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Lehner F, Crippa A, Sigg S, Eberli D, Mortezavi A. Transperineal template saturation and conventional biopsy for stage prediction in prostate cancer. BJU Int 2023; 132:696-704. [PMID: 37704215 DOI: 10.1111/bju.16181] [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] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To evaluate the performance of risk calculators (RCs) predicting lymph node invasion (LNI) and extraprostatic extension (EPE) in men undergoing transperineal magnetic resonance imaging/transrectal ultrasound (TRUS)-fusion template saturation biopsy (TTSB) and conventional systematic TRUS-guided biopsy (SB). PATIENTS AND METHODS The RCs were tested in a consecutive cohort of 645 men undergoing radical prostatectomy with extended pelvic LN dissection between 2005 and 2019. TTSB was performed in 230 (35.7%) and SB in 415 (64.3%) men. Risk of LNI and EPE was calculated using the available RCs. Discrimination, calibration, and clinical usefulness stratified by different biopsy techniques were assessed. RESULTS Lymph node invasion was observed in 23 (10%) and EPE in 73 (31.8%) of cases with TTSB and 53 (12.8%) and 158 (38%) with SB, respectively. RCs showed an excellent discrimination and acceptable calibration for prediction of LNI based on TTSB (area under the curve [AUC]/risk estimation: Memorial Sloan Kettering Cancer Center [MSKCC]-RC 0.79/-4%, Briganti (2012)-RC 0.82/-4%, Gandaglia-RC 0.81/+6%). These were comparable in SB (MSKCC-RC 0.78/+2%; Briganti (2012)-RC 0.77/-3%). Decision curve analysis (DCA) revealed a net benefit at threshold probabilities between 3% and 6% when TTSB was used. For prediction of EPE based on TTSB an inferior discrimination and variable calibration were observed (AUC/risk estimation: MSKCC-RC 0.71/+8% and Martini (2018)-RC 0.69/+2%) achieving a net benefit on DCA only at risk thresholds of >17%. Performance of RCs for prediction of LNI and EPE based on SB showed comparable results with a better performance in the DCA for LNI (risk thresholds 1-2%) and poorer performance for EPE (risk threshold >20%). This study is limited by its retrospective single-institution design. CONCLUSIONS The potentially more accurate grading ability of TTSB did not result in improved performance of preoperative RCs. Prediction tools for LNI proved clinical usefulness while RCs for EPE did not.
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Affiliation(s)
- Fabienne Lehner
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Silvan Sigg
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, University Hospital Basel, Basel, Switzerland
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He BM, Yang QW, Shi ZK, Ji TR, Wang SD, Zhou H, Jin ZC, Yan ZC, Zhang JJ, Wang HF. Association of biopsy core number and location with pain in patients undergoing a transperineal prostate biopsy under local anaesthesia: a secondary analysis of the APROPOS trial. Int J Surg 2023; 109:3061-3069. [PMID: 37526126 PMCID: PMC10583920 DOI: 10.1097/js9.0000000000000593] [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: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND APROPOS was a multicentre, randomized, blinded trial focus on investigating the perineal nerve block versus the periprostatic block in pain control for men undergoing a transperineal prostate biopsy. In the analysis reported here, the authors aimed to evaluate the association of biopsy core count and location with pain outcomes in patients undergoing a transperineal prostate biopsy under local anesthesia. METHODS APROPOS was performed at six medical centers in China. Patients with suspected prostate cancer were randomized to receive either a perineal nerve block or a periprostatic block (1:1), followed by a transperineal prostate biopsy. The secondary analysis outcomes were the worst pain experienced during the prostate biopsy and postbiopsy pain at 1,6, and 24 h. RESULTS Between 12 August 2020 and 20 July 2022, a total of 192 patients were randomized in the original trial, and 188 were involved in this analysis, with 94 patients per group. Participants had a median (IQR) age of 68 (63-72) and a median (IQR) prostate volume of 42.51 (30.04-62.84). The patient population had a median (IQR) number of biopsy cores of 15 (12-17.50), and 26.06% of patients had a biopsy cores count of more than 15. After adjusting the baseline characteristics, the number of biopsy cores was associated with the worst pain during the biopsy procedure in both the perineal nerve block group ( β 0.19, 95% CI: 0.12-0.26, P <0.001) and the periprostatic block group ( β 0.16, 95% CI: 0.07-0.24, P <0.001). A similar association was also evident for the postbiopsy pain at 1, 6, and 24 h. A lesser degree of pain in both groups at any time (r range -0.57 to -0.01 for both groups) was associated with biopsy cores from the peripheral zone of the middle gland, while other locations were associated with a higher degree of pain. In addition, the location of the biopsy core had less of an effect on pain during the biopsy (r range -0.01-0.25 for both groups) than it did on postbiopsy pain (r range -0.57-0.60 for both groups). CONCLUSIONS In this secondary analysis of a randomized trial, biopsy core count and location were associated with pain in patients undergoing a transperineal prostate biopsy under local anesthesia. These results may be helpful for making clinical decisions about the anesthetic approach for scheduled transperineal prostate biopsies.
