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Li EV, Busza AM, Siddiqui MR, Aguiar JA, Keeter MK, Neill C, Kumar SK, Mi X, Schaeffer EM, Patel HD, Ross AE. Detection of clinically significant prostate cancer following initial omission of biopsy in multiparametric MRI era. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00853-9. [PMID: 38858446 DOI: 10.1038/s41391-024-00853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Multiparametric prostate MRI (mpMRI) is being increasingly adopted for work-up of prostate cancer. For patients selected to omit biopsy, we identified factors associated with repeat MRI, eventual prostate biopsy, and subsequent detection of clinically significant prostate cancer (csPCa, Grade Group ≥2). METHODS We identified biopsy-naïve men presenting with PSA 2-20 ng/mL (March 2018-June 2021) undergoing initial mpMRI with PIRADS 1-3 lesions who were not selected for biopsy with ≥6 months follow-up. We examined factors associated with repeat mpMRI, progression to biopsy, and subsequent detection of csPCa with univariable and multivariable logistic regression. RESULTS Of 1494 men, 31% (463/1494) did not pursue biopsy. PSA density (PSAD) ≤ 0.1, prostate health index (PHI) < 55, and PIRADS 1-2 were associated with omission of prostate biopsy. csPCa diagnosis-free survival was 97.6% (326/334) with median follow up of 23.1 months (IQR 15.1-34.6 months). Black race, PSA, PHI, PSA density, and PSA and PHI velocity were significant predictors of undergoing repeat mpMRI (15.6%, 52/334) and subsequent biopsy (8.4%, 28/334). 8 men were subsequently diagnosed with csPCa (N = 7 on prostate biopsy; N = 1 incidentally on holmium enucleation of prostate). All patients diagnosed with csPCa had PIRADS 4-5 on repeat mpMRI. CONCLUSIONS The subsequent detection rate of csPCa among patients not initially biopsied after mpMRI was low at 2.4%. Decisions to omit biopsy after initial reassuring PHI, PSAD, and mpMRI appear safe with subsequent reassuring serum biomarkers and for cause mpMRI during follow-up.
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Affiliation(s)
- Eric V Li
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Anna M Busza
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Mohammad R Siddiqui
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jonathan A Aguiar
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Mary-Kate Keeter
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Clayton Neill
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Sai K Kumar
- Department of Preventive Medicine-Division of Biostatistics, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Xinlei Mi
- Department of Preventive Medicine-Division of Biostatistics, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Edward M Schaeffer
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Hiten D Patel
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Ashley E Ross
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
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Schieda N, Nisha Y, Hadziomerovic AR, Prabhakar S, Flood TA, Breau RH, McGrath TA, Ramsay T, Morash C. Comparison of Positive Predictive Values of Biparametric MRI and Multiparametric MRI-directed Transrectal US-guided Targeted Prostate Biopsy. Radiology 2024; 311:e231383. [PMID: 38860899 DOI: 10.1148/radiol.231383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background Biparametric MRI (bpMRI) of the prostate is an alternative to multiparametric MRI (mpMRI), with lower cost and increased accessibility. Studies investigating the positive predictive value (PPV) of bpMRI-directed compared with mpMRI-directed targeted biopsy are lacking in the literature. Purpose To compare the PPVs of bpMRI-directed and mpMRI-directed targeted prostate biopsies. Materials and Methods This retrospective cross-sectional study evaluated men who underwent bpMRI-directed or mpMRI-directed transrectal US (TRUS)-guided targeted prostate biopsy at a single institution from January 2015 to December 2022. The PPVs for any prostate cancer (PCa) and clinically significant PCa (International Society of Urological Pathology grade ≥2) were calculated for bpMRI and mpMRI using mixed-effects logistic regression modeling. Results A total