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Albers P, Bennett J, Evans M, Martin ES, Wang B, Broomfield S, Martín AM, Tu W, Fung C, Kinnaird A. Value of Incremental Biopsy Cores for Microultrasound Targeted Prostate Biopsies. Urology 2024; 184:142-148. [PMID: 38052325 DOI: 10.1016/j.urology.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To determine the optimal number of cores needed during microultrasound-informed prostate biopsy for the detection of clinically significant prostate cancer (csPCa, defined as Gleason Grade Group ≥2). METHODS A retrospective review of 1011 consecutive patients between September 2021 and July 2023 at our institution were identified; 536 underwent microultrasound biopsy and 475 underwent magnetic resonance imaging (MRI)/ultrasound (US) targeted biopsy. Lesions were given a Prostate Risk Identification using Microultrasound (PRI-MUS) score, with lesions PRI-MUS ≥3 targeted. MRI lesions were scored with Prostate Imaging-Reporting and Data System (PI-RADS) and lesions PI-RADS ≥3 were targeted. The primary outcome is the detection of csPCa stratified by number of cores. RESULTS One hundred thirty-eight patients underwent targeted biopsies for microultrasound only lesions, 182 for microultrasound and MRI lesions and 426 underwent MRI/US for MRI lesions. The first targeted core detected 78.0% (46/59), 77.8% (63/81), and 78.8% (216/274) of csPCa for microultrasound, microultrasound+MRI, and MRI/US, respectively. Comparing first to third core, there was not a significant difference in overall detection of csPCa by microultrasound, though MRI/US was significantly different (28.4% vs 36.4% P = .12, 32.5% vs 41.8% P = .06, 42.5% vs 53.9% P < .001 for microultrasound, microultrasound+MRI, and MRI/US, respectively). PI-RADS 3 and PRI-MUS 3 lesions had lower first core detection rates compared to PI-RADS 5 and PRI-MUS 5 lesions (44.4% vs 85.4% P = .01, 65.2% vs 81.4% P = .14, 60% vs 83.1% P = .07 for microultrasound, microultrasound+MRI, and MRI/US, respectively). CONCLUSION A three-core targeted biopsy per microultrasound lesion improves detection rate of csPCa and should be considered to improve diagnostic accuracy.
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Affiliation(s)
- Patrick Albers
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jacob Bennett
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Moira Evans
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ella St Martin
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Betty Wang
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Stacey Broomfield
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Anaïs Medina Martín
- Alberta Prostate Cancer Research Initiative (APCaRI), Edmonton, Alberta, Canada
| | - Wendy Tu
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Fung
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Alberta Prostate Cancer Research Initiative (APCaRI), Edmonton, Alberta, Canada; Cancer Research Institute of Northern Alberta (CRINA), Edmonton, Alberta, Canada; Alberta Centre for Urologic Research and Excellence (ACURE), Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
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Derigs F, Kowalewski KF, Hartung FO, Waldbillig F, Neuberger M, von Hardenberg J, Westhoff N. A Matched-pair Analysis Comparing Systematic Prostate Biopsy by Conventional Transrectal Ultrasound-guidance Versus Software-based Predefined 3D-Guidance. Urology 2023; 177:128-133. [PMID: 37019390 DOI: 10.1016/j.urology.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To compare software-based three-dimensional-guided systematic prostate biopsy (3D-GSB) with conventional transrectal ultrasound-guided systematic biopsy (TGSB) regarding prostate cancer (PCa) detection rates (CDR). METHODS In total, 956 patients (200 TGSB patients and 756 3D-GSB patients) without prior positive biopsies and with a prostate-specific antigen value ≤20 ng/ml were eligible for analysis. TGSB and 3D-GSB cases were matched in a 1:1 ratio using propensity score matching with age, prostate-specific antigen, prostate volume, previous biopsy status, and suspicious palpatory finding as confounders. 3D-GSB was conducted with the semi-robotic prostate fusion-biopsy system Artemis. For each patient in both groups, SB was conducted in a similar pattern with 12 cores. All cores in 3D-GSB were automatically planned and mapped on a 3D-model as well as on the real-time transrectal ultrasound imaging. Primary end points were the clinically significant (cs) and overall CDR. Secondary end point was the cancer-positive core rate. RESULTS After matching, the csCDR was not significantly different between the 3D-GSB and the TGSB groups (33.3% vs 28.8%, P = .385). Overall CDR was significantly higher for 3D-GSB compared to TGSB (55.6% vs 39.9%, P = .002). 3D-GSB detected significantly more non-significant PCa than TGSB (22.2% vs 11.1%, P = .004). In patients with PCa, the number of cancer-positive SB cores was significantly higher by TGSB (42% vs 25%, P < .001). CONCLUSION 3D-GSB was associated with a higher CDR than TGSB. However, no significant difference was shown in detection of csPCa between both techniques. Therefore, currently, 3D-GSB does not appear to add value to conventional TGSB.