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Affiliation(s)
- Bi-Ming He
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Qi-Wei Yang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Zhen-Kai Shi
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Tang-Rao Ji
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
- Department of Urology, Lanxi People’s Hospital, Lanxi, People’s Republic of China
| | - Shuai-Dong Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Hai Zhou
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Zhi-Chao Jin
- Department of Health Statistics, Naval Medical University, Shanghai
| | - Zhi-Chao Yan
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Jia-Jun Zhang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
| | - Hai-Feng Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University
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Kwon HJ, Rhew SA, Yoon CE, Shin D, Bang S, Park YH, Cho HJ, Ha US, Hong SH, Lee JY, Kim SW, Moon HW. Comparing 12-core and 20-core biopsy for prostate cancer diagnosis with transperineal MR/US fusion biopsy: assessing the effective number of systemic cores using propensity score matching. Int Urol Nephrol 2023; 55:2465-2471. [PMID: 37340208 PMCID: PMC10499967 DOI: 10.1007/s11255-023-03674-2] [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: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE For transperineal (TP) prostate biopsy, target biopsy for visible lesions on MRI is important, but there is no consensus of the number of systemic biopsy cores. Our study aimed to confirm the diagnostic efficiency of 20-core systemic biopsy by comparison with 12-core using propensity score matching (PSM). METHODS The 494 patients conducted the naive TP biopsy were retrospectively analyzed. There were 293 patients with 12-core biopsy and 201 patients with 20-core biopsy. PSM was performed for minimizing confounding variables, and the established effects' value was analyzed for 'index-positive or negative' clinically significant prostate cancer (csPCa) (Index means PIRADS Score ≥ 3 on multiparametric prostate MRI). RESULTS At 12-core biopsy, there were 126 cases of prostate cancer (43.0%), and 97 cases of csPCa (33.1%). At 20-core biopsy, there were 91 cases (45.3%) and 63 cases (31.3%). After propensity score matching, for index-negative csPCa, the estimated odds ratio was 4.03 (95% CI 1.35-12.09, p value 0.0128), and for index-positive csPCa, the estimated odds ratio was 0.98 (95% CI 0.63-1.52, p value 0.9308). CONCLUSIONS The 20-core biopsy did not show a higher detection rate for csPCa in comparison with the 12-core biopsy. However, when MRI did not show a suspicious lesion, 20-core biopsy showed higher odd ratio in comparison with 12-core biopsy. Therefore, if there is a suspicious lesion in MRI, 20-core biopsy is excessive and 12-core biopsy is sufficient. Whereas if there is no suspicious lesion in MRI, it is better to proceed with 20-core biopsy.
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Affiliation(s)
- Hyeok Jae Kwon
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seung Ah Rhew
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chang Eil Yoon
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dongho Shin
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seokhwan Bang
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Hyun Park
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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He BM, Ka-Fung Chiu P, Tao T, Lan JH, Cai JT, Zhou SC, Li RB, Ren Y, Ka-Lun L, Xu RY, Chen JR, Lan D, Gao JL, Chu SG, Jin ZC, Huang FF, Shi ZK, Yang QW, Zhou H, Wang SD, Ji TR, Han QP, Wang CM, Chi-Fai N, Wang HF. Perineal nerve block versus periprostatic block for patients undergoing transperineal prostate biopsy (APROPOS): a prospective, multicentre, randomised controlled study. EClinicalMedicine 2023; 58:101919. [PMID: 37007736 PMCID: PMC10060616 DOI: 10.1016/j.eclinm.2023.101919] [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: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/04/2023] Open
Abstract
Background We aimed to investigate perineal nerve block versus periprostatic block in pain control for men undergoing a transperineal prostate biopsy. Methods In this prospective, randomised, blinded and parallel-group trial, men in six Chinese hospitals with suspected prostate cancer were randomly assigned (1:1) at the point of local anaesthesia to receive a perineal nerve block or periprostatic block and followed by a transperineal prostate biopsy. Centres used their usual biopsy procedure. Operators who performed anaesthesia were trained in both techniques before the trial and were masked to the randomised allocation until the time of anaesthesia and were not involved in the subsequent biopsy procedure and any assessment or analysis. Other investigators and the patients were masked until trial completion. The primary outcome was the level of the worst pain experienced during the prostate biopsy procedure. Secondary outcomes included pain (post-biopsy at 1, 6 and 24 h), changes in blood pressure, heart rate and breathing rate during the biopsy procedure, external manifestations of pain during biopsy, anaesthesia satisfaction, the detection rate of PCa and clinically significant PCa. This trial is registered on ClinicalTrials.gov, NCT04501055. Findings Between August 13, 2020, and July 20, 2022, 192 men were randomly assigned to perineal nerve block or periprostatic block, 96 per study group. Perineal nerve block was superior for the relief of pain during the biopsy procedure (mean 2.80 for perineal nerve block and 3.98 for periprostatic block; adjusted difference in means -1.17, P < 0.001). Although the perineal nerve block had a lower mean pain score at 1 h post-biopsy compared with the periprostatic block (0.23 vs 0.43, P = 0.042), they were equivalent at 6 h (0.16 vs 0.25, P = 0.389) and 24 h (0.10 vs 0.26, P = 0.184) respectively. For the change in vital signs during biopsy procedure, perineal nerve block was significantly superior to periprostatic block in terms of maximum value of systolic blood pressure, maximum value of mean arterial pressure and maximum value of heart rate. There are no statistical differences in average value of systolic blood pressure, average value of mean, average value of heart rate, diastolic blood pressure and breathing rate. Perineal nerve block was also superior to periprostatic block in external manifestations of pain (1.88 vs 3.00, P < 0.001) and anaesthesia satisfaction (8.93 vs 11.90, P < 0.001). Equivalence was shown for the detection rate of PCa (31.25% for perineal nerve block and 29.17% for periprostatic block, P = 0.753) or csPCa (23.96% for perineal nerve block and 20.83% for periprostatic block, P = 0.604). 33 (34.8%) of 96 patients in the perineal nerve block group and 40 (41.67%) of 96 patients in the periprostatic block group had at least one complication. Interpretation Perineal nerve block was superior to periprostatic block in pain control for men undergoing a transperineal prostate biopsy. Funding Grant 2019YFC0119100 from the National Key Research and Development Program of China.