of 1538 patients (mean age, 67 years ± 8 [SD]) with 1860 lesions underwent bpMRI-directed (55%, 849 of 1538) or mpMRI-directed (45%, 689 of 1538) prostate biopsy. When adjusted for the number of lesions and Prostate Imaging Reporting and Data System (PI-RADS) score, there was no difference in PPVs for any PCa or clinically significant PCa (P = .61 and .97, respectively) with bpMRI-directed (55% [95% CI: 51, 59] and 34% [95% CI: 30, 38], respectively) or mpMRI-directed (56% [95% CI: 52, 61] and 34% [95% CI: 30, 39], respectively) TRUS-guided targeted biopsy. PPVs for any PCa and clinically significant PCa stratified according to clinical indication were as follows: biopsy-naive men, 64% (95% CI: 59, 69) and 43% (95% CI: 39, 48) for bpMRI, 67% (95% CI: 59, 75) and 51% (95% CI: 43, 59) for mpMRI (P = .65 and .26, respectively); and active surveillance, 59% (95% CI: 49, 69) and 30% (95% CI: 22, 39) for bpMRI, 73% (95% CI: 65, 89) and 38% (95% CI: 31, 47) for mpMRI (P = .04 and .23, respectively). Conclusion There was no evidence of a difference in PPV for clinically significant PCa between bpMRI- and mpMRI-directed TRUS-guided targeted biopsy. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Nicola Schieda
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Yashmin Nisha
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Alexa R Hadziomerovic
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Suman Prabhakar
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Trevor A Flood
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Rodney H Breau
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Trevor A McGrath
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Tim Ramsay
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
| | - Christopher Morash
- From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.)
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3
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Bennett R, Li EV, Ho AY, Aguiar J, Mahenthiran AK, Suk-Ouichai C, Kumar SK, Neill C, Schaeffer EM, Jawahar A, Patel HD, Ross AE. Contemporary Diagnosis of Very Low-risk Prostate Cancer in a Multihospital Health Care System. Eur Urol Oncol 2024:S2588-9311(24)00109-3. [PMID: 38734544 DOI: 10.1016/j.euo.2024.04.015] [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: 02/26/2024] [Revised: 04/07/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
The National Comprehensive Cancer Network (NCCN) very low risk (VLR) category for prostate cancer (PCa) represents clinically insignificant disease, and detection of VLR PCa contributes to overdiagnosis. Greater use of magnetic resonance imaging (MRI) and biomarkers before patient selection for prostate biopsy (PBx) reduces unnecessary biopsies and may reduce the diagnosis of clinically insignificant PCa. We tested a hypothesis that the proportion of VLR diagnoses has decreased with greater use of MRI-informed PBx using data from our 11-hospital system. From 2018 to 2023, 351/3197 (11%) men diagnosed with PCa met the NCCN VLR criteria. The proportion of VLR diagnoses did not change from 2018 to 2023 (p = 0.8) despite an increase in the use of MRI-informed PBx (from 49% to 82%; p < 0.001). Of patients who underwent combined systematic and targeted PBx and were diagnosed with VLR disease, cancer was found in systematic PBx regions in 79% of cases and in targeted PBx regions in 31% of cases. When performing both systematic and targeted PBx, prebiopsy MRI-based risk calculators could limit VLR diagnosis by 41% using a risk threshold of >5% for Gleason grade group ≥3 PCa to recommend biopsy; the reduction would be 77% if performing targeted PBx only. These findings suggest that VLR disease continues to account for a significant minority of PCa diagnoses and could be limited by targeted PBx and risk stratification calculators. PATIENT SUMMARY: We looked at recent trends for the diagnosis of very low-risk (VLR) prostate cancer. We found that VLR cancer still seems to be frequently diagnosed despite the use of MRI (magnetic resonance imaging) scans before biopsy. The use of risk calculators to identify men who could avoid biopsy and/or biopsy only for lesions that are visible on MRI could reduce the overdiagnosis of VLR prostate cancer.
