Detection of Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2019; 76:284-303. [PMID: 31130434 DOI: 10.1016/j.eururo.2019.04.043] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/29/2019] [Indexed: 01/08/2023]
Abstract
CONTEXT Magnetic resonance imaging (MRI)-targeted prostate biopsy (MRI-TB) may be an alternative to systematic biopsy for diagnosing prostate cancer. OBJECTIVE The primary aims of this systematic review and meta-analysis were to compare the detection rates of clinically significant and clinically insignificant cancer by MRI-TB with those by systematic biopsy in men undergoing prostate biopsy to identify prostate cancer. EVIDENCE ACQUISITION A literature search was conducted using the PubMed, Embase, Web of Science, Cochrane library, and Clinicaltrials.gov databases. We included prospective and retrospective paired studies where the index test was MRI-TB and the comparator test was systematic biopsy. We also included randomised controlled trials (RCTs) if one arm included MRI-TB and another arm included systematic biopsy. The risk of bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 checklist. In addition, the Cochrane risk of bias 2.0 tool was used for RCTs. EVIDENCE SYNTHESIS We included 68 studies with a paired design and eight RCTs, comprising a total of 14709 men who either received both MRI-TB and systematic biopsy, or were randomised to receive one of the tests. MRI-TB detected more men with clinically significant cancer than systematic biopsy (detection ratio [DR] 1.16 [95% confidence interval {CI} 1.09-1.24], p<0.0001) and fewer men with clinically insignificant cancer than systematic biopsy (DR 0.66 [95% CI 0.57-0.76], p<0.0001). The proportion of cores positive for cancer was greater for MRI-TB than for systematic biopsy (relative risk 3.17 [95% CI 2.82-3.56], p<0.0001). CONCLUSIONS MRI-TB is an attractive alternative diagnostic strategy to systematic biopsy. PATIENT SUMMARY We evaluated the published literature, comparing two methods of diagnosing prostate cancer. We found that biopsies targeted to suspicious areas on magnetic resonance imaging were better at detecting prostate cancer that needs to be treated and avoiding the diagnosis of disease that does not need treatment than the traditional systematic biopsy.
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Affiliation(s)
- Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK.
| | - Armando Stabile
- Division of Surgery and Interventional Science, University College, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Joana B Neves
- Division of Surgery and Interventional Science, University College, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Science, University College, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yaalini Shanmugabavan
- Division of Surgery and Interventional Science, University College, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK
| | - Keiran D Clement
- British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Queen Elizabeth University Hospital, Glasgow, UK
| | - Debashis Sarkar
- British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Royal Hampshire County Hospital, Winchester, UK
| | - Yiannis Philippou
- British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - David Thurtle
- British Urology Researchers in Surgical Training (BURST) Research Collaborative, London, UK; Academic Urology Group, University of Cambridge, Cambridge, UK
| | - Jonathan Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre (University Hospital Birmingham NHS Foundation Trust and University of Birmingham), Birmingham, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College, London, UK; NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre (University Hospital Birmingham NHS Foundation Trust and University of Birmingham), Birmingham, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College, London, UK
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How to make clinical decisions to avoid unnecessary prostate screening in biopsy-naïve men with PI-RADs v2 score ≤ 3? Int J Clin Oncol 2019; 25:175-186. [DOI: 10.1007/s10147-019-01524-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
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Radtke JP, Giganti F, Wiesenfarth M, Stabile A, Marenco J, Orczyk C, Kasivisvanathan V, Nyarangi-Dix JN, Schütz V, Dieffenbacher S, Görtz M, Stenzinger A, Roth W, Freeman A, Punwani S, Bonekamp D, Schlemmer HP, Hohenfellner M, Emberton M, Moore CM. Prediction of significant prostate cancer in biopsy-naïve men: Validation of a novel risk model combining MRI and clinical parameters and comparison to an ERSPC risk calculator and PI-RADS. PLoS One 2019; 14:e0221350. [PMID: 31450235 PMCID: PMC6710031 DOI: 10.1371/journal.pone.0221350] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Risk models (RM) need external validation to assess their value beyond the setting in which they were developed. We validated a RM combining