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Almalki YE, Mansour MGED, Ali SA, Basha MAA, Abdelkawi MM, Alduraibi SK, Almushayti ZA, Aldhilan AS, Aboualkheir M, Amin D, Metkees M, Basha AMA, Ebaid NY. Advanced strain elastography is a reliable approach for prostate cancer detection in patients with elevated PSA levels. Sci Rep 2024; 14:2917. [PMID: 38316992 PMCID: PMC10844258 DOI: 10.1038/s41598-024-53440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
This study aimed to examine the validity and reproducibility of strain elastography (SE) for detecting prostate cancer (PCa) in patients with elevated prostate-specific antigen (PSA) levels. The study included 107 patients with elevated PSA levels. All eligible patients underwent transrectal ultrasound (TRUS) with real-time elastography (RTE) to detect suspicious lesions. Two readers independently evaluated the lesions and assigned a strain ratio and elastography score to each lesion. Histopathology was used as a reference standard to estimate the validity of RTE in predicting malignant lesions. An intraclass correlation (ICC) was performed to detect reliability of the strain ratios and elastography scores. TRUS-guided biopsy detected malignancies in 64 (59.8%) patients. TRUS with RTE revealed 122 lesions. The strain ratio index (SRI) cut-off values to diagnose malignancy were 4.05 and 4.35, with sensitivity, specificity, and accuracy of 94.7%, 91.3%, and 93.4%, respectively. An elastography score > 3 was the best cut-off value for detecting malignancy. According to readers, the sensitivity, specificity, and accuracy were 91.3-94.7%, 89.5-93.4%, and 91.3-90.9%, respectively. Excellent inter-reader agreement was recorded for SRI and elastography scores, with ICC of 0.937 and 0.800, respectively. SE proves to be an efficient tool for detecting PCa with high accuracy in patients with elevated PSA levels.
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Affiliation(s)
- Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, 61441, Kingdom of Saudi Arabia
| | | | - Susan Adil Ali
- Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt
| | | | | | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, 42353, Kingdom of Saudi Arabia
| | - Darine Amin
- Department of Biological Anthropology, Medical Research Division, National Research Centre, Giza, 12622, Egypt
| | - Mohamed Metkees
- Department of Biological Anthropology, Medical Research Division, National Research Centre, Giza, 12622, Egypt
| | - Ahmed M A Basha
- Faculty of General Medicine, St. Petersburg State University, Egypt Branch, Cairo, 11646, Egypt
| | - Noha Yahia Ebaid
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
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2
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van Breugel SJ, Low I, Christie ML, Pokorny MR, Nagarajan R, Holtkamp HU, Srinivasa K, Amirapu S, Nieuwoudt MK, Simpson MC, Zargar-Shoshtari K, Aguergaray C. Raman spectroscopy system for real-time diagnosis of clinically significant prostate cancer tissue. JOURNAL OF BIOPHOTONICS 2023; 16:e202200334. [PMID: 36715344 DOI: 10.1002/jbio.202200334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 05/17/2023]
Abstract
Prostate cancer (PCa) is a significant healthcare problem worldwide. Current diagnosis and treatment methods are limited by a lack of precise in vivo tissue analysis methods. Real-time cancer identification and grading could dramatically improve current protocols. Here, we report the testing of a thin optical probe using Raman spectroscopy (RS) and classification methods to detect and grade PCa accurately in real-time. We present the first clinical trial on fresh ex vivo biopsy cores from an 84 patient cohort. Findings from 2395 spectra measured on 599 biopsy cores show high accuracy for diagnosing and grading PCa. We can detect clinically significant PCa from benign and clinically insignificant PCa with 90% sensitivity and 80.2% specificity. We also demonstrate the ability to differentiate cancer grades with 90% sensitivity and specificity ≥82.8%. This work demonstrates the utility of RS for real-time PCa detection and grading during routine transrectal biopsy appointments.
