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Taha F, Branchu B, Demichel N, Goudaimy S, Bui AP, Delchet O, Larre S. PIRADS≥4 MRI lesion: Is performing systematic biopsies still essential for detecting clinically significant prostate cancer? THE FRENCH JOURNAL OF UROLOGY 2024; 34:102572. [PMID: 38330830 DOI: 10.1016/j.fjurol.2024.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/22/2023] [Accepted: 12/10/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION In the era of targeted prostate biopsies, the necessity of performing randomized biopsies systematically is under question. Our objective is to evaluate the rate of clinically significant prostate cancer (csPCa), defined by presence of ISUP≥2 prostate cancer, diagnosed only on randomized cores in case of a PIRADS≥4 target lesion on MRI. The secondary objective is to evaluate whether specific variables can predict the presence of undetected csPCa in targeted biopsies. METHODS Retrospective data on targeted biopsies performed from 2015 to 2021 in our hospital were collected. Procedures were performed with MRI/Transrectal US fusion Trinity platform from Koelis®. All the MRI images were reviewed and the targets were classified using the PIRADS V2.1 classification. Inclusion criteria comprised procedures featuring at least one PIRADS≥4 targeted lesion were included. All procedures consisted 1-4 targeted cores and 12-core systematic biopsy. RESULTS We included 358 patients. In 44 patients (12.3%) csPCa was exclusively detected in randomized cores. Among these cases, only 12 patients (27.2%) showed no cancer on the targeted biopsies. Merely 4 patients (9.09%) lacked csPCa-positive cores on the same side as the index lesion. Factors such as PSA, PSA density, prostate volume, and digital rectal examination showed no significant association with the presence of csPCa exclusively on randomized cores. Likewise, the size, location, and PIRADS classification of the target demonstrated no significant impact. CONCLUSION Our findings indicate that in 12.3% of cases, targeted biopsies alone are insufficient for detecting the presence of csPCa. As such, systematic biopsies remain necessary to date. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fayek Taha
- CHU de Reims, 1, rue du General-Koenig, 51100 Reims, France.
| | - Benjamin Branchu
- Centre d'urologie Trenel, 184, place Aristide-Briand, 69560 Sainte-Colombe, France
| | | | | | | | | | - Stéphane Larre
- CHU de Reims, 1, rue du General-Koenig, 51100 Reims, France
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Oderda M, Dematteis A, Calleris G, Conti A, D'Agate D, Falcone M, Marquis A, Montefusco G, Marra G, Gontero P. Predictors of Prostate Cancer at Fusion Biopsy: The Role of Positive Family History, Hypertension, Diabetes, and Body Mass Index. Curr Oncol 2023; 30:4957-4965. [PMID: 37232832 DOI: 10.3390/curroncol30050374] [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: 03/25/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND PSA density and an elevated PI-RADS score are among the strongest predictors of prostate cancer (PCa) in a fusion biopsy. Positive family history, hypertension, diabetes, and obesity have also been associated with the risk of developing PCa. We aim to identify predictors of the prostate cancer detection rate (CDR) in a series of patients undergoing a fusion biopsy. METHODS We retrospectively evaluated 736 consecutive patients who underwent an elastic fusion biopsy from 2020 to 2022. Targeted biopsies (2-4 cores per MRI target) were followed by systematic mapping (10-12 cores). Clinically significant PCa (csPCa) was defined as ISUP score ≥ 2. Uni- and multi-variable logistic regression analyses were performed to identify predictors of CDR among age, body mass index (BMI), hypertension, diabetes, positive family history, PSA, a positive digital rectal examination (DRE), PSA density ≥ 0.15, previous negative biopsy status, PI-RADS score, and size of MRI lesion. RESULTS The median patients' age was 71 years, and median PSA was 6.6 ng/mL. A total of 20% of patients had a positive digital rectal examination. Suspicious lesions in mpMRI were scored as 3, 4, and 5 in 14.9%, 55.0%, and 17.5% of cases, respectively. The CDR was 63.2% for all cancers and 58.7% for csPCa. Only age (OR 1.04, p < 0.001), a positive DRE (OR 1.75, p = 0.04), PSA density (OR 2.68, p < 0.001), and elevated PI-RADS score (OR 4.02, p = 0.003) were significant predictors of the CDR in the multivariable analysis for overall PCa. The same associations were found for csPCa. The size of an MRI lesion was associated with the CDR only in uni-variable analysis (OR 1.07, p < 0.001). BMI, hypertension, diabetes, and a positive family history were not predictors of PCa. CONCLUSIONS In a series of patients selected for a fusion biopsy, positive family history, hypertension, diabetes, or BMI are not predictors of PCa detection. PSA-density and PI-RADS score are confirmed to be strong predictors of the CDR.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Alessandro Dematteis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Adriana Conti