mpMRI and clinical parameters for the probability of harboring significant prostate cancer (sPC, Gleason Score ≥ 3+4) for biopsy-naïve men. MATERIAL AND METHODS The original RM was based on data of 670 biopsy-naïve men from Heidelberg University Hospital who underwent mpMRI with PI-RADS scoring prior to MRI/TRUS-fusion biopsy 2012-2015. Validity was tested by a consecutive cohort of biopsy-naïve men from Heidelberg (n = 160) and externally by a cohort of 133 men from University College London Hospital (UCLH). Assessment of validity was performed at fusion-biopsy by calibration plots, receiver operating characteristics curve and decision curve analyses. The RM`s performance was compared to ERSPC-RC3, ERSPC-RC3+PI-RADSv1.0 and PI-RADSv1.0 alone. RESULTS SPC was detected in 76 men (48%) at Heidelberg and 38 men (29%) at UCLH. The areas under the curve (AUC) were 0.86 for the RM in both cohorts. For ERSPC-RC3+PI-RADSv1.0 the AUC was 0.84 in Heidelberg and 0.82 at UCLH, for ERSPC-RC3 0.76 at Heidelberg and 0.77 at UCLH and for PI-RADSv1.0 0.79 in Heidelberg and 0.82 at UCLH. Calibration curves suggest that prevalence of sPC needs to be adjusted to local circumstances, as the RM overestimated the risk of harboring sPC in the UCLH cohort. After prevalence-adjustment with respect to the prevalence underlying ERSPC-RC3 to ensure a generalizable comparison, not only between the Heidelberg and die UCLH subgroup, the RM`s Net benefit was superior over the ERSPC`s and the mpMRI`s for threshold probabilities above 0.1 in both cohorts. CONCLUSIONS The RM discriminated well between men with and without sPC at initial MRI-targeted biopsy but overestimated the sPC-risk at UCLH. Taking prevalence into account, the model demonstrated benefit compared with clinical risk calculators and PI-RADSv1.0 in making the decision to biopsy men at suspicion of PC. However, prevalence differences must be taken into account when using or validating the presented risk model.
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Affiliation(s)
- Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Armando Stabile
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jose Marenco
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Dieffenbacher
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wilfried Roth
- Institute of Pathology, University of Heidelberg, Heidelberg Germany
- Institute of Pathology, University Medicine Mainz, Mainz, Germany
| | - Alex Freeman
- Department of Pathology, University College Hospital, London, United Kingdom
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Imaging, University College London Hospitals NHS Foundation Trust, University College London, London, United Kingdom
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | | | | | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Lu YF, Zhang Q, Yao WG, Chen HY, Chen JY, Xu CC, Yu RS. Optimizing prostate cancer accumulating model: combined PI-RADS v2 with prostate specific antigen and its derivative data. Cancer Imaging 2019; 19:26. [PMID: 31122297 PMCID: PMC6533650 DOI: 10.1186/s40644-019-0208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/16/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To establish a new accumulating model to enhance the accuracy of prostate cancer (PCa) diagnosis by incorporating prostate-specific antigen (PSA) and its derivative data into the Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2). METHODS A total of 357 patients who underwent prostate biopsy between January 2014 and December 2017 were included in this study. All patients had 3.0 T multiparametric magnetic resonance imaging (MRI) and complete laboratory examinations. PI-RADS v2 was used to assess the imaging. PSA, PSA density (PSAD), the free/total PSA ratio (f/t PSA) and the Gleason score (GS) were classified into four-tiered levels, and optimal weights were pursued on these managed levels to build a PCa accumulating model. A receiver operating characteristic curve was generated. RESULTS In all, 174 patients (48.7%) had benign prostatic hyperplasia, and 183 (51.3%) had PCa, among whom 149 (81.4%, 149/183) had clinically significant PCa. The established model 6 (PI-RADS v2 + level of PSAD + level of f/t PSA+ level of PSA) had a sensitivity and specificity of 81.4 and 84.5%, respectively, at the cut-off point of 11 in PCa diagnosis. Correspondingly, at the 12 cut-off point, the sensitivity and specificity were 87.7 and 83.0%, respectively, in diagnosing clinically significant PCa. The score of the new accumulating system was significantly different among the defined GS groups (p < 0.001). The mean values and 95% confidence intervals for GS 1-4 groups were 10.20 (9.63-10.40), 12.03 (11.19-12.87), 14.12 (13.60-14.64) and 15.44 (15.09-15.79). CONCLUSIONS A new PCa accumulating model may be useful in improving the accuracy of the primary diagnosis of PCa and helpful in the clinical decision to perform a biopsy when MRI results are negative.
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Affiliation(s)
- Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie-Fang Road, Zhejiang, 310009, Hangzhou, China
| | - Qian Zhang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie-Fang Road, Zhejiang, 310009, Hangzhou, China
| | - Wei-Gen Yao
- Department of Radiology, Yangming Affiliated Hospital, School of Medicine, Ningbo University, Yuyao, 315400, Zhejiang, China
| | - Hai-Yan Chen
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie-Fang Road, Zhejiang, 310009, Hangzhou, China
| | - Jie-Yu Chen
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie-Fang Road, Zhejiang, 310009, Hangzhou, China
| | - Cong-Cong Xu
- Department of Urology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie-Fang Road, Zhejiang, 310009, Hangzhou, China.
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Das CJ, Razik A, Sharma S, Verma S. Prostate biopsy: when and how to perform. Clin Radiol 2019; 74:853-864. [PMID: 31079953 DOI: 10.1016/j.crad.2019.03.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/15/2019] [Indexed: 12/24/2022]
Abstract
Prostate cancer, unlike other cancers, has been sampled in a non-targeted, systematic manner in the past three decades. On account of the low volume of prostate sampled despite the multiple cores acquired, systematic transrectal (TRUS) biopsy suffered from low sensitivity in picking up clinically significant prostate cancer. In addition, a significant number of cancers of the anterior, lateral peripheral zone, and the apex were missed as these areas were undersampled or missed during this biopsy protocol. Subsequently, the number of cores acquired was increased with special focus given to targeting the previously undersampled areas. These procedures led to an increase in the complication rates as well as detection of more clinically insignificant cancers. The advent of multiparametric magnetic resonance imaging (MRI) and its high intrinsic tissue contrast enabled better detection of prostate cancer. This led to the introduction of MRI-targeted biopsies with either MRI-TRUS fusion or under direct (in-gantry) guidance. MRI-targeted biopsies increased the percentage of positive cores and detection of clinically significant prostate cancers; however, these are expensive, time-intensive, require significant capital investment and operator expertise. This article describes the indications, workflow, complications, advantages, and disadvantages of TRUS-guided biopsy followed by MRI-guided biopsies.
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Affiliation(s)
- C J Das
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - A Razik
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - S Sharma
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - S Verma
- Department of Radiology, The Veterans Administration Hospital Cincinnati, The University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45267, USA.
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Brown LC, Ahmed HU, Faria R, El-Shater Bosaily A, Gabe R, Kaplan RS, Parmar M, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham A, Oldroyd R, Parker C, Bott S, Burns-Cox N, Dudderidge T, Ghei M, Henderson A, Persad R, Rosario DJ, Shergill I, Winkler M, Soares M, Spackman E, Sculpher M, Emberton M. Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone: the PROMIS study. Health Technol Assess 2019; 22:1-176. [PMID: 30040065 DOI: 10.3310/hta22390] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Men with suspected prostate cancer usually undergo transrectal ultrasound (TRUS)-guided prostate biopsy. TRUS-guided biopsy can cause side effects and has relatively poor diagnostic accuracy. Multiparametric magnetic resonance imaging (mpMRI) used as a triage test might allow men to avoid unnecessary TRUS-guided biopsy and improve diagnostic accuracy. OBJECTIVES To (1) assess the ability of mpMRI to identify men who can safely avoid unnecessary biopsy, (2) assess the ability of the mpMRI-based pathway to improve the rate of detection of clinically significant (CS) cancer compared with TRUS-guided biopsy and (3) estimate the cost-effectiveness of a mpMRI-based diagnostic pathway. DESIGN A validating paired-cohort study and an economic evaluation using a decision-analytic model. SETTING Eleven NHS hospitals in England. PARTICIPANTS Men at risk of prostate cancer undergoing a first prostate biopsy. INTERVENTIONS Participants underwent three tests: (1) mpMRI (the index test), (2) TRUS-guided biopsy (the current standard) and (3) template prostate mapping (TPM) biopsy (the reference test). MAIN OUTCOME MEASURES Diagnostic accuracy of mpMRI, TRUS-guided biopsy and TPM-biopsy measured by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using primary and secondary definitions of CS cancer. The percentage of negative magnetic resonance imaging (MRI) scans was used to identify men who might be able to avoid biopsy. RESULTS Diagnostic study - a total of 740 men were registered and 576 underwent all three tests. According to TPM-biopsy, the prevalence of any cancer was 71% [95% confidence interval (CI) 67% to 75%]. The prevalence of CS cancer according to the primary definition (a Gleason score of ≥ 4 + 3 and/or cancer core length of ≥ 6 mm) was 40% (95% CI 36% to 44%). For CS cancer, TRUS-guided biopsy showed a sensitivity of 48% (95% CI 42% to 55%), specificity of 96% (95% CI 94% to 98%), PPV of 90% (95% CI 83% to 94%) and NPV of 74% (95% CI 69% to 78%). The sensitivity of mpMRI was 93% (95% CI 88% to 96%), specificity was 41% (95% CI 36% to 46%), PPV was 51% (95% CI 46% to 56%) and NPV was 89% (95% CI 83% to 94%). A negative mpMRI scan was recorded for 158 men (27%). Of these, 17 were found to have CS cancer on TPM-biopsy. Economic evaluation - the most cost-effective strategy involved testing all men with mpMRI, followed by MRI-guided TRUS-guided biopsy in those patients with suspected CS cancer, followed by rebiopsy if CS cancer was not detected. This strategy is cost-effective at the TRUS-guided biopsy definition 2 (any Gleason pattern of ≥ 4 and/or cancer core length of ≥ 4 mm), mpMRI definition 2 (lesion volume of ≥ 0.2 ml and/or Gleason score of ≥ 3 + 4) and cut-off point 2 (likely to be benign) and detects 95% (95% CI 92% to 98%) of CS cancers. The main drivers of cost-effectiveness were the unit costs of tests, the improvement in sensitivity of MRI-guided TRUS-guided biopsy compared with blind TRUS-guided biopsy and the longer-term costs and outcomes of men with cancer. LIMITATIONS The PROstate Magnetic resonance Imaging Study (PROMIS) was carried out in a selected group and excluded men with a prostate volume of > 100 ml, who are less likely to have cancer. The limitations in the economic modelling arise from the limited evidence on the long-term outcomes of men with prostate cancer and on the sensitivity of MRI-targeted repeat biopsy. CONCLUSIONS Incorporating mpMRI into the diagnostic pathway as an initial test prior to prostate biopsy may (1) reduce the proportion of men having unnecessary biopsies, (2) improve the detection of CS prostate cancer and (3) increase the cost-effectiveness of the prostate cancer diagnostic and therapeutic pathway. The PROMIS data set will be used for future research; this is likely to include modelling prognostic factors for CS cancer, optimising MRI scan sequencing and biomarker or translational research analyses using the blood and urine samples collected. Better-quality evidence on long-term outcomes in prostate cancer under the various management strategies is required to better assess cost-effectiveness. The value-of-information analysis should be developed further to assess new research to commission. TRIAL REGISTRATION Current Controlled Trials ISRCTN16082556 and NCT01292291. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 39. See the NIHR Journals Library website for further project information. This project was also supported and partially funded by the NIHR Biomedical Research Centre at University College London (UCL) Hospitals NHS Foundation Trust and UCL and by The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research Biomedical Research Centre and was co-ordinated by the Medical Research Council's Clinical Trials Unit at UCL (grant code MC_UU_12023/28). It was sponsored by UCL. Funding for the additional collection of blood and urine samples for translational research was provided by Prostate Cancer UK.