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Affiliation(s)
- Richard Bennett
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Eric V Li
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Austin Y Ho
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Aguiar
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ashorne K Mahenthiran
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chalairat Suk-Ouichai
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sai K Kumar
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Clayton Neill
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anugayathri Jawahar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ashley E Ross
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Zhang C, Tu X, Dai J, Zhang Z, Shen C, Wu Q, Liu Z, Lin T, Qiu S, Yang L, Yang L, Zhang M, Cai D, Bao Y, Zeng H, Wei Q. Utilization trend of prebiopsy multiparametric magnetic resonance imaging and its impact on prostate cancer detection: Real-world insights from a high-volume center in southwest China. Prostate 2024; 84:539-548. [PMID: 38173301 DOI: 10.1002/pros.24669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/24/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Data on the utilization and effects of prebiopsy prostate multiparametric magnetic resonance imaging (mpMRI) to support its routine use in real-world setting are still scarce. OBJECTIVE To evaluate the change of clinical practice of prebiopsy mpMRI over time, and assess its diagnostic accuracy. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed data from 6168 patients who underwent primary prostate biopsy (PBx) between January 2011 and December 2021 and had prostate-specific antigen (PSA) values ranging from 3 to 100 ng/mL. INTERVENTION Prebiopsy MRI at the time of PBx. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We performed general linear regression and to elucidate trends in the annual use of prebiopsy mpMRI and conducted multivariable logistic regression to evaluate the potential benefits of incorporating prebiopsy mpMRI for prostate cancer (PCa) detection. RESULTS AND LIMITATIONS The utilization of prebiopsy mpMRI significantly increased from 9.2% in 2011 to 75.0% in 2021 (p < 0.001). In addition, prebiopsy mpMRI significantly reduced negative PBx by 8.6% while improving the detection of clinically significant PCa (csPCa) by 7.0%. Regression analysis showed that the utilization of prebiopsy mpMRI was significantly associated with a 48% (95% confidence interval [CI]: 1.19-1.84) and 36% (95% CI: 1.12-1.66) increased PCa detection rate in the PSA 3-10 ng/mL and 10-20 ng/mL groups, respectively; and a 34% increased csPCa detection rate in the PSA 10-20 ng/mL group (95% CI: 1.09-1.64). The retrospective design and the single center cohort constituted the limitations of this study. CONCLUSIONS Our study demonstrated a notable rise in the utilization of prebiopsy mpMRI in the past decade. The adoption of this imaging technique was significantly associated with an increased probability of detecting prostate cancer. PATIENT SUMMARY From 2011 to 2021, we demonstrated a steady increase in the utilization of prebiopsy mpMRI among biopsy-naïve men. We also confirmed the positive impact of prebiopsy mpMRI utilization on the detection of prostate cancer.
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Affiliation(s)
- Chichen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Tu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zilong Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chenlan Shen
- Department of Laboratory Medicine, Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyou Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Department of Molecular Oncology, Institute of Oncology Research (IOR), Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengni Zhang
- Department of Pathology and Laboratory of Pathology, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Diming Cai
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Greenberg JW, Koller CR, Lightfoot C, Brinkley GJ, Leinwand G, Wang J, Krane LS. Annual mpMRI surveillance: PI-RADS upgrading and increasing trend correlated with patients who harbor clinically significant disease. Urol Oncol 2024; 42:158.e11-158.e16. [PMID: 38365461 DOI: 10.1016/j.urolonc.2024.01.005] [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: 10/27/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Prostate cancer screening has routinely identified men with very low- or low-risk disease, per the National Comprehensive Cancer Network guidelines. Current literature has demonstrated that the most appropriate management strategy for these patients is active surveillance (AS). The mainstay of AS includes periodic biopsies and biannual prostate-specific antigen tests. However, multiparametric magnetic resonance imaging (mpMRI) is uniquely posed to improve patient surveillance. This study aimed to evaluate the utility of an annual mpMRI in patients on AS, focusing on radiologic upgrading and Prostate Imaging-Reporting and Data System (PI-RADS) trends as indicators of clinically significant disease. METHODS This prospective, single intuition, study enrolled 208 patients on AS who had at least two biopsies and 1 mpMRI with a median follow-up of 5.03 years. The main outcome variable was time to Gleason grade (GG) reclassification. RESULTS After delineating patients on their initial PI-RADS score, men with score 3 and 5 lesions at first MRI had comparable GG reclassification-free survival to their counterparts. Conversely, men with initial PI-RADS 4 lesions showed a lower 5-year GG reclassification-free survival compared to those with PI-RADS score 1-2. The cohort was then subset to 70 patients who obtained ≥2 mpMRIs on protocol. Men experiencing uptrending mpMRI scores had an increased risk of GG reclassification, with a 35.4% difference in 5 year GG reclassification-free survival probability on the Kaplan-Meier curve analysis. CONCLUSION In conclusion, this study demonstrates that for men on AS with stable recapitulated disease, an annual MRI may replace repeat biopsies after confirmatory sampling has been obtained. On the other hand, men who initiate AS with PI-RADS 4 and/or who display uptrending mpMRI scores require periodic biopsies along with repeat imaging. This study highlights the utility of integrating an annual MRI into AS protocols, thus promising a more effective approach to management.