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Affiliation(s)
- Bi-Ming He
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Peter Ka-Fung Chiu
- SH HO Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Tao Tao
- Department of Urology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Jian-Hua Lan
- Department of Urology, Guang'an People's Hospital of Sichuan Province, China
| | - Jian-Tong Cai
- Department of Urology, Shi Shi Municipal General Hospital, Fujian province, China
| | - Sheng-Cai Zhou
- Department of Urology, People's Hospital of Yiyuan County, Zibo City, Shandong, China
| | - Rong-Bing Li
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Ren
- Department of Medical Equipment, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - L.O. Ka-Lun
- SH HO Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong-Yao Xu
- Department of Urology, Shi Shi Municipal General Hospital, Fujian province, China
| | - Jian-Rong Chen
- Department of Urology, Shi Shi Municipal General Hospital, Fujian province, China
| | - Dong Lan
- Department of Urology, Guang'an People's Hospital of Sichuan Province, China
| | - Jin-Li Gao
- Department of Pathology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shu-Guang Chu
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhi-Chao Jin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Fang-fang Huang
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen-Kai Shi
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi-Wei Yang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hai Zhou
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuai-Dong Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tang-Rao Ji
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Urology, Lanxi People's Hospital, Lanxi, China
| | - Qi-Peng Han
- Department of Urology, People's Hospital of Yiyuan County, Zibo City, Shandong, China
| | - Chang-Ming Wang
- Department of Urology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - N.G. Chi-Fai
- SH HO Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hai-Feng Wang
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
- Corresponding author. Department of Urology, Shanghai East Hospital, No. 150, Jimo Road, Shanghai, 200120, China.
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Satish P, Freeman A, Kelly D, Kirkham A, Orczyk C, Simpson BS, Giganti F, Whitaker HC, Emberton M, Norris JM. Relationship of prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e050376. [PMID: 34987040 PMCID: PMC8734010 DOI: 10.1136/bmjopen-2021-050376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI) has improved the triage of men with suspected prostate cancer, through precision prebiopsy identification of clinically significant disease. While multiple important characteristics, including tumour grade and size have been shown to affect conspicuity on mpMRI, tumour location and association with mpMRI visibility is an underexplored facet of this field. Therefore, the objective of this systematic review and meta-analysis is to collate the extant evidence comparing MRI performance between different locations within the prostate in men with existing or suspected prostate cancer. This review will help clarify mechanisms that underpin whether a tumour is visible, and the prognostic implications of our findings. METHODS AND ANALYSIS The databases MEDLINE, PubMed, Embase and Cochrane will be systematically searched for relevant studies. Eligible studies will be full-text English-language articles that examine the effect of zonal location on mpMRI conspicuity. Two reviewers will perform study selection, data extraction and quality assessment. A third reviewer will be involved if consensus is not achieved. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will inform the methodology and reporting of the review. Study bias will be assessed using a modified Newcastle-Ottawa scale. A thematic approach will be used to synthesise key location-based factors associated with mpMRI conspicuity. A meta-analysis will be conducted to form a pooled value of the sensitivity and specificity of mpMRI at different tumour locations. ETHICS AND DISSEMINATION Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021228087.
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Affiliation(s)
- Pranav Satish
- UCL Division of Surgery & Interventional Science, UCL Medical School, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Joseph M Norris
- Division of Surgery and Interventional Science, University College London, London, UK
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6
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Satish P, Simpson B, Freeman A, Giganti F, Kirkham A, Orczyk C, Whitaker H, Emberton M, Norris JM. Mapping Contemporary Biopsy Zones to Traditional Prostatic Anatomy: The Key to Understanding Relationships Between Prostate Cancer Topography, Magnetic Resonance Imaging Conspicuity, and Clinical Risk. Eur Urol 2021; 80:263-265. [PMID: 34059394 DOI: 10.1016/j.eururo.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Pranav Satish
- UCL School of Medicine, University College London, London, UK; UCL Division of Surgery & Interventional Science, University College London, London, UK.
| | | | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Giganti
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clement Orczyk
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley Whitaker
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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7
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Sandahl M, Pedersen BG, Ulhøi BP, Borre M, Sørensen KD. Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study. BJU Int 2021; 128:702-712. [PMID: 33964113 DOI: 10.1111/bju.15443] [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: 12/09/2022]
Abstract
OBJECTIVE To investigate whether a risk score for prostate cancer (PCa) lifetime risk can be used to optimise triaging of patients with a negative prostate biopsy, but under sustained suspicion of PCa. PATIENTS AND METHODS In this prospective clinical study, we included, and risk scored patients who had a PCa-negative transrectal ultrasonography (TRUS)-guided prostate biopsy, but elevated prostate-specific antigen (PSA), a suspicious prostate digital rectal examination and/or a positive family history (FH) of PCa. The risk score estimated individual lifetime risk of PCa, based on a polygenic risk score (33 single nucleotide polymorphisms), age, and FH of PCa. Patients were followed, under urological supervision, for up to 4 years with annual controls, always including PSA measurements. Multiparametric magnetic resonance imaging (mpMRI) and/or prostate biopsy was performed at selected annual controls depending on risk score and at the urologist's/patient's discretion, which means that the follow-up differed based on the risk score. RESULTS We included 429 patients. After risk scoring, 376/429 (88%) patients were allocated to a normal-risk group (<30% PCa lifetime risk) and 53/429 (12%) to a high-risk group (≥30% PCa lifetime risk). The high-risk group had significantly different follow-up, with more biopsy and mpMRI sessions compared to the normal-risk group. PCa was detected in 89/429 (21%) patients, with 67/376 (18%) patients diagnosed in the normal-risk group and 22/53 (42%) in the high-risk group. There was no statistically significant difference in the cumulative incidence of PCa between the normal-risk group and the high-risk group after 4 years of follow-up. Currently, 67/429 (16%) patients are still being followed in this ongoing study. CONCLUSION In a 4-year perspective, our PCa lifetime risk score did not demonstrate significant prognostic value for triaging patients, with a negative TRUS-guided biopsy and sustained suspicion of PCa.
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Affiliation(s)
- Mads Sandahl
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Michael Borre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Karina Dalsgaard Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine (MOMA), Aarhus University Hospital, Aarhus, Denmark
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8
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Nair SM, Hatiboglu G, Relle J, Hetou K, Hafron J, Harle C, Kassam Z, Staruch R, Burtnyk M, Bonekamp D, Schlemmer HP, Roethke MC, Mueller-Wolf M, Pahernik S, Chin JL. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. BJU Int 2020; 127:544-552. [PMID: 33037765 DOI: 10.1111/bju.15268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To report the 3-year follow-up of a Phase I study of magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) in 30 men with localised prostate cancer. Favourable 12-month safety and ablation precision were previously described. PATIENTS AND METHODS As a mandated safety criterion, TULSA was delivered as near whole-gland ablation, applying 3-mm margins sparing 10% of peripheral prostate tissue in 30 men. After 12-month biopsy and MRI, biannual follow-up included prostate-specific antigen (PSA), adverse events (AEs), and functional quality-of-life assessment, with repeat systematic biopsy at 3 years. RESULTS A 3-year follow-up was completed by 22 patients. Between 1 and 3 years, there were no new serious or severe AEs. Urinary and bowel function remained stable. Erectile function recovered by 1 year and was stable at 3 years. The PSA level decreased 95% to a median (interquartile range) nadir of 0.33 (0.1-0.4) ng/mL, stable to 0.8 (0.4-1.6) ng/mL at 3 years. Serial biopsies identified clinically significant disease in 10/29 men (34%) and any cancer in 17/29 (59%). By 3 years, seven men had recurrence (four histological, three biochemical) and had undergone salvage therapy without complications (including six prostatectomies). At 3 years, three of 22 men refused biopsy, and two of the 22 (9%) had clinically significant disease (one new, one persistent). Predictors of salvage therapy requirement included less extensive ablation coverage and higher PSA nadir. CONCLUSION With 3-year Phase I follow-up, TULSA demonstrates safe and precise ablation for men with localised prostate cancer, providing predictable PSA and biopsy outcomes, without affecting functional abilities or precluding salvage therapy.
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Affiliation(s)
- Shiva M Nair
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Gencay Hatiboglu
- German Cancer Research Center, University Hospital, Heidelberg, Germany
| | | | - Khalil Hetou
- London Health Sciences Centre, Western University, London, ON, Canada
| | | | - Christopher Harle
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Zahra Kassam
- London Health Sciences Centre, Western University, London, ON, Canada
| | | | | | - David Bonekamp
- German Cancer Research Center, University Hospital, Heidelberg, Germany
| | | | | | - Maya Mueller-Wolf
- German Cancer Research Center, University Hospital, Heidelberg, Germany
| | - Sascha Pahernik
- German Cancer Research Center, University Hospital, Heidelberg, Germany
| | - Joseph L Chin
- London Health Sciences Centre, Western University, London, ON, Canada
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9
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Noureldin ME, Connor MJ, Boxall N, Miah S, Shah T, Walz J. Current techniques of prostate biopsy: an update from past to present. Transl Androl Urol 2020; 9:1510-1517. [PMID: 32676438 PMCID: PMC7354294 DOI: 10.21037/tau.2019.09.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Knowing the demerits of the transrectal ultrasound guided biopsy has led to a shift in the general techniques and technology of the prostate biopsy. In addition, the advances in magnetic resonance imaging (MRI) sensitivity and the evidence from the PROMIS trial about its ability to detect clinically significant tumours encourage urologists and industry to implement MRI-guided targeted biopsy. However, the science is still looking how to improve safety and increase its cancer detection rate (CDR).