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Affiliation(s)
- Suse J van Breugel
- The Photon Factory, University of Auckland, Auckland, New Zealand
- School of Chemical Sciences, University of Auckland, Auckland, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
| | - Irene Low
- Counties Manukau District Healthboard, Auckland, New Zealand
| | - Mary L Christie
- Counties Manukau District Healthboard, Auckland, New Zealand
| | - Morgan R Pokorny
- Counties Manukau District Healthboard, Auckland, New Zealand
- Auckland District Healthboard, Auckland, New Zealand
| | - Ramya Nagarajan
- Counties Manukau District Healthboard, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Hannah U Holtkamp
- The Photon Factory, University of Auckland, Auckland, New Zealand
- School of Chemical Sciences, University of Auckland, Auckland, New Zealand
| | - Komal Srinivasa
- Auckland District Healthboard, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Satya Amirapu
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michel K Nieuwoudt
- The Photon Factory, University of Auckland, Auckland, New Zealand
- School of Chemical Sciences, University of Auckland, Auckland, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
- The MacDiarmid Institute for Advanced Materials and Nanotechnology, Victoria University of Wellington, Wellington, New Zealand
| | - M Cather Simpson
- The Photon Factory, University of Auckland, Auckland, New Zealand
- School of Chemical Sciences, University of Auckland, Auckland, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
- The MacDiarmid Institute for Advanced Materials and Nanotechnology, Victoria University of Wellington, Wellington, New Zealand
- Department of Physics, University of Auckland, Auckland, New Zealand
| | - Kamran Zargar-Shoshtari
- Counties Manukau District Healthboard, Auckland, New Zealand
- Auckland District Healthboard, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Claude Aguergaray
- The Photon Factory, University of Auckland, Auckland, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
- Department of Physics, University of Auckland, Auckland, New Zealand
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3
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Leyh-Bannurah SR, Boiko S, Beyersdorff D, Falkenbach F, Ekrutt J, Maurer T, Graefen M, Kachanov M, Budäus L. Pan-segmental intraprostatic lesions involving mid-gland and apex of prostate (mid-apical lesions): assessing the true value of extreme apical biopsy cores. World J Urol 2022; 40:1653-1659. [PMID: 35501610 PMCID: PMC9236964 DOI: 10.1007/s00345-022-04006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objective When considering increased morbidity of apical biopsies, the added diagnostic value of separate targeting of mid-gland and apical segment of the pan-segmental mid-apical mpMRI prostate cancer (PCa) suspicious lesions was assessed. Materials and methods A total of 420 patients with a single mpMRI PCa-suspicious PI-RADS ≥ 3 intraprostatic lesion extending from the mid-gland to the apical segment of the gland underwent transrectal MRI-targeted (TBx) and systematic prostate biopsy. Clinically significant PCa (CsPCa) was defined as Gleason Score (GS) ≥ 3 + 4. PCa detection rates of TBx cores were assessed according to targeted anatomical segments. Finally, the diagnostic values of two theoretical TBx protocols utilizing 1-core (A) vs. 2-cores (B) per anatomical segment were compared. Results TBx within the pan-segmental mid-apical lesions yielded 44% of csPCa. After stratification into mid- vs. apical segment of the lesion, csPCa was detected in 36% (mid-gland) and 32% (apex), respectively. Within the patients who had no csPCa detection by mid-gland sampling (64%, n = 270), extreme apical TBx yielded additional 8.1% of csPCa. Comparison of extreme apical TBx strategy B vs. overall PCa detection in our cohort revealed corresponding similar rates of 49 vs.50% and 31 vs.32%, respectively. Conclusion Separate analyses of both segments, mid-gland and apex, clearly revealed the diagnostic contribution of apical TBx. Our findings strongly suggest to perform extreme apical TBx even within pan-segmental lesions. Moreover, our results indicate that a higher number of cores sampled from the mid-gland segment might be avoided if complemented with a two-core extreme apical TBx. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04006-2.