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Affiliation(s)
- Jacob W Greenberg
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | | | - Christine Lightfoot
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Garrett J Brinkley
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Gabriel Leinwand
- Department of Urology, Southeastern Louisiana Veterans Health Care System, New Orleans, LA
| | - Julie Wang
- Department of Urology, Southeastern Louisiana Veterans Health Care System, New Orleans, LA
| | - L Spencer Krane
- Department of Urology, Southeastern Louisiana Veterans Health Care System, New Orleans, LA.
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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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Lin FX, Xu ZP. Serum free prostate-specific antigen density (fPSAD) as a predictor of prostate cancer: a new parameter worthy of attention. Ir J Med Sci 2024; 193:627-628. [PMID: 37725320 DOI: 10.1007/s11845-023-03533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Fu-Xiang Lin
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, Guangdong, People's Republic of China
| | - Zhan-Ping Xu
- Department of Urology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, Guangdong, People's Republic of China.
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Patel HD, Remmers S, Ellis JL, Li EV, Roobol MJ, Fang AM, Davik P, Rais-Bahrami S, Murphy AB, Ross AE, Gupta GN. Comparison of Magnetic Resonance Imaging-Based Risk Calculators to Predict Prostate Cancer Risk. JAMA Netw Open 2024; 7:e241516. [PMID: 38451522 PMCID: PMC10921249 DOI: 10.1001/jamanetworkopen.2024.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/18/2024] [Indexed: 03/08/2024] Open
Abstract
Importance Magnetic resonance imaging (MRI)-based risk calculators can replace or augment traditional prostate cancer (PCa) risk prediction tools. However, few data are available comparing performance of different MRI-based risk calculators in external cohorts across different countries or screening paradigms. Objective To externally validate and compare MRI-based PCa risk calculators (Prospective Loyola University Multiparametric MRI [PLUM], UCLA [University of California, Los Angeles]-Cornell, Van Leeuwen, and Rotterdam Prostate Cancer Risk Calculator-MRI [RPCRC-MRI]) in cohorts from Europe and North America. Design, Setting, and Participants This multi-institutional, external validation diagnostic study of 3 unique cohorts was performed from January 1, 2015, to December 31, 2022. Two cohorts from Europe and North America used MRI before biopsy, while a third cohort used an advanced serum biomarker, the Prostate Health Index (PHI), before MRI or biopsy. Participants included adult men without a PCa diagnosis receiving MRI before prostate biopsy. Interventions Prostate MRI followed by prostate biopsy. Main Outcomes and Measures The primary outcome was diagnosis of clinically significant PCa (grade group ≥2). Receiver operating characteristics for area under the curve (AUC) estimates, calibration plots, and decision curve analysis were evaluated. Results A total of 2181 patients across the 3 cohorts were included, with a median age of 65 (IQR, 58-70) years and a median prostate-specific antigen level of 5.92 (IQR, 4.32-8.94) ng/mL. All models had good diagnostic discrimination in the European cohort, with AUCs of 0.90 for the PLUM (95% CI, 0.86-0.93), UCLA-Cornell (95% CI, 0.86-0.93), Van Leeuwen (95% CI, 0.87-0.93), and RPCRC-MRI (95% CI, 0.86-0.93) models. All models had good discrimination in the North American cohort, with an AUC of 0.85 (95% CI, 0.80-0.89) for PLUM and AUCs of 0.83 for the UCLA-Cornell (95% CI, 0.80-0.88), Van Leeuwen (95% CI, 0.79-0.88), and RPCRC-MRI (95% CI, 0.78-0.87) models, with somewhat better calibration for the RPCRC-MRI and PLUM models. In the PHI cohort, all models were prone to underestimate clinically significant PCa risk, with best calibration and discrimination for the UCLA-Cornell (AUC, 0.83 [95% CI, 0.81-0.85]) model, followed by the PLUM model (AUC, 0.82 [95% CI, 0.80-0.84]). The Van Leeuwen model was poorly calibrated in all 3 cohorts. On decision curve analysis, all models provided similar net benefit in the European cohort, with higher benefit for the PLUM and RPCRC-MRI models at a threshold greater than 22% in the North American cohort. The UCLA-Cornell model demonstrated highest net benefit in the PHI cohort. Conclusions and Relevance In this external validation study of patients receiving MRI and prostate biopsy, the results support the use of the PLUM or RPCRC-MRI models in MRI-based screening pathways regardless of European or North American setting. However, tools specific to screening pathways incorporating advanced biomarkers as reflex tests are needed due to underprediction.