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Affiliation(s)
- Mohamed Essam Noureldin
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicholas Boxall
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | - Saiful Miah
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | - Taimur Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
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10
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Cancer Detection Rates of Systematic and Targeted Prostate Biopsies after Biparametric MRI. Prostate Cancer 2020; 2020:4626781. [PMID: 32308996 PMCID: PMC7157788 DOI: 10.1155/2020/4626781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/29/2020] [Accepted: 03/06/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To compare prostate cancer detection rates (CDRs) and pathology results with targeted prostate biopsy (TB) and systematic prostate biopsy (SB) in biopsy-naive men. Methods An in-patient control study of 82 men undergoing SB and subsequent TB in case of positive prostate MRI between 2015 and 2017 in the Jeroen Bosch Hospital, the Netherlands. Results Prostate cancer (PCa) was detected in 54.9% with 70.7% agreement between TB and SB. Significant PCa (Gleason score ≥7) was detected in 24.4%. The CDR with TB and SB was 35.4% and 48.8%, respectively (p=0.052). The CDR of significant prostate cancer with TB and SB was both 20.7%. Clinically significant pathology upgrading occurred in 7.3% by adding TB to SB and 22.0% by adding SB to TB. Conclusions There is no statistically significant difference between CDRs of SB and TB. Both SB and TB miss significant PCas. Moreover, pathology upgrading occurred more often by adding SB to TB than vice versa. This indicates that the omission of SB in this study population might not be justified.
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11
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Alexander EJ, Murray JR, Morgan VA, Giles SL, Riches SF, Hazell S, Thomas K, Sohaib SA, Thompson A, Gao A, Dearnaley DP, DeSouza NM. Validation of T2- and diffusion-weighted magnetic resonance imaging for mapping intra-prostatic tumour prior to focal boost dose-escalation using intensity-modulated radiotherapy (IMRT). Radiother Oncol 2019; 141:181-187. [PMID: 31493904 PMCID: PMC6908966 DOI: 10.1016/j.radonc.2019.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE To assess the diagnostic accuracy and inter-observer agreement of T2-weighted (T2W) and diffusion-weighted (DW) magnetic resonance imaging (MRI) for mapping intra-prostatic tumour lesions (IPLs) for the purpose of focal dose-escalation in prostate cancer radiotherapy. MATERIALS AND METHODS Twenty-six men selected for radical treatment with radiotherapy were recruited prospectively and underwent pre-treatment T2W+DW-MRI and 5 mm spaced transperineal template-guided mapping prostate biopsies (TTMPB). A 'traffic-light' system was used to score both data sets. Radiologically suspicious lesions measuring ≥0.5 cm3 were classified as red; suspicious lesions 0.2-0.5 cm3 or larger lesions equivocal for tumour were classified as amber. The histopathology assessment combined pathological grade and tumour length on biopsy (red = ≥4 mm primary Gleason grade 4/5 or ≥6 mm primary Gleason grade 3). Two radiologists assessed the MRI data and inter-observer agreement was measured with Cohens' Kappa co-efficient. RESULTS Twenty-five of 26 men had red image-defined IPLs by both readers, 24 had red pathology-defined lesions. There was a good correlation between lesions ≥0.5 cm3 classified "red" on imaging and "red" histopathology in biopsies (Reader 1: r = 0.61, p < 0.0001, Reader 2: r = 0.44, p = 0.03). Diagnostic accuracy for both readers for red image-defined lesions was sensitivity 85-86%, specificity 93-98%, positive predictive value (PPV) 79-92% and negative predictive value (NPV) 96%. Inter-observer agreement was good (Cohen's Kappa 0.61). CONCLUSIONS MRI is accurate for mapping clinically significant prostate cancer; diffusion-restricted lesions ≥0.5 cm3 can be confidently identified for radiation dose boosting.
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Affiliation(s)
- E J Alexander
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - J R Murray
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - V A Morgan
- The Institute of Cancer Research, Sutton, UK.
| | - S L Giles
- The Institute of Cancer Research, Sutton, UK.
| | - S F Riches
- The Institute of Cancer Research, Sutton, UK.
| | - S Hazell
- The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - K Thomas
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - S A Sohaib
- The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - A Thompson
- The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - A Gao
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - D P Dearnaley
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
| | - N M DeSouza
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK.