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4
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Häggman M, Dahlman P, Ahlberg M, Liss P, Cantera Ahlman R, Dragomir A, Ladjevardi S. Bi-parametric MRI/TRUS fusion targeted repeat biopsy after systematic 10-12 core TRUS-guided biopsy reveals more significant prostate cancer especially in anteriorly located tumors. Acta Radiol Open 2022; 11:20584601221085520. [PMID: 35392628 PMCID: PMC8980410 DOI: 10.1177/20584601221085520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background MRI and fusion guided biopsy have an increased role in the diagnosis of prostate cancer. Purpose To demonstrate the possible advantages with Bi-parametric MRI fusion-guided repeat biopsy over systematic 10-12-core biopsy for the diagnosis of prostate cancer. Material and Methods Four hundred and twenty-three consecutive men, with previous systematic 10-12-core TRUS-guided biopsy, and with suspicion of, or diagnosis of, low-risk prostate cancer underwent fusion-guided prostate biopsy between February 2015 and February 2017. The material was retrospectively assessed. In 220 cases no previous cancer was diagnosed, and in 203 cases confirmatory fusion guided biopsy was performed prior to active monitoring. MRI was classified according to PI-RADS. Systematic biopsy was compared to fusion guided biopsy for the detection of cancer, and PI-RADS was compared to the Gleason score. Results Fusion guided biopsy detected significantly more cancers than systematic (p < .001). Gleason scores were higher in the fusion biopsy group (p < .001). Anterior tumors were present in 54% of patients. Fusion biopsy from these lesions showed cancer in 53% with previously negative biopsy in systematic biopsies and 66% of them were upgraded from low risk to intermediate or high-risk cancers. Conclusion These results show superior detection rate and grading of bi-parametric MRI/TRUS fusion targeted repeat biopsy over systematic 10-12 core biopsies. Fusion guided biopsy detects more significant cancers despite using fewer cores. The risk group was changed for many patients initially selected for active surveillance due to upgrading of tumors. Bi-parametric MRI shows promising results in detecting anterior tumors in patients with suspected prostate cancer.
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Affiliation(s)
- Michael Häggman
- Department of Urology, Uppsala University Hospital, Uppsala, Sweden
| | - Pär Dahlman
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Ahlberg
- Department of Urology, Uppsala University Hospital, Uppsala, Sweden
| | - Per Liss
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Anca Dragomir
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
- Department of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Sam Ladjevardi
- Department of Urology, Uppsala University Hospital, Uppsala, Sweden
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5
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Ellis EE, Frye TP. Role of multi-parametric magnetic resonance imaging fusion biopsy in active surveillance of prostate cancer: a systematic review. Ther Adv Urol 2022; 14:17562872221106883. [PMID: 35872881 PMCID: PMC9297445 DOI: 10.1177/17562872221106883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Our goal is to review current literature regarding the role of multi-parametric magnetic resonance imaging (mpMRI) in the active surveillance (AS) of prostate cancer (PCa) and identify trends in rate of reclassification of risk category, performance of fusion biopsy (FB) versus systematic biopsy (SB), and progression-free survival. Methods: We performed a comprehensive literature search in PubMed and identified 121 articles. A narrative summary was performed. Results: Thirty-two articles were chosen to be featured in this review. SB and FB are complementary in detecting higher-grade disease in follow-up. While FB was more likely than SB to detect clinically significant disease, FB missed 6.4–11% of clinically significant disease. Imaging factors that predicted upgrading include number of lesions on magnetic resonance imaging (MRI), lesion density, and MRI suspicion level. Conclusion: Incorporating mpMRI FB in conjunction with SB should be part of contemporary AS protocols. mpMRI should additionally be used routinely for follow-up; however, mpMRI is not currently sensitive enough in detecting disease progression to replace biopsy in the surveillance protocol.