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Affiliation(s)
- Hiten D. Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeffrey L. Ellis
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Eric V. Li
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrew M. Fang
- Department of Urology, University of Alabama at Birmingham
| | - Petter Davik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim
- Department of Urology, St Olavs Hospital, Trondheim, Norway
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham
- Department of Radiology, University of Alabama at Birmingham
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham
| | - Adam B. Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ashley E. Ross
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gopal N. Gupta
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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9
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Turchi B, Lombardo R, Franco A, Tema G, Nacchia A, Cicione A, Pastore AL, Carbone A, Fuschi A, Franco G, Tubaro A, De Nunzio C. Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial. Curr Oncol 2024; 31:747-758. [PMID: 38392049 PMCID: PMC10887997 DOI: 10.3390/curroncol31020055] [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: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient's discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients' experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Cosimo De Nunzio
- Department of Urology, Sapienza University of Rome, 00100 Rome, Italy; (B.T.); (R.L.); (A.F.); (G.T.); (A.N.); (A.C.); (A.L.P.); (A.C.); (A.F.); (G.F.); (A.T.)
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10
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Lombardo R, Tema G, Nacchia A, Mancini E, Franco S, Zammitti F, Franco A, Cash H, Gravina C, Guidotti A, Gallo G, Ghezzo N, Cicione A, Tubaro A, Autorino R, De Nunzio C. Role of Perilesional Sampling of Patients Undergoing Fusion Prostate Biopsies. Life (Basel) 2023; 13:1719. [PMID: 37629576 PMCID: PMC10455324 DOI: 10.3390/life13081719] [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: 06/09/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Recently, researchers have proposed perilesional sampling during prostate biopsies to avoid systematic biopsies of patients at risk of prostate cancer. The aim of our study is to evaluate the role of perilesional sampling to avoid systematic biopsies of patients undergoing fusion biopsies. A prospective cohort of patients undergoing transrectal MRI transrectal fusion biopsies were consecutively enrolled. All the patients underwent systematic biopsies (SB), targeted biopsies (TB) and perilesional biopsies within 10 mm from the lesion (PB). The detection rates of different strategies were determined. A total of 262 patients were enrolled. The median age of those enrolled was 70 years. The mean BMI was 27 kg/m2, and the mean and prostate volume was 52 mL. A PIRADS score ≥ 4 was recorded in 163/262 (40%) patients. Overall, the detection rates of cancer were 43.5% (114/262) and 35% (92/262) for csPCa. The use of the target + peri-target strategy resulted in a detection of 32.8% (86/262) of cancer cases and of 29% (76/262) of csPCa cases (Grade Group > 2). Using the target plus peri-target approach resulted in us missing 18/262 (7%) of the csPCa cases, avoiding the diagnosis of 8/262 (3%) of nsPCa cases. A biopsy strategy including lesional and perilesional sampling could avoid unnecessary prostate biopsies. However, the risk of missing significant cancers is present. Future studies should assess the cost-benefit relationship of different strategies.
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Affiliation(s)
- Riccardo Lombardo
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Giorgia Tema
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Antonio Nacchia
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Elisa Mancini
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Sara Franco
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Filippo Zammitti
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Antonio Franco
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Hannes Cash
- Department of Urology, University of Magdeburg, 39106 Magdeburg, Germany;
| | - Carmen Gravina
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Alessio Guidotti
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Giacomo Gallo
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Nicola Ghezzo
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Antonio Cicione
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Andrea Tubaro
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
| | - Riccardo Autorino
- Department of Urology, University of Chicago, Chicago, IL 60637, USA;
| | - Cosimo De Nunzio
- Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy; (R.L.); (G.T.); (A.N.); (E.M.); (S.F.); (F.Z.); (A.F.); (C.G.); (A.G.); (G.G.); (N.G.); (A.C.); (A.T.)
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11
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Boehm BE, York ME, Petrovics G, Kohaar I, Chesnut GT. Biomarkers of Aggressive Prostate Cancer at Diagnosis. Int J Mol Sci 2023; 24:ijms24032185. [PMID: 36768533 PMCID: PMC9916581 DOI: 10.3390/ijms24032185] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 01/24/2023] Open
Abstract
In the United States, prostate cancer (CaP) remains the second leading cause of cancer deaths in men. CaP is predominantly indolent at diagnosis, with a small fraction (25-30%) representing an aggressive subtype (Gleason score 7-10) that is prone to metastatic progression. This fact, coupled with the criticism surrounding the role of prostate specific antigen in prostate cancer screening, demonstrates the current need for a biomarker(s) that can identify clinically significant CaP and avoid unnecessary biopsy procedures and psychological implications of being diagnosed with low-risk prostate cancer. Although several diagnostic biomarkers are available to clinicians, very few comparative trials have been performed to assess the clinical effectiveness of these biomarkers. It is of note, however, that a majority of these clinical trials have been over-represented by men of Caucasian origin, despite the fact that African American men have a 1.7 times higher incidence and 2.1 times higher rate of mortality from prostate cancer. Biomarkers for CaP diagnosis based on the tissue of origin include urine-based gene expression assays (PCA3, Select MDx, ExoDx Prostate IntelliScore, Mi-Prostate Score, PCA3-PCGEM1 gene panel), blood-based protein biomarkers (4K, PHI), and tissue-based DNA biomarker (Confirm MDx). Another potential direction that has emerged to aid in the CaP diagnosis include multi-parametric magnetic resonance imaging (mpMRI) and bi-parametric magnetic resonance imaging (bpMRI), which in conjunction with clinically validated biomarkers may provide a better approach to predict clinically significant CaP at diagnosis. In this review, we discuss some of the adjunctive biomarker tests along with newer imaging modalities that are currently available to help clinicians decide which patients are at risk of having high-grade CaP on prostate biopsy with the emphasis on clinical utility of the tests across African American (AA) and Caucasian (CA) men.
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Affiliation(s)
- Brock E. Boehm
- Urology Service, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Monica E. York
- School of Medicine, Uniformed Services University of Health Science, Bethesda, MD 20814, USA
| | - Gyorgy Petrovics
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Henry Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD 20817, USA
| | - Indu Kohaar
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Henry Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD 20817, USA
- Correspondence: (I.K.); (G.T.C.)
| | - Gregory T. Chesnut
- Urology Service, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Correspondence: (I.K.); (G.T.C.)
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