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Daniele D'Agate
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Marco Falcone
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Gabriele Montefusco
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes JL, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Roumeguere T, Faletti R, Gontero P. Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy. Prostate 2023; 83:162-168. [PMID: 36259316 DOI: 10.1002/pros.24449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION When performing targeted biopsy (TBx), the need to add systematic biopsies (SBx) is often debated. Aim of the study is to evaluate the added value of SBx in addition to TBx in terms of prostate cancer (PCa) detection rates (CDR), and to test the concordance between multiparametric magnetic resonance imaging (mpMRI) findings and fusion biopsy results in terms of cancer location. METHODS We performed a retrospective, multicentric study that gathered data on 1992 consecutive patients who underwent elastic fusion biopsy between 2011 and 2020. A standardized approach was used, with TBx (2-4 cores per target) followed by SBx (12-14 cores). We assessed CDR of TBx, of SBx, and TBx+SBx for all cancers and clinically significant PCa (csPCa), defined as ISUP score ≥2. CDR was evaluated according to radiological and clinical parameters, with a particular focus on PI-RADS 3 lesions. In a subgroup of 1254 patients we tested the discordance between mpMRI findings and fusion biopsy results in terms of cancer location. Uni- and multivariable logistic regression analyses were performed to identify predictors of CDR. RESULTS CDR of TBx+SBx was 63.0% for all cancers and 38.8% of csPCa. Per-patient analysis showed that SBx in addition to TBx improved CDR by 4.5% for all cancers and 3.4% for csPCa. Patients with lesions scored as PI-RADS 3, 4, and 5 were diagnosed with PCa in 27.9%, 72.8%, and 92.3%, and csPCa in 10.7%, 43.6%, and 69.3%, respectively. When positive, PI-RADS 3 lesions were ISUP grade 1 in 61.1% of cases. Per-lesion analysis showed that discordance between mpMRI and biopsy was found in 56.6% of cases, with 710 patients having positive SBx outside mpMRI targets, of which 414 (58.0%) were clinically significant. PSA density ≥0.15 was a strong predictor of CDR. CONCLUSIONS The addition of systematic mapping to TBx contributes to a minority of per-patient diagnoses but detects a high number of PCa foci outside mpMRI targets, increasing biopsy accuracy for the assessment of cancer burden within the prostate. High PSA-density significantly increases the risk of PCa, both in the whole cohort and in PI-RADS 3 cases.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Ciccariello
- Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Dematteis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Romain Diamand
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Descotes
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Valerio Forte
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Aurel Messas
- Department of Urology, Hopitaux de Paris, Paris, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Alexandre Peltier
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Leire Rius
- Department of Urology, Galdakao Hospital, Bilbao, Spain
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Thierry Roumeguere
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Riccardo Faletti
- Division of Radiology, Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
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Gander J, Guandalino M, Vedrine N, Charbonnel C, Gayrel P, Ceruti F, Guy L. Comparaison des biopsies de prostate systématiques, ciblées et combinées pour le diagnostic de cancer de prostate en cas de lésion à l’IRM. Prog Urol 2022; 32:836-842. [DOI: 10.1016/j.purol.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/27/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Zhang Z, Zhou Q, Ang X, Hu C, Ouyang J, Zhang J. The research of the application of a new urinary biomarker PCA-M of prostate cancer (PSA from 4 to 20 ng/ml). ALL LIFE 2022. [DOI: 10.1080/26895293.2022.2038689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Zhiyu Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Qi Zhou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Xiaojie Ang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Can Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Jianglei Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