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Affiliation(s)
| | - Thomas P Frye
- University of Rochester Medical Center, 601 Elmwood Ave Box 656, Rochester, NY 14620, USA
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6
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Kawa SM, Benzon Larsen S, Helgstrand JT, Iversen P, Brasso K, Røder MA. What is the risk of prostate cancer mortality following negative systematic TRUS-guided biopsies? A systematic review. BMJ Open 2020; 10:e040965. [PMID: 33371032 PMCID: PMC7751212 DOI: 10.1136/bmjopen-2020-040965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the risk of prostate cancer-specific mortality (PCSM) following initial negative systematic transrectal ultrasound-guided (TRUS) prostate biopsies. DESIGN Systematic review. DATA SOURCES PubMed and Embase were searched using a string combination with keywords/Medical Subject Headings terms and free text in the search builder. Date of search was 13 April 2020. STUDY SELECTION Studies addressing PCSM following initial negative TRUS biopsies. Randomised controlled trials and population-based studies including men with initial negative TRUS biopsies reported in English from 1990 until present were included. DATA EXTRACTION Data extraction was done using a predefined form by two authors independently and compared with confirm data; risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies when applicable. RESULTS Four eligible studies were identified. Outcomes were reported differently in the studies as both cumulative incidence and Kaplan-Meier estimates have been used. Regardless of the study differences, all studies reported low estimated incidence of PCSM of 1.8%-5.2% in men with negative TRUS biopsies during the following 10-20 years. Main limitation in all studies was limited follow-up. CONCLUSION Only a few studies have investigated the risk of PCSM following initial negative biopsies and all studies included patients before the era of MRI of the prostate. However, the studies point to the fact that the risk of PCSM is low following initial negative TRUS biopsies, and that the level of prostate-specific antigen before biopsies holds prognostic information. This may be considered when advising patients about the need for further diagnostic evaluation. PROSPERO REGISTRATION NUMBER CRD42019134548.
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Affiliation(s)
- Sandra Miriam Kawa
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - John Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
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7
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mpMRI-targeted biopsy versus systematic biopsy for clinically significant prostate cancer diagnosis: a systematic review and metaanalysis. Curr Opin Urol 2020; 30:711-719. [PMID: 32732624 DOI: 10.1097/mou.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We aimed to compare the accuracy of clinically significant prostate cancer (csPCa) diagnosis by magnetic resonance imaging-targeted biopsy (MRI-TB) versus systematic biopsy (SB) in men suspected of having prostate cancer (PCa). RECENT FINDINGS In biopsy-naïve patients, MRI-TB was more accurate to identify csPCa than SB. However, when comparing specifically MRI-TB versus transperineal (SB), we did not find any difference. Furthermore, in a repeat biopsy scenario, MRI-TB found more csPCa than SB as well. Finally, postanalysis comparing combined biopsy (SB plus MRI-TB) suggests that the later alone may play a role in both scenarios for identifying csPCa. SUMMARY MRI-TB found more csPCa than SB in patients with suspected PCa in both scenarios, naïve and repeat biopsies, but more studies comparing those methods are warranted before any recommendation on this topic.
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8
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Targeted and Systematic Biopsy for the Diagnosis and Management of Prostate Cancer - A Case for Lesion Targeted-Only Biopsies. Clin Oncol (R Coll Radiol) 2020; 32:136-143. [PMID: 32035580 DOI: 10.1016/j.clon.2020.01.001] [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: 10/31/2019] [Revised: 12/11/2019] [Accepted: 01/07/2020] [Indexed: 11/23/2022]
Abstract
For much of the 1990s, transrectal ultrasound systematic biopsy was the standard approach for prostate cancer diagnosis. However, in the past decade multiparametric magnetic resonance imaging, multiparametric ultrasound and image fusion targeting have come to the fore. Here we present the state-of-the-art diagnostic strategies in prostate cancer detection and examine the case for target-only biopsy, as well as the benefits and limitations.