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Affiliation(s)
- Louise Clare Brown
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rhian Gabe
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Katie Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexander Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Chris Parker
- Department of Academic Urology, Royal Marsden Hospital, Sutton, UK
| | | | | | | | - Maneesh Ghei
- Department of Urology, Whittington Hospital, London, UK
| | | | - Rajendra Persad
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | | | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Wegelin O, Exterkate L, van der Leest M, Kummer JA, Vreuls W, de Bruin PC, Bosch J, Barentsz JO, Somford DM, van Melick HH. The FUTURE Trial: A Multicenter Randomised Controlled Trial on Target Biopsy Techniques Based on Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer in Patients with Prior Negative Biopsies. Eur Urol 2019; 75:582-590. [DOI: 10.1016/j.eururo.2018.11.040] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
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Barth BK, Rupp NJ, Cornelius A, Nanz D, Grobholz R, Schmidtpeter M, Wild PJ, Eberli D, Donati OF. Diagnostic Accuracy of a MR Protocol Acquired with and without Endorectal Coil for Detection of Prostate Cancer: A Multicenter Study. Curr Urol 2019; 12:88-96. [PMID: 31114466 DOI: 10.1159/000489425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction The purpose of this study was to compare diagnostic accuracy of a prostate multiparametric magnetic resonance imaging (mpMRI) protocol for detection of prostate cancer between images acquired with and without en-dorectal coil (ERC). Materials This study was approved by the regional ethics committee. Between 2014 and 2015, 33 patients (median age 51.3 years; range 42.1-77.3 years) who underwent prostate-MRI at 3T scanners at 2 different institutions, acquired with (mpMRIERC) and without (mpMRIPPA) ERC and who received radical prostatectomy, were included in this retrospective study. Two expert readers (R1, R2) attributed a PI-RADS version 2 score for the most suspect (i. e. index) lesion for mpMRIPPA and mpMRIERC. Sensitivity and positive predictive value for detection of index lesions were assessed using 2 × 2 contingency tables. Differences between groups were tested using the McNemar test. Whole-mount histopathology served as reference standard. Results On a quadrant-basis cumulative sensitivity ranged between 0.61-0.67 and 0.76-0.88 for mpMRIPPA and mpMRIERC protocols, respectively (p > 0.05). Cumulative positive predictive value ranged between 0.80-0.81 and 0.89-0.91 for mpMRIPPA and mpMRIERC protocols, respectively. The differences were not statistically significant for R1 (p = 0.267) or R2 (p = 0.508). Conclusion Our results suggest that there may be no significant differences for detection of prostate cancer between images acquired with and without an ERC.
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Affiliation(s)
- Borna K Barth
- Institute of Diagnostic and Interventional Radiology, Zurich
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, Zurich
| | - Alexander Cornelius
- Department of Urology, University Hospital Zurich and University of Zurich, Zurich
| | - Daniel Nanz
- Institute of Diagnostic and Interventional Radiology, Zurich.,Department of Radiology, Zurich
| | | | - Martin Schmidtpeter
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich.,Department of Urology, Cantonal Hospital Aarau, Aarau
| | - Peter J Wild
- Department of Pathology and Molecular Pathology, Zurich.,Urologiepraxis Lenzburg, Lenzburg, Switzerland
| | - Daniel Eberli
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Olivio F Donati
- Institute of Diagnostic and Interventional Radiology, Zurich
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Kumar N, Yadav S, Kumar S, Saurav K, Prasad V, Vasudeva P. Comparison of percentage free PSA, MRI and GaPSMA PET scan for diagnosing cancer prostate in men with PSA between 4 and 20 ng/ml. Indian J Urol 2019; 35:202-207. [PMID: 31367071 PMCID: PMC6639993 DOI: 10.4103/iju.iju_91_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction: We compared the diagnostic accuracy of percentage free prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and gallium-68 prostate-specific membrane antigen positron emission tomography (Ga-PSMA PET) to detect cancer prostate in men with PSA between 4 and 20 ng/ml in prebiopsy settings. Materials and Methods: This prospective study evaluated men with PSA values between 4 and 20 ng/ml, and all patients underwent percentage free PSA estimation, mpMRI, and Ga-PSMA PET scan, followed by cognitive fusion/registration biopsy along with systematic 12-core biopsy to detect cancer prostate. The diagnostic accuracy of percentage free PSA, mpMRI, and Ga-PSMA PET scan was compared with results of cognitive fusion/registration biopsy. Results: A total of 15 patients were included, of which 11 had an identifiable lesion on imaging and 9 had malignancy on the final histopathology report. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy of mpMRI were 62.5%, 71.4%, 71.4%, 62.5%, and 66.6%, respectively, and that of Ga-PSMA PET scan were 88.8%, 66.6%, 80%, 80%, and 80%, respectively. The sensitivity of detection of clinically significant cancers for Ga-PSMA was higher (100%) compared to MRI (33.3%). However, Ga-PSMA also detected a greater number of insignificant lesions as compared to MRI. Conclusion: Ga-PSMA PET scan has high NPV and accuracy in predicting presence of cancer and can also be used to direct specific biopsy cores during systematic biopsy.