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12
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Stone NN, Skouteris V, Metsinis PM. Transperineal mapping biopsy improves selection of brachytherapy boost for men with localized prostate cancer. Brachytherapy 2019; 19:33-37. [PMID: 31690515 DOI: 10.1016/j.brachy.2019.09.007] [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: 08/01/2019] [Revised: 08/22/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine if transperineal mapping biopsy (TPMB) can improve the selection of brachytherapy alone (BT) or brachytherapy boost (BTB) in men with localized prostate cancer. METHODS AND MATERIALS Two hundred and eighteen men underwent TPMB with a mean of 48.6 cores retrieved. Comparisons were made between prebiopsy risk features and biopsy results to treatment choice with associations tested with ANOVA (bootstrap), χ2 test (Pearson), and linear regression. Survival estimates were tested by the Kaplan-Meier method with comparisons by log rank. RESULTS Mean age, prostate specific antigen (PSA), prostate specific antigen density (PSAD), and prostate volume were 67.2 years, 8.1 ng/mL, 0.19, and 50.3 cc, respectively. 105 (48.2%) biopsies were positive for Gleason Group (GG) 1: 34 (32.4%), 2: 21 (20%), 3: 31 (29.5%), 4: 7 (6.7%), and 5: 12 (11.4%). The mean number of positive cores (PCs) was 7.3 (median 6, range 1-37). Men with six or more PCs had higher PSA (11.3 vs. 6.0 ng/mL, p = 0.025) and PSAD (0.34 vs. 0.13, p = 0.013). Overall brachytherapy was used in 74 (70.5%) as either monotherapy or boost therapy. Men with BTB had higher PSA (9.7 vs. 6.7 ng/mL, p = 0.029), PSAD (0.27 vs. 0.16, p = 0.007), GG (3.3 vs. 1.8, p < 0.001), more bilateral disease (75.9% vs. 55.6%, odds ratio 3.9, p = 0.008), and PCs (10.9 vs. 4.4, p < 0.001). On linear regression, only GG (p = 0.008) and PCs (p = 0.044) were associated with BTB. Biochemical-free failure at 5 years was 92.7%. CONCLUSIONS TPMB improves the selection of patients for BTB. Men with more PCs are more likely to have BTB. Restricting the need for BTB to those with greater volume prostate cancer may reduce radiation side effects.
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Affiliation(s)
- Nelson N Stone
- Departments of Urology and Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
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13
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Beltran L, Ahmad AS, Sandu H, Kudahetti S, Soosay G, Møller H, Cuzick J, Berney DM. Histopathologic False-positive Diagnoses of Prostate Cancer in the Age of Immunohistochemistry. Am J Surg Pathol 2019; 43:361-368. [PMID: 30531531 PMCID: PMC6375390 DOI: 10.1097/pas.0000000000001202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There are few studies into the rate and causes of histopathologic false-positive diagnosis of prostate cancer. Only 2 of these, including a previous one from our group, incorporate survival data. In addition, in none of the previous studies had immunohistochemistry (IHC) been originally requested on any of the misdiagnosed cases. Diagnostic biopsies (n=1080) and transurethral resection of prostate specimens (n=314) from 1394 men with clinically localized prostate cancer diagnosed in the United Kingdom but treated conservatively between 1990 and 2003 were reviewed by a panel of 3 genitourinary pathologists. Thirty-five cases were excluded for being potentially incomplete. Of the remaining 1359, 30 (2.2%) were reassigned to a nonmalignant category (26 benign and 4 suspicious for malignancy). IHC had been originally performed on 7 of these. The reasons for the errors were recorded on each case: adenosis (19), partial atrophy (3), prostatic intraepithelial neoplasia (2), seminal vesicle epithelium (1), and hyperplasia (1). Follow-up of these men revealed only one prostate cancer-related death, possibly due to unsampled tumor. In conclusion, a relatively small number of prostate cancer mimics were responsible for a large proportion of the false-positive prostate cancer diagnoses and the use of IHC did not prevent the overcall of benign entities as cancer in approximately a quarter of these cases. Targeting these mimics at educational events and raising awareness of the pitfalls in the interpretation of IHC in prostate cancer diagnosis, emphasizing that glands within a suspicious focus should be treated as a whole rather than individually, may be beneficial in lowering the rate of false-positive diagnosis.
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Affiliation(s)
- Luis Beltran
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Amar S Ahmad
- UK Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Holly Sandu
- UK Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Sakunthala Kudahetti
- Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK
| | | | - Henrik Møller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jack Cuzick
- UK Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Daniel M Berney
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
- Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK
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14
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Jansen I, Lucas M, Savci-Heijink CD, Meijer SL, Marquering HA, de Bruin DM, Zondervan PJ. Histopathology: ditch the slides, because digital and 3D are on show. World J Urol 2018; 36:549-555. [PMID: 29396786 PMCID: PMC5871638 DOI: 10.1007/s00345-018-2202-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/19/2018] [Indexed: 02/08/2023] Open
Abstract
Due to the growing field of digital pathology, more and more digital histology slides are becoming available. This improves the accessibility, allows teleconsultations from specialized pathologists, improves education, and might give urologist the possibility to review the slides in patient management systems. Moreover, by stacking multiple two-dimensional (2D) digital slides, three-dimensional volumes can be created, allowing improved insight in the growth pattern of a tumor. With the addition of computer-aided diagnosis systems, pathologist can be guided to regions of interest, potentially reducing the workload and interobserver variation. Digital (3D) pathology has the potential to improve dialog between the pathologist and urologist, and, therefore, results in a better treatment selection for urologic patients.
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Affiliation(s)
- Ilaria Jansen
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Marit Lucas
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Sybren L. Meijer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Henk A. Marquering
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel M. de Bruin
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Patricia J. Zondervan
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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15
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Kammerer-Jacquet SF, Compérat E, Egevad L, Hes O, Oxley J, Varma M, Kristiansen G, Berney DM. Handling and reporting of transperineal template prostate biopsy in Europe: a web-based survey by the European Network of Uropathology (ENUP). Virchows Arch 2018; 472:599-604. [PMID: 29327138 DOI: 10.1007/s00428-017-2265-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/30/2017] [Accepted: 11/05/2017] [Indexed: 01/01/2023]
Abstract
Transperineal template prostate biopsies (TTPB) are performed for assessments after unexpected negative transrectal ultrasound biopsies (TRUSB), correlation with imaging findings and during active surveillance. The impact of TTPBs on pathology has not been analysed. The European Network of Uropathology (ENUP) distributed a survey on TTPB, including how specimens were received, processed and analysed. Two hundred forty-four replies were received from 22 countries with TTPBs seen by 68.4% of the responders (n = 167). Biopsies were received in more than 12 pots in 35.2%. The number of cores embedded per cassette varied between 1 (39.5%) and 3 or more (39.5%). Three levels were cut in 48.3%, between 2 and 3 serial sections in 57.2% and unstained spare sections in 45.1%. No statistical difference was observed with TRUSB management. The number of positive cores was always reported and the majority gave extent per core (82.3%), per region (67.1%) and greatest involvement per core (69.4%). Total involvement in the whole series and continuous/discontinuous infiltrates were reported in 42.2 and 45.4%, respectively. The majority (79.4%) reported Gleason score in each site or core, and 59.6% gave an overall score. A minority (28.5%) provided a map or a diagram. For 19%, TTPB had adversely affected laboratory workload with only 27% managing to negotiate extra costs. Most laboratories process samples thoroughly and report TTPB similarly to TRUSB. Although TTPB have caused considerable extra work, it remains uncosted in most centres. Guidance is needed for workload impact and minimum standards of processing if TTPB work continues to increase.
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Affiliation(s)
- Solene-Florence Kammerer-Jacquet
- Barts Cancer University-Queen Mary University, Charterhouse square, EC1M, London, 6BQ, UK. .,Service d'Anatomie et Cytologie Pathologiques, Université de Rennes 1, Université Bretagne Loire, 35042, Rennes, France.
| | - Eva Compérat
- Hôpital Tenon, HUEP, AP-HP, Université la Sorbonne, Paris, France
| | | | - Ondra Hes
- Charles University, Pilsen, Czech Republic
| | - Jon Oxley
- North Bristol NHS Trust, Bristol, UK
| | | | | | - Daniel M Berney
- Barts Cancer University-Queen Mary University, Charterhouse square, EC1M, London, 6BQ, UK
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16
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Chen K, Tay KJ, Law YM, Aydin H, Ho H, Cheng C, Yuen JSP. Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance. Asian J Urol 2017; 5:184-193. [PMID: 29988897 PMCID: PMC6033238 DOI: 10.1016/j.ajur.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/03/2016] [Accepted: 04/25/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Active surveillance (AS) offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer. An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place. We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging (MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer. Methods This prospective, single-blinded study included men with low-risk prostate cancer (D'Amico's Criteria) diagnosed on conventional transrectal ultrasound-guided biopsy. Patients first underwent multiparametric MRI of the prostate ≥6 weeks after initial biopsy. Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System (PIRADS) score. Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform. Results The age of the 19 men included is 65.4 ± 4.9 years (mean ± SD). Prostate specific antigen (PSA) at diagnosis and at the time of transperineal biopsy were comparable (7.3 ± 1.7 ng/mL and 7.0 ± 1.8 ng/mL, p = 0.67), so were prostate volumes (34.2 ± 8.9 mL and 32.1 ± 13.4 mL, p = 0.28). MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy (11.7% vs. 6.5%, p = 0.02), this was more than 3 times superior for Gleason 7 disease (5.9% vs. 1.6%, p < 0.01). Four of 18 (22.2%) patients with MRI lesions had significant disease with MRI-targeted biopsy alone. Three of 19 patients (15.8%) had significant disease with template biopsy alone. In combination, both techniques upclassified five patients (26.3%), all of whom underwent radical prostatectomy. Whole mount histology confirmed tumour location and grade. All six patients with PIRADS 5 lesions had cancer detected (66.6% significant disease). Conclusion A combination of MRI-targeted and template biopsy may optimally risk-classify “low-risk” patients diagnosed on initial conventional transrectal ultrasonography (TRUS) prostate biopsy.