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9
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Mannaerts CK, Engelbrecht MRW, Postema AW, van Kollenburg RAA, Hoeks CMA, Savci-Heijink CD, Van Sloun RJG, Wildeboer RR, De Reijke TM, Mischi M, Wijkstra H. Detection of clinically significant prostate cancer in biopsy-naïve men: direct comparison of systematic biopsy, multiparametric MRI- and contrast-ultrasound-dispersion imaging-targeted biopsy. BJU Int 2020; 126:481-493. [PMID: 32315112 DOI: 10.1111/bju.15093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare and evaluate a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) strategy, contrast-ultrasound-dispersion imaging (CUDI)-TBx strategy and systematic biopsy (SBx) strategy for the detection of clinically significant prostate cancer (csPCa) in biopsy-naïve men. PATIENTS AND METHODS A prospective, single-centre paired diagnostic study included 150 biopsy-naïve men, from November 2015 to November 2018. All men underwent pre-biopsy mpMRI and CUDI followed by a 12-core SBx taken by an operator blinded from the imaging results. Men with suspicious lesions on mpMRI and/or CUDI also underwent MRI-TRUS fusion-TBx and/or cognitive CUDI-TBx after SBx by a second operator. A non-inferiority analysis of the mpMRI- and CUDI-TBx strategies in comparison with SBx for International Society of Urological Pathology Grade Group [GG] ≥2 PCa in any core with a non-inferiority margin of 1 percentage point was performed. Additional analyses for GG ≥2 PCa with cribriform growth pattern and/or intraductal carcinoma (CR/IDC), and GG ≥3 PCa were performed. Differences in detection rates were tested using McNemar's test with adjusted Wald confidence intervals. RESULTS After enrolment of 150 men, an interim analysis was performed. Both the mpMRI- and CUDI-TBx strategies were inferior to SBx for GG ≥2 PCa detection and the study was stopped. SBx found significantly more GG ≥2 PCa: 39% (56/142), as compared with 29% (41/142) and 28% (40/142) for mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). SBx found significantly more GG = 1 PCa: 14% (20/142) compared to 1% (two of 142) and 3% (four of 142) with mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). Detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa did not differ significantly between the strategies. The mpMRI- and CUDI-TBx strategies were comparable in detection but the mpMRI-TBx strategy had less false-positive findings (18% vs 53%). CONCLUSIONS In our study in biopsy-naïve men, the mpMRI- and CUDI-TBx strategies had comparable PCa detection rates, but the mpMRI-TBX strategy had the least false-positive findings. Both strategies were inferior to SBx for the detection of GG ≥2 PCa, despite reduced detection of insignificant GG = 1 PCa. Both strategies did not significantly differ from SBx for the detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa.
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Affiliation(s)
- Christophe K Mannaerts
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc R W Engelbrecht
- Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W Postema
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob A A van Kollenburg
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline M A Hoeks
- Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Cemile Dilara Savci-Heijink
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud J G Van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rogier R Wildeboer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Theo M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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10
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Maxeiner A, Nest AM, Stephan C, Cash H, Baur ADJ, Fischer T, Kilic E, Piper SK, Nowak CP, Busch J, Miller K, Mang J. Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies. Urol Int 2019; 104:205-213. [PMID: 31801153 DOI: 10.1159/000504266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/18/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Patients with consistent suspicion for prostate cancer (PCa) and multiple negative prebiopsies prior to multiparametric magnetic resonance imaging (mpMRI) are still frequently evaluated for an image-guided biopsy and are reported with heterogeneous detection rates. The inclusion of a systematic biopsy (SB) is also still recommended with predominant sampling within the posterior/peripheral zone of the prostate. The aim of this study was (I) to evaluate PCa detection rates using a modified 10 core SB template including anterior biopsies in combination with mpMRI/ultrasound fusion-guided targeted biopsy (TB) in patients with 3 or more negative prebiopsies and (II) to compare mpMRI index lesion localization with histologically confirmed locali-zation from associated prostatectomy samples. METHODS Overall 1,337 consecutive patients underwent sensor-based registration TB of the prostate and a subsequent 10-core SB between January 2012 and December 2015 at our institution. For this study, 101 patients with ≥3 negative prebiopsies and prostate imaging - reporting data system lesions ≥3 were pooled prospectively and underwent TB and a modified SB including 2 ventral (anterior) biopsies. Detection rates were estimated for the modified SB, TB, and its combination. A subgroup analysis of 35 patients undergoing prostatectomy was performed by a head-to-head comparison of mpMRI index lesion and histologically confirmed PCa index lesion localization. RESULTS The overall detection rate for PCa was 54.5%. The combination of TB and SB detected 14 (25.4%) more cases missed by TB alone (p < 0.001) and 7 (12.7%) more cases missed by SB alone (p = 0.016), respectively. A postoperative Gleason upgrade was seen in 12/35 (34.3%) cases within the TB group and in 14/35 (40.0%) in the SB group, respectively. The subgroup analysis showed a predominant location of PCa index lesions anteriorly at the level of the midgland. The MRI detection rate of the anteriorly located index lesions was 70.4% (15/21 cases) with a clinically significant Gleason score (≥3 + 4 = 7a [International Society of Urological Pathology grade 2]) in 80.9%. Interestingly a modified SB template detected 90.5% (19/21) of the anteriorly located index lesions. CONCLUSION Our data suggest that in patients with multiple prebiopsies PCa seems to be predominantly located anteriorly. We suggest the general integration of anterior biopsies despite TB in repeat biopsy patients.