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Kaufmann B, Saba K, Schmidli TS, Stutz S, Bissig L, Britschgi AJ, Schaeren E, Gu A, Langenegger N, Sulser T, Eberli D, Keller EX, Hermanns T, Poyet C. Prostate cancer detection rate in men undergoing transperineal template-guided saturation and targeted prostate biopsy. Prostate 2022; 82:388-396. [PMID: 34914121 PMCID: PMC9299705 DOI: 10.1002/pros.24286] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare prostate cancer (PCa) detection rate of transperineal template-guided saturation prostate biopsy (SBx) and multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound fusion guided targeted biopsy (TBx). MATERIALS AND METHODS: We prospectively enrolled 392 men who underwent SBx and TBx in case of suspicious lesions from November 2016 to October 2019. Triggers for a biopsy were an elevated prostate-specific antigen (PSA) and/or positive digital rectal examination and only treatment naïve patients without a previous diagnosis of PCa were included. Study inclusion occurred before biopsy and a prebiopsy mpMRI was available in all men. SBx were taken from 20 different locations according to the modified Barzell zones. The primary endpoint was the detection rate of clinically significant PCa (csPCa) and insignificant PCa (ciPCa) by SBx and/or TBx by comparing the two methods alone and in combination. Additional TBx were taken for any prostate imaging-reporting and data system (PI-RADS) lesion ≥3 seen on the mpMRI. csPCa was defined as any Gleason score ≥7 and ciPCa as Gleason score 6. RESULTS A total of 392 men with a median age of 64 years (interquartile range [IQR]: 58-69), a median PSA of 7.0 ng/ml (IQR: 4.8-10.1) were enrolled. Overall, PCa was found in 200 (51%) of all biopsied men, with 158 (79%) being csPCa and 42 (21%) ciPCa. A total of 268 (68%) men with a suspicious mpMRI and underwent a combined TBx and SBx, of whom csPCa was found in 139 (52%). In this subgroup, 116/139 (83%) csPCa would have been detected by TBx alone, and an additional 23 (17%) were found by SBx. Men with a negative mpMRI (PI-RADS < 3, n = 124, 32%) were found to have csPCa in 19 (15%) cases. In patients with a negative mpMRI in combination with a PSA density <0.1 ng/ml2 , only 8% (3/36) had csPCa. If only TBx would have been performed and all men with a negative mpMRI would not have been biopsed, 42/158 (27%) of csPCa would have been missed, and 38/42 (90%) ciPCa would have not been detected. On multivariable analysis, significant predictors of csPCa were increasing PSA (odds ratio, OR: 1.07 [95% confidence interval, CI: 1.03-1.11]), increasing age (OR: 1.07 [95% CI: 1.03-1.11]), PI-RADS score ≥ 3 (OR: 6.49 [95% CI: 3.55-11.89]), and smaller prostate volume (OR: 0.96 [95% CI: 0.95 -0.97] (p < 0.05 for all parameters). CONCLUSION In comparison to SBx, TBx alone detects csPCa in only ¾ of all men with a positive mpMRI lesion. Thus, systematic biopsies in addition to TBx have to be considered at least in some who undergo a prostate biopsy. In men with a negative mpMRI, SBx still detects 15% csPCa, but similarly overdetecting ciPCa. According to our results, low PSA density and negative mpMRI findings could be used to decide which men can safely avoid biopsy.
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Affiliation(s)
- Basil Kaufmann
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Karim Saba
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Tobias S. Schmidli
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Stephanie Stutz
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Leon Bissig
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Anna Jelena Britschgi
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Evodia Schaeren
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Alexander Gu
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Nicole Langenegger
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Tullio Sulser
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Daniel Eberli
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Etienne X. Keller
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Cédric Poyet
- Department of Urology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
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Knaub RJ, Allaf ME, Gorin MA. Freehand Transperineal Prostate Biopsy with Three-Dimensional Ultrasound Organ-Based Tracking. J Endourol 2021; 35:S7-S16. [PMID: 34499547 DOI: 10.1089/end.2021.0569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Transperineal prostate biopsy carries a significantly lower risk of infectious complications compared with the transrectal approach. We provide a step-by-step description of our current procedural technique for performing transperineal prostate biopsy under local anesthesia. A key component of our technique is the use of a disposable, probe-mounted needle guide that minimizes the number punctures to the perineal skin and allows for continuous needle visualization throughout the procedure. We have paired this device with a novel fusion biopsy platform that utilizes three-dimensional transrectal ultrasound to enable targeting of suspicious lesions found prebiopsy MRI as well as allows for mapping of biopsy core locations for postprocedure review and use at the time of subsequent prostate biopsy or ablation procedures.
