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Taverna G, Bozzini G, Grizzi F, Seveso M, Mandressi A, Balzarini L, Mrakic F, Bono P, De Franceco O, Buffi N, Lughezzani G, Lazzeri M, Casale P, Guazzoni GF. Endorectal multiparametric 3-tesla magnetic resonance imaging associated with systematic cognitive biopsies does not increase prostate cancer detection rate: a randomized prospective trial. World J Urol 2015; 34:797-803. [PMID: 26481226 DOI: 10.1007/s00345-015-1711-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate prostate cancer (PC) detection rate, employing endorectal multiparametric 3-tesla magnetic resonance imaging (MRI) driving subsequent cognitive systematic prostatic biopsy (CSPB) versus a homogenous group of patients who did not undergo endorectal MRI. MATERIALS AND METHODS A series of patients with a first negative biopsy were enrolled in the study. Patients were randomized into two groups: Group A: patients underwent MRI and subsequent CSPB; Group B: patients that did not undergo MRI. Each patient underwent a 13-core sampling. Patients from Group A had four cores more for each MRI suspected lesion. The cancer detection rate was calculated for each group with regard to possible matches or mismatches between MRI evidence and pathological reports. RESULTS Two hundred consecutive patients were investigated. Fifty out of 200 (25 %) patients had a diagnosis of PC, 24 in Group A and 26 in Group B. In Group A, 67 patients (67 %) were positive for suspected lesions at the MRI. The mismatch between MRI findings and the CSPB outcome was 61 % with an MRI-driven detection rate of 15 %. Group B detection rate was 26 % with no significant differences versus Group A (P = NS). Patient discomfort was higher in Group A (82 %). The accuracy of CSPB was 41 % with a positive predictive value of 22.3 %. This rate is lower in high-grade cancers (11.9 %). The cost-effectiveness was higher in Group A. CONCLUSIONS Prostate cancer detection rate does not improve by CSPB. The accuracy of CSPB was lower in high-grade PC, and a higher cost was found with CSPB.
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Affiliation(s)
- Gianluigi Taverna
- Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy.
| | - Giorgio Bozzini
- Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy
| | - Fabio Grizzi
- Humanitas Research Hospital, Humanitas University, Rozzano, Italy
| | - Mauro Seveso
- Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy
| | - Alberto Mandressi
- Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy
| | - Luca Balzarini
- Department of Radiology, Humanitas Research Hospital, Rozzano, Italy
| | - Federica Mrakic
- Department of Radiology, Humanitas Research Hospital, Rozzano, Italy
| | - Pietro Bono
- Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy
| | - Oliviero De Franceco
- Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy
| | | | | | - Massimo Lazzeri
- Department of Urology, Humanitas Research Hospital, Rozzano, Italy
| | - Paolo Casale
- Department of Urology, Humanitas Research Hospital, Rozzano, Italy
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Taverna G, Morandi G, Seveso M, Giusti G, Benetti A, Colombo P, Minuti F, Grizzi F, Graziotti P. Colour Doppler and microbubble contrast agent ultrasonography do not improve cancer detection rate in transrectal systematic prostate biopsy sampling. BJU Int 2011; 108:1723-7. [PMID: 21756276 DOI: 10.1111/j.1464-410x.2011.10199.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mitterberger M, Horninger W, Pelzer A, Strasser H, Bartsch G, Moser P, Halpern EJ, Gradl J, Aigner F, Pallwein L, Frauscher F. A prospective randomized trial comparing contrast-enhanced targeted versus systematic ultrasound guided biopsies: impact on prostate cancer detection. Prostate 2007; 67:1537-42. [PMID: 17705242 DOI: 10.1002/pros.20639] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We performed a prospective randomized trial comparing 5 contrast-enhanced color Doppler (CECD) ultrasound (US) targeted biopsy cores to 10 gray-scale US guided systematic biopsy (SB) cores to determine the impact on the cancer detection rate. METHODS We prospectively randomized 100 prostate specific antigen (PSA) screening volunteers with an elevated PSA (> or =1.25 ng/ml and free-to-total PSA < 18%) to undergo contrast-enhanced targeted or SB. Contrast-enhanced targeted biopsies with a limited number of five cores were performed into hypervascular areas of the peripheral zone (PZ) during administration of the US contrast agent SonoVue (Bracco, Italy). A subjective grading of the vascularity from 0 to 3 was used: grade 0, no color signal; 1, low density; 2, medium density; and 3, high density of color signals. Ten SBs were obtained in a standard spatial distribution. Cancer detection rates were compared in the groups. RESULTS Cancer was detected in 16/50 subjects (32%) by targeted biopsy, and in 13/50 patients (26%) with SB. The cancer detection rate was significantly better for the targeted approach (P < 0.04, McNemar). The detection rate for targeted biopsy cores (15.6% or 39/250 cores) was significantly better than for SB cores (6.8% or 34/500 cores, P < 0.001, McNemar). CONCLUSIONS CECD targeted biopsy detected more cancers than SB with a reduced number of biopsy cores.
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