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Affiliation(s)
- Andreas Maxeiner
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany,
| | - Alexander M Nest
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Carsten Stephan
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany.,Berlin Institute for Urologic Research, Berlin, Germany
| | - Hannes Cash
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Alexander D J Baur
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Campus Mitte, Berlin, Germany
| | - Thomas Fischer
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Campus Mitte, Berlin, Germany
| | - Ergin Kilic
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pathology, Campus Mitte, Berlin, Germany.,Institute of Pathology, Klinikum Leverkusen, Leverkusen, Germany
| | - Sophie K Piper
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Campus Mitte, Berlin, Germany
| | - Claus-P Nowak
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Campus Mitte, Berlin, Germany
| | - Jonas Busch
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Kurt Miller
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Josef Mang
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
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11
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Verep S, Erdem S, Ozluk Y, Kilicaslan I, Sanli O, Ozcan F. The pathological upgrading after radical prostatectomy in low-risk prostate cancer patients who are eligible for active surveillance: How safe is it to depend on bioptic pathology? Prostate 2019; 79:1523-1529. [PMID: 31269285 DOI: 10.1002/pros.23873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/29/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Active surveillance (AS) is one of the treatment alternatives in low-risk prostate cancer (PCa). The pathological upgrading after radical prostatectomy (RP) were investigated in patients who were eligible for AS in the present study. METHODS Between August 2006 and July 2017, 627 patients underwent RP in our institution. One hundred and thirty-six patients who were eligible for AS at the time of RP were included in this study. The previously defined AS criteria Gleason 3 + 3=6 adenocarcinoma at maximum two biopsy cores, prostate-specific antigen (PSA) < 10 ng/mL and clinical T stage ≤ 2a were used in the study. The demographics, clinical, and histopathological outcomes were retrospectively compared between two groups, which were divided in accordance with the upgrading status at final pathology as Group 1 (n = 67, upgrading) and Group 2 (n = 69, nonupgrading). RESULTS Gleason upgrading (GU) was found in 67 (49.3%) patients, and 17 patients (12.5%) were upstaged to pT3a. The upgrading to Gleason 3 + 4 was reported in 38.7% of patients, however, 7.4%, and 3.7% of the patients were upgraded to Gleason 4 + 3, and Gleason 4 + 4, respectively. The 10.3% of the patients had extraprostatic involvement, and the rate (19.4% vs 1.4%, P = .002) was significantly higher in Group 1. PSA density (P = .001), tumor size (P < .001), tumor percentage (P < .001), apical involvement (P = .013), and perineural invasion (P < .001) in RP specimen were higher in Group 1. Multivariate analysis showed that perineural invasion (OR = 4.26; 95%CI: 1.76-10.33; P = .001) and pathologic T stage (OR = 5.45; 95%CI: 1.08-27.4; P = .04) were independently associated with GU. CONCLUSIONS Since 12.5% of the patients upstaged to pT3a disease, and there is a possible risk of Gleason 4 pattern, upgrading of the tumor should carefully be kept in mind before offering AS to low-risk patients with PCa.