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Affiliation(s)
- Fabian Derigs
- Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Friedrich Otto Hartung
- Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Frank Waldbillig
- Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Manuel Neuberger
- Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Jost von Hardenberg
- Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Niklas Westhoff
- Department of Urology and Urologic Surgery, University Medical Centre, University Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Sze C, Singh Z, Punyala A, Satya P, Sadinski M, Narayan R, Nacev A, Kumar D, Adams J, Nicholas K, Margolis D, Chughtai B. Feasibility and preliminary clinical tolerability of low-field MRI-guided prostate biopsy. Prostate 2023; 83:656-662. [PMID: 36808735 DOI: 10.1002/pros.24499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE We evaluate the clinical feasibility of a portable, low-field magnetic resonance imaging (MRI) system for prostate cancer (PCa) biopsy. METHODS A retrospective analysis of men who underwent a 12-core systematic transrectal ultrasound-guided prostate biopsy (SB) and a low-field MRI guided transperineal targeted biopsy (MRI-TB). Comparison of the detection of clinically significant PCa (csPCa) (Gleason Grade [GG] ≥ 2) by SB and low field MRI-TB, stratified by Prostate Imaging Reporting & Data System (PI-RADS) score, prostate volume, and prostate serum antigen (PSA) was performed. RESULTS A total of 39 men underwent both the MRI-TB and SB biopsy. Median (interquartile range [IQR]) age was 69.0 (61.5-73) years, body mass index (BMI) was 28.9 kg/m2 (25.3-34.3), prostate volume was 46.5 cc (32-72.7), and PSA was 9.5 ng/ml (5.5-13.2). The majority (64.4%) of patients had PI-RADS ≥ 4 lesions and 25% of lesions were anterior on pre-biopsy MRII. Cancer detection rate (CDR) was greatest when combining SB and MRI-TB (64.1%). MRI-TB detected 74.3% (29/39) cancers. Of which, 53.8% (21/39) were csPCa while SB detected 42.5% (17/39) csPCa (p = 0.21). In 32.5% (13/39) of cases, MRI-TB upstaged the final diagnosis, compared to 15% (6/39) of cases in which SB upstaged the final diagnosis (p = 0.11). CONCLUSION Low-field MRI-TB is clinically feasible. Although future studies on the accuracy of MRI-TB system are needed, the initial CDR is comparable to those seen with fusion-based prostate biopsies. A transperineal and targeted approach may be beneficial in patients with higher BMI and anterior lesions.
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Affiliation(s)
- Christina Sze
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
| | - Zorawar Singh
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
- New York Medical College, New York, New York, USA
| | - Ananth Punyala
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
| | | | | | | | | | | | - John Adams
- Mississippi Urology, Jackson, Mississippi, USA
| | | | - Daniel Margolis
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
| | - Bilal Chughtai
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
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Liang L, Cheng Y, Qi F, Zhang L, Cao D, Cheng G, Hua L. A Comparative Study of Prostate Cancer Detection Rate Between Transperineal COG-TB and Transperineal FUS-TB in Patients with PSA ≤20 ng/mL. J Endourol 2020; 34:1008-1014. [PMID: 32600058 DOI: 10.1089/end.2020.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The combination of prebiopsy MRI and transperineal targeted biopsies is being increasingly used to obtain tissues from patients with suspected prostate cancer (PCa). Objective: To investigate the difference in PCa detection rate between transperineal cognitive fusion TB (COG-TB) and transperineal software fusion TB (FUS-TB). Participants: The present study included 163 male patients with suspected PCa who had not undergone prostate biopsy, had a prostate-specific antigen (PSA) level of ≤20 ng/mL, and had been examined by bi-parameter MRI and confirmed to have prostate nodules by prostate imaging reporting and data system version 2 (PI-RADS V2) scores ≥3 (from December 3, 2018 to October 7, 2019). Intervention: Seventy-one patients underwent transperineal COG-TB, and 92 patients underwent transperineal FUS-TB. The detection rate of the first four needles was compared. Results: No significant difference was found in the overall detection rate of PCa between COG-TB and FUS-TB (60.56% vs 51.08%, p = 0.228). This result was consistent even after stratifying by PI-RADS score. There was also no significant difference between COG-TB and FUS-TB in the detection rate of clinically significant PCa (p = 0.641). Moreover, COG-TB and FUS-TB showed no difference in the detection rate of PCa with different Gleason scores. Conclusions: In patients with suspected PCa with PSA ≤20 ng/mL and PI-RADS ≥3, FUS-TB was comparable to COG-TB in the detection rate of PCa.
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Affiliation(s)
- Linghui Liang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yifei Cheng
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Qi
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Zhang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongliang Cao
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gong Cheng
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lixin Hua
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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