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Affiliation(s)
- Niraj Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Siddharth Yadav
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sandeep Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kumar Saurav
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vishnu Prasad
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pawan Vasudeva
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Kasivisvanathan V, Ambrosi A, Giganti F, Chau E, Kirkham A, Punwani S, Allen C, Emberton M, Moore CM. A Dedicated Prostate MRI Teaching Course Improves the Ability of the Urologist to Interpret Clinically Significant Prostate Cancer on Multiparametric MRI. Eur Urol 2019; 75:203-204. [PMID: 30327275 DOI: 10.1016/j.eururo.2018.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; British Urology Researchers in Surgical Training (BURST) Research Collaborative, UK.
| | | | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Edwin Chau
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, University College London, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Hwang SI, Lee HJ, Lee SE, Hong SK, Byun SS, Lee SC, Choe G. Value of MR-US fusion in guidance of repeated prostate biopsy in men with PSA < 10 ng/mL. Clin Imaging 2019; 53:1-5. [DOI: 10.1016/j.clinimag.2018.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 11/16/2022]
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Shoji S. Magnetic resonance imaging-transrectal ultrasound fusion image-guided prostate biopsy: Current status of the cancer detection and the prospects of tailor-made medicine of the prostate cancer. Investig Clin Urol 2018; 60:4-13. [PMID: 30637355 PMCID: PMC6318202 DOI: 10.4111/icu.2019.60.1.4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
Multi-parametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPCa) because of its growing availability and its ability to combine anatomical and functional data. Magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion imaging provides MRI information with TRUS images for prostate biopsies. This technique combines the superior sensitivity of MRI for targeting suspicious lesions with the practicality and familiarity of TRUS. MRI-TRUS fusion image-guided prostate biopsy is performed with different types of image registration (rigid vs. elastic) and needle tracking methods (electromagnetic tracking vs. mechanical position encoders vs. image-based software tracking). A systematic review and meta-analysis showed that MRI-targeted biopsy detected csPCa at a significantly higher rate than did TRUS-guided biopsy, while it detected significantly fewer cases of insignificant PCas. In addition to the high accuracy of MRI-targeted biopsy for csPCa, localization of csPCa is accurate. The ability to choose the route of biopsy (transperineal vs. transrectal) is required, depending on the patients' risk and the location and size of suspicious lesions on mpMRI. Fusion image-guided prostate biopsy has the potential to allow precise management of prostate cancer, including active surveillance, radical treatment, and focal therapy.
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Affiliation(s)
- Sunao Shoji
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
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Tae JH, Shim JS, Jin HJ, Yoon SG, No TI, Kim JY, Kang SH, Cheon J, Kang SG. Initial experience of magnetic resonance imaging/ultrasonography fusion transperineal biopsy: Biopsy techniques and results for 75 patients. Investig Clin Urol 2018; 59:363-370. [PMID: 30402568 PMCID: PMC6215777 DOI: 10.4111/icu.2018.59.6.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose The aim of this study is to describe the technique and to report early results of transperineal magnetic resonance imaging and ultrasonography (MRI-US) fusion biopsy. Materials and Methods A total of 75 patients underwent MRI-US fusion transperineal biopsy. Targeted biopsy via MRI-US fusion imaging was carried out for cancer-suspicious lesions with additional systematic biopsy. Detection rates for overall and clinically significant prostate cancer (csPCa) were evaluated and compared between systematic and targeted biopsy. In addition, further investigation into the detection rate according to prostate imaging reporting and data system (PI-RADS) score was done. Results of repeat biopsies were also evaluated. Results Overall cancer detection rate was 61.3% (46 patients) and the detection rate for csPCa was 42.7% (32 patients). Overall detection rates for systematic and targeted biopsy were 41.3% and 57.3% (p<0.05), respectively. Detection rates for csPCa were 26.7% and 41.3%, respectively (p<0.05). The cancer detection rates via MRI fusion target biopsy were 30.8% in PI-RADS 3, 62.1% in PI-RADS 4 and 89.4% in PI-RADS 5. Rates of csPCa missed by targeted biopsy and systematic biopsy were 0.0% and 25.0%, respectively. The cancer detection rate in repeat biopsies was 61.1% (11 among 18 patients) in which 55.5% of cancer suspected lesions were located in the anterior portion. Conclusions Transperineal MRI-US fusion biopsy is useful for improving overall cancer detection rate and especially detection of csPCa. Transperineal MRI-US targeted biopsy show potential benefits to improve cancer detection rate in patients with high PI-RADS score, tumor located at the anterior portion and in repeat biopsies.
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Affiliation(s)
- Jong Hyun Tae
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Hyun Jung Jin
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Sung Goo Yoon
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Tae Il No
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
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Bass EJ, Freeman A, Jameson C, Punwani S, Moore CM, Arya M, Emberton M, Ahmed HU. Prostate cancer diagnostic pathway: Is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK. BMJ Open 2018; 8:e024941. [PMID: 30361408 PMCID: PMC6224764 DOI: 10.1136/bmjopen-2018-024941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/24/2018] [Accepted: 09/20/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of a novel multiparametric MRI (mpMRI) and cognitive fusion transperineal targeted biopsy (MRTB) led prostate cancer (PCa) diagnostic service with regard to cancer detection and reducing time to diagnosis and treatment. DESIGN Consecutive men being investigated for possible PCa under the UK 2-week wait guidelines. SETTING Tertiary referral centre for PCa in the UK. PARTICIPANTS Men referred with a raised prostate-specific antigen (PSA) or abnormal digital rectal examination between February 2015 and March 2016 under the UK 2-week rule guideline. INTERVENTIONS An mpMRI was performed prior to patients attending clinic, on the same day. If required, MRTB was offered. Results were available within 48 hours and discussed at a specialist multidisciplinary team meeting. Patients returned for counselling within 7 days PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome measures in this regard included the time to diagnosis and treatment of patients referred with a suspicion of PCa. Quality control outcome measures included clinically significant and total cancer detection rates. RESULTS 112 men were referred to the service. 111 (99.1%) underwent mpMRI. Median PSA was 9.4 ng/mL (IQR 5.6-21.0). 87 patients had a target on mpMRI with 25 scoring Likert 3/5 for likelihood of disease, 26 4/5 and 36 5/5.57 (51%) patients received a local anaesthetic, Magnetic resonance imaging targeted biopsy (MRTB). Cancer was detected in 45 (79%). 43 (96%) had University College London definition 2 disease or greater. The times to diagnosis and treatment were a median of 8 and 20 days, respectively. CONCLUSIONS This approach greatly reduces the time to diagnosis and treatment. Detection rates of significant cancer are high. Similar services may be valuable to patients with a potential diagnosis of PCa.
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Affiliation(s)
- Edward James Bass
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles Jameson
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Medicine, Centre for Medical Imaging, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hashim Uddin Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Histopathological to multiparametric MRI spatial mapping of extended systematic sextant and MR/TRUS-fusion-targeted biopsy of the prostate. Eur Radiol 2018; 29:1820-1830. [DOI: 10.1007/s00330-018-5751-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/15/2018] [Accepted: 09/11/2018] [Indexed: 01/08/2023]
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Covin B, Roumiguié M, Quintyn-Ranty ML, Graff P, Khalifa J, Aziza R, Ploussard G, Portalez D, Malavaud B. Refining the risk-stratification of transrectal biopsy-detected prostate cancer by elastic fusion registration transperineal biopsies. World J Urol 2018; 37:269-275. [PMID: 30145777 DOI: 10.1007/s00345-018-2459-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/16/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate image-guided Transperineal Elastic-Registration biopsy (TPER-B) in the risk-stratification of low-intermediate risk prostate cancer detected by Transrectal-ultrasound biopsy (TRUS-B) when estimates of cancer grade and volume discorded with multiparametric Magnetic Resonance Imaging (MRI). METHODS All patients referred for active surveillance or organ-conservative management were collegially reviewed for consistency between TRUS-B results and MRI. Image-guided TPER-B of the index target (IT) defined as the largest Prostate Imaging-Reporting Data System-v2 ≥ 3 abnormality was organized for discordant cases. Pathology reported Gleason grade, maximum cancer core length (MCCL) and total CCL (TCCL). RESULTS Of 237 prostate cancer patients (1-4/2018), 30 were required TPER-B for risk-stratification. Eight cores were obtained [Median and IQR: 8 (6-9)] including six (IQR: 4-6) in the IT. TPER-B of the IT yielded longer MCCL [Mean and (95%CI): 6.9 (5.0-8.8) vs. 2.6 mm (1.9-3.3), p < 0.0001] and TCCL [19.7 (11.6-27.8) vs. 3.6 mm (2.6-4.5), p = 0.0002] than TRUS-B of the gland. On TPER-B cores, longer MCCL [Mean and (95%CI): 8.7 mm (6.7-10.7) vs. 4.1 mm (0.6-7.6), p = 0.002] were measured in Gleason score-7 cancers. TPER-B cores upgraded 13/30 (43.3%) patients. 14/30 (46.7%) met University College London-definition 1 and 18/30 (60.0%) definition 2, which correlate with clinically significant cancers > 0.5 mL and > 0.2 mL, respectively. 7/16 (43.8%) patients under active surveillance were re-allocated toward prostatectomy (n = 5) or radiation therapy (n = 2). In 14 patients not yet assigned, TPER-B risk-stratification spurred the selection (13/14, 92.9%) of treatments with curative intent. CONCLUSION Image-guided TPER-B of the index target provided more cancer material for pathology. Subsequent re-evaluation of cancer volume and grade switched a majority of patients towards higher-risk groups and treatments with curative intent.
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Affiliation(s)
- Bertrand Covin
- Department of Urology, Institut Universitaire du Cancer, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, Toulouse, France
| | | | - Pierre Graff
- Department of Radiation Oncology, Institut Universitaire du Cancer, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer, Toulouse, France
| | - Richard Aziza
- Department of Radiology, Institut Universitaire du Cancer, Toulouse, France
| | | | - Daniel Portalez
- Department of Radiology, Institut Universitaire du Cancer, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer, Toulouse, France.
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Accuracy of the magnetic resonance imaging pathway in the detection of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2018; 22:39-48. [PMID: 30108376 DOI: 10.1038/s41391-018-0075-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/07/2018] [Accepted: 05/25/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although magnetic resonance imaging and subsequent targeted biopsy ('MRI pathway') have been widely adopted in routine clinical practice, it is still a common practice to perform systematic biopsy concurrently, because the accuracy of the MRI pathway is yet to be fully defined. This systematic review of the literature assessed the sensitivity of the MRI pathway for detecting clinically significant prostate cancer. METHODS Multiple databases were searched up to May 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement for studies assessing the accuracy of MR-guided biopsy (MRGB) compared to a reference standard which consisted of both MRGB and systematic biopsy with at least 20-cores. The primary outcome was the sensitivity of detecting clinically significant prostate cancer defined as Gleason ≥7 disease. RESULTS A total of 15 studies met the predefined inclusion criteria. Overall, studies were assessed to be of low quality with inadequate blinding of personnel, which could introduce performance and detection bias. The calculated summary sensitivity of the MRI pathway was 78.3% [95%CI 75.0-81.4%]. There was moderate heterogeneity between the included studies (I2 = 36%). Subgroup analysis was performed based on clinical setting, the strength of MRI magnet and mode of image fusion as factors but no interaction was identified between any of the subgroups. No publication bias was identified. CONCLUSION The MRI pathway cannot yet be solely relied upon to diagnose clinically significant disease and hence additional systematic sampling should still be performed during the biopsy procedure.
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Azadi J, Nguyen ML, Leroy A, Macura KJ, Gorin MA, Rowe SP. The emerging role of imaging in prostate cancer secondary screening: multiparametric magnetic resonance imaging and the incipient incorporation of molecular imaging. Br J Radiol 2018; 91:20170960. [PMID: 30048145 DOI: 10.1259/bjr.20170960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
An increasingly robust body of evidence indicates that multiparametric MRI (mpMRI) prior to prostate biopsy can improve the detection of clinically significant prostate cancer while avoiding unnecessary biopsies. As a result, the use of mpMRI and biopsy platforms that allow for the real-time fusion of mpMRI and transrectal ultrasound images is now routinely used in clinical practice. On the horizon, molecular imaging offers the promise of improved sensitivity relative to mpMRI and early data would suggest that the combination of mpMRI and positron emission tomography using radiotracers targeting prostate-specific membrane antigen provide a more accurate assessment than either modality alone. In this review, we examine the current role of imaging to aid in the initial diagnosis of prostate cancer.
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Affiliation(s)
- Javad Azadi
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - My-Linh Nguyen
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | | | - Katarzyna J Macura
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA.,3 The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine , Baltimore , MD, USA
| | - Michael A Gorin
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA.,3 The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine , Baltimore , MD, USA
| | - Steven P Rowe
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA.,3 The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine , Baltimore , MD, USA
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Das CJ, Razik A, Sharma S. Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy of the Prostate—An Update. Semin Roentgenol 2018; 53:219-226. [DOI: 10.1053/j.ro.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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