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Affiliation(s)
- Samed Verep
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selcuk Erdem
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Oner Sanli
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Faruk Ozcan
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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12
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Boesen L. Magnetic resonance imaging-transrectal ultrasound image fusion guidance of prostate biopsies: current status, challenges and future perspectives. Scand J Urol 2019; 53:89-96. [PMID: 31006323 DOI: 10.1080/21681805.2019.1600581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The use of multiparametric magnetic resonance imaging (mpMRI) in prostate cancer (PCa) diagnosis is rapidly evolving to try to overcome the limitations of the current diagnostic pathway using systematic transrectal ultrasound-guided biopsies (TRUSbx) for all men with clinical suspicion of PCa. Prostate mpMRI allows for high quality lesion detection and characterization and has been shown to improve detection of significant PCa with a more accurate Gleason score grading. Suspicious lesions can be stratified by suspicion and sampled by selective MRI-guided targeted biopsies (TBx) for improved diagnostic accuracy. Several TBx methods have been established and include MRI/TRUS image fusion biopsies (cognitive or software-assisted) and in-bore biopsies, but none have yet proven superior in clinical practice. However, while MRI in-bore biopsy is not routinely used due to its costs and limited availability, MRI/TRUS image fusion is rapidly embraced as it allows skilled urologists to perform TBx in an outpatient clinic. Furthermore, it gives the operator the advantage of adding TBx to the systematic standard biopsy scheme, which is the currently recommended approach. With the anticipated increased future use of prebiopsy mpMRI, a more widespread implementation of MRI/TRUS image fusion platforms is concurrently expected in clinical practice. Therefore, the objective of this review is to assess the current status, challenges and future perspectives of prostate MRI/TRUS image fusion biopsies.
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Affiliation(s)
- Lars Boesen
- a Department of Urology and Urological Research , Herlev Gentofte University Hospital , Herlev , Denmark
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13
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Sathianathen NJ, Warlick CA, Soubra A, Balaji P, Metzger GJ, Spilseth B, Murugan P, Ordonez M, Weight CJ, Konety BR. Difference in MRI-guided biopsy cancer detection rates between individual clinicians. Urol Oncol 2019; 37:299.e1-299.e6. [PMID: 30797649 DOI: 10.1016/j.urolonc.2019.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/13/2019] [Accepted: 01/31/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE A number of studies have described the overall institutional learning curve for magnetic resonance imaging-guided biopsy but none have evaluated differences and interactions between clinicians. Therefore, we aim to measure and compare the cancer detection rates between individual radiologists and urologists at a single academic institution. METHODS A consecutive sample of patients undergoing magnetic resonance imaging-guided biopsy at a single institution were included for analysis. The detection of any and clinically significant (Gleason score ≥3+4) prostate cancer was compared between radiologists and urologists after adjusting for relevant demographic and clinical characteristics. Analysis was conducted on a perlesion basis and only the results of the targeted cores were considered in the primary analysis. RESULTS Two hundred eighty-one patients with 418 lesions were included in the study. Prostate cancer of any grade was detected in 43.7% (183/418) of targeted lesions. There was no difference in the distribution of Prostate Imaging Reporting and Data System (PIRADS) scores attributed by each radiologist (p = 0.43). The individual radiologist cancer detection rate for both overall and clinically significant cancer was similar across each PIRADS score except for the detection of any cancer in PIRADS 3 lesions (p = 0.03). There was no difference in the detection rates of any grade or clinically significant cancer between urologists. CONCLUSION This single institutional analysis found that the performance of radiologists and urologists was largely comparable. Theonly variation observed was among radiologists for PIRADS 3 lesions.
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Affiliation(s)
| | | | - Ayman Soubra
- Department of Urology, University of Minnesota, Minneapolis, MN
| | | | | | | | - Paari Murugan
- Department of Pathology, University of Minnesota, Minneapolis, MN
| | - Maria Ordonez
- Department of Urology, University of Minnesota, Minneapolis, MN
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14
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Prostate Cancer Detection and Diagnosis: Role of Ultrasound with MRI Correlates. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0318-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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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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