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Affiliation(s)
- Ross J Knaub
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, Maryland, USA.,Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Barry Delongchamps N, Schull A, Anract J, Abecassis JP, Zerbib M, Sibony M, Jilet L, Abdoul H, Goffin V, Peyromaure M. Feasibility and safety of targeted focal microwave ablation of the index tumor in patients with low to intermediate risk prostate cancer: Results of the FOSTINE trial. PLoS One 2021; 16:e0252040. [PMID: 34260598 PMCID: PMC8279354 DOI: 10.1371/journal.pone.0252040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the feasibility, safety and precision of organ-based tracking (OBT)-fusion targeted focal microwave ablation (FMA), in patients with low to intermediate risk prostate cancer. PATIENTS AND METHOD Ten patients with a visible index tumor of Gleason score ≤3+4, largest diameter <20mm were included. Transrectal OBT-fusion targeted FMA was performed using an 18G needle. Primary endpoint was the evidence of complete overlap of the index tumor by ablation zone necrosis on MRI 7 days after ablation. Urinary and sexual function were assessed with IPSS, IIEF5 and MSHQ-EjD-SF. Oncological outcomes were assessed with PSA at 2 and 6 months, and re-biopsy at 6 months. RESULTS Median [IQR] age was 64.5 [61-72] years and baseline PSA was 5 [4.3-8.1] ng/mL. Seven (70%) and 3 (30%) patients had a low and intermediate risk cancer, respectively. Median largest tumor axis was of 11 [9.0-15.0] mm. Median duration of procedure was of 82 [44-170] min. No patient reported any pain or rectal bleeding, and all 10 patients were discharged the next day. Seven days after ablation, total necrosis of the index tumor on MRI was obtained in eight (80% [95%CI 55%-100%]) patients. One patient was treated with radical prostatectomy. Re-biopsy at 6 months in the other 9 did not show evidence of cancer in 4 patients. IPSS, IIEF-5 and MSHQ-EjD-SF were not statistically different between baseline and 6 months follow up. CONCLUSIONS OBT-fusion targeted FMA was feasible, precise, and safe in patients with low to intermediate risk localized prostate cancer.
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Affiliation(s)
- Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | - Alexandre Schull
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Julien Anract
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | | | - Marc Zerbib
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Mathilde Sibony
- Department of Pathology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Léa Jilet
- Clinical Research Unit, Cochin hospital, APHP, Paris Descartes University, Paris, France
| | - Hendy Abdoul
- Clinical Research Unit, Cochin hospital, APHP, Paris Descartes University, Paris, France
| | - Vincent Goffin
- Inserm Unit U1151, Paris Descartes University, Paris, France
| | - Michaël Peyromaure
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- Inserm Unit U1151, Paris Descartes University, Paris, France
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9
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Beitone C, Fiard G, Troccaz J. Towards real-time free-hand biopsy navigation. Med Phys 2021; 48:3904-3915. [PMID: 33159811 DOI: 10.1002/mp.14582] [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: 07/01/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Performing a transrectal ultrasound (TRUS) prostate biopsy is at the heart of the current prostate cancer detection procedure. With today's two-dimensional (2D) live ultrasound (US) imaging equipment, this task remains complex due to the poor visibility of cancerous tissue on TRUS images and the limited anatomical context available in the 2D TRUS plane. This paper presents a rigid 2D/3DUS registration method for navigated prostate biopsy. This allows continuous localization of the biopsy trajectory during the procedure. METHODS We proposed an organ-based approach to achieve real-time rigid registration without the need for any probe localization device. The registration method combines image similarity and geometric proximity of detected features. Additions to our previous work include a multi-level approach and the use of a rejection rate favouring the best matches. Their aim is to increase the accuracy and time performances. These modifications and their in-depth evaluation on real clinical cases and comparison to this previous work are described. We performed static and dynamic evaluations along biopsy trajectories on a very large amount of data acquired under uncontrolled routine conditions. The computed transforms are compared to a ground truth obtained either from corresponding manually detected fiducials or from an already evaluated registration method. RESULTS All results show that the current method outperforms its previous version, both in terms of accuracy (the average error reported here is 12 to 17% smaller depending on the experiment) and processing time (from 20 to 60 times faster compared to the previous implementation). The dynamic registration experiment demonstrates that the method can be successfully used for continuous tracking of the biopsy location w.r.t the prostate at a rate that varies between 5 and 15 Hz. CONCLUSIONS This work shows that on the fly 2D/3DUS registration can be performed very efficiently on biopsy trajectories. This allows us to plan further improvements in prostate navigation and a clinical transfer.