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Affiliation(s)
- Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Hakan Aydin
- Department of Pathology, Singapore General Hospital, Singapore
| | - Henry Ho
- Department of Urology, Singapore General Hospital, Singapore
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17
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Kanthabalan A, Peters M, Van Vulpen M, McCartan N, Hindley RG, Emara A, Moore CM, Arya M, Emberton M, Ahmed HU. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. BJU Int 2017; 120:246-256. [DOI: 10.1111/bju.13831] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abi Kanthabalan
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Max Peters
- Department of Radiation Oncology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Marco Van Vulpen
- Department of Radiation Oncology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Neil McCartan
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | | | - Amr Emara
- Department of Urology; Hampshire Hospitals NHS Foundation Trust; Basingstoke UK
| | - Caroline M. Moore
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Manit Arya
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Mark Emberton
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Hashim Uddin Ahmed
- Division of Surgery and Interventional Science; University College London; London UK
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
- Division of Surgery; Department of Surgery and Cancer; Faculty of Medicine; Imperial College London; London UK
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18
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Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham AP, Oldroyd R, Parker C, Emberton M. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389:815-822. [PMID: 28110982 DOI: 10.1016/s0140-6736(16)32401-1] [Citation(s) in RCA: 2029] [Impact Index Per Article: 289.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Men with high serum prostate specific antigen usually undergo transrectal ultrasound-guided prostate biopsy (TRUS-biopsy). TRUS-biopsy can cause side-effects including bleeding, pain, and infection. Multi-parametric magnetic resonance imaging (MP-MRI) used as a triage test might allow men to avoid unnecessary TRUS-biopsy and improve diagnostic accuracy. METHODS We did this multicentre, paired-cohort, confirmatory study to test diagnostic accuracy of MP-MRI and TRUS-biopsy against a reference test (template prostate mapping biopsy [TPM-biopsy]). Men with prostate-specific antigen concentrations up to 15 ng/mL, with no previous biopsy, underwent 1·5 Tesla MP-MRI followed by both TRUS-biopsy and TPM-biopsy. The conduct and reporting of each test was done blind to other test results. Clinically significant cancer was defined as Gleason score ≥4 + 3 or a maximum cancer core length 6 mm or longer. This study is registered on ClinicalTrials.gov, NCT01292291. FINDINGS Between May 17, 2012, and November 9, 2015, we enrolled 740 men, 576 of whom underwent 1·5 Tesla MP-MRI followed by both TRUS-biopsy and TPM-biopsy. On TPM-biopsy, 408 (71%) of 576 men had cancer with 230 (40%) of 576 patients clinically significant. For clinically significant cancer, MP-MRI was more sensitive (93%, 95% CI 88-96%) than TRUS-biopsy (48%, 42-55%; p<0·0001) and less specific (41%, 36-46% for MP-MRI vs 96%, 94-98% for TRUS-biopsy; p<0·0001). 44 (5·9%) of 740 patients reported serious adverse events, including 8 cases of sepsis. INTERPRETATION Using MP-MRI to triage men might allow 27% of patients avoid a primary biopsy and diagnosis of 5% fewer clinically insignificant cancers. If subsequent TRUS-biopsies were directed by MP-MRI findings, up to 18% more cases of clinically significant cancer might be detected compared with the standard pathway of TRUS-biopsy for all. MP-MRI, used as a triage test before first prostate biopsy, could reduce unnecessary biopsies by a quarter. MP-MRI can also reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer. FUNDING PROMIS is funded by the UK Government Department of Health, National Institute of Health Research-Health Technology Assessment Programme, (Project number 09/22/67). This project is also supported and partly funded by UCLH/UCL Biomedical Research Centre and The Royal Marsden and Institute for Cancer Research Biomedical Research Centre and is coordinated by the Medical Research Council Clinical Trials Unit (MRC CTU) at UCL. It is sponsored by University College London (UCL).
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Affiliation(s)
- Hashim U Ahmed
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
| | - Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | | | - Rhian Gabe
- Hull York Medical School and Department of Health Sciences, University of York, UK
| | | | | | | | - Katie Ward
- MRC Clinical Trials Unit at UCL, London, UK
| | | | - Alex Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, UK
| | - Alex P Kirkham
- Department of Radiology, UCLH NHS Foundation Trust, London, UK
| | | | - Chris Parker
- Department of Academic Urology, Royal Marsden Hospital, Sutton, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
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19
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Combined T2 and diffusion-weighted MR imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies. World J Urol 2016; 35:213-220. [PMID: 27236302 PMCID: PMC5272897 DOI: 10.1007/s00345-016-1855-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/14/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose Transperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported. Materials and methods A total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study. Results In total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate. Conclusions Transperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate.
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20
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Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review. World J Urol 2016; 34:1521-1531. [PMID: 27012712 PMCID: PMC5063906 DOI: 10.1007/s00345-016-1811-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022] Open
Abstract
Background/Aim Patients with locally recurrent prostate cancer after primary radiotherapy can be eligible for salvage treatment. Whole-gland salvage techniques carry a high risk of toxicity. A focal salvage approach might reduce the risk of adverse events while maintaining cancer control in carefully selected patients. The aim of this review was to evaluate current literature to assess whether focal salvage leads to a comparable or favourable recurrence rate and less toxicity compared to whole-gland salvage. Methods A literature search was performed using PubMed, Embase and the Cochrane Library. A total of 3015 articles were screened and assessed for quality. Eight papers [on focal cryoablation (n = 3), brachytherapy (n = 3) and high-intensity focused ultrasound (n = 2)] were used to report outcomes. Results One-, 2-, 3- and 5-year biochemical disease-free survival (BDFS) ranges for focal salvage are, respectively, 69–100, 49–100, 50–91 and 46.5–54.5 %. Severe genitourinary, gastrointestinal and sexual function toxicity rates are 0–33.3 %. One study directly compares focal to whole-gland salvage cryotherapy, showing 5-year BDFS of, respectively, 54.4 and 86.5 % with lower toxicity rates for focal salvage patients. Conclusion Provisional data suggest that BDFS rates of focal salvage are in line with those of whole-gland approaches. There is evidence that focal salvage could decrease severe toxicity and preserve erectile function. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1811-9) contains supplementary material, which is available to authorized users.
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