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Affiliation(s)
- Clément Beitone
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, F-38000, France
| | - Gaëlle Fiard
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, F-38000, France.,Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
| | - Jocelyne Troccaz
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, F-38000, France
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10
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Vesval Q, Fiard G, Villers A, Norris JM, Olivier J. Should we perform systematic biopsies in case of suspicious MRI for prostate cancer in 2020? A review of literature. Prog Urol 2020; 31:147-157. [PMID: 33189555 DOI: 10.1016/j.purol.2020.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/15/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
CONTEXT Multiparametric magnetic resonance imaging (MRI) is now recommended before performing prostate biopsies, looking for suspicious lesions to perform targeted biopsies (TB). However, the association or exclusive performance of systematic biopsies (SB), criticized for its morbidity and for the detection of insignificant cancers, remains debated. OBJECTIVE To perform a literature review to answer three questions: (1) In the presence of a suspicious MRI lesion, should we always perform SB in addition to TB? (2) Can we avoid SB when considering focal treatment? (3) Is there an increase in adverse events when associating SB with TB? SOURCES A non-systematic literature review was carried out on Medline in April 2020 using the keywords "MRI", "PROSTATE CANCER", "SYSTEMATIC BIOPSY", "TARGETED BIOPSY", "ADVERSE EVENTS". The references of the selected articles were analyzed for additional articles. Selection of Studies published in the last five years were analyzed and retained if the available data made it possible to answer one of the three questions asked. RESULTS In biopsy-naive patients, the added value of SB to TB for detection of significative cancer varied from +5 to+7% and was reduced to +1 to +3% in the case of a previous series of negative biopsies. For patients under active surveillance, this added value was higher, ranging from +8% to +17%. MRI has a negative predictive value of 85 to 95%, but this value drops to 55% for the detection of secondary or tertiary foci. The use of SB is necessary if focal treatment is considered. Serious complications from biopsies requiring hospitalization range from 1.4 to 6.9% and are increased by the number of previous biopsy series performed more than by the number of biopsies per series. CONCLUSION In the presence of a suspicious MRI lesion, SB is indicated in addition to TB but can be discussed in patients with previous negative biopsies. They are necessary if focal treatment is considered to aid surgical planning. Severe complications from biopsies do not seem to increase when SB are associated to TB, but rather with the number of biopsy series performed.
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Affiliation(s)
- Q Vesval
- Department of Urology, Hospital Claude Huriez, CHRU Lille, France; Université de Lille 2, Faculté de médecine Henri Warembourg, Lille, France.
| | - G Fiard
- UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - A Villers
- Department of Urology, Hospital Claude Huriez, CHRU Lille, France; Université de Lille 2, Faculté de médecine Henri Warembourg, Lille, France
| | - J M Norris
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - J Olivier
- Department of Urology, Hospital Claude Huriez, CHRU Lille, France; Université de Lille 2, Faculté de médecine Henri Warembourg, Lille, France; UCL Division of Surgery and Interventional Science, University College London, London, UK
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11
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Miah S, Hosking-Jervis F, Connor MJ, Eldred-Evans D, Shah TT, Arya M, Barber N, Bhardwa J, Bott S, Burke D, Doherty A, Foster C, Freeman A, Hindley R, Jameson C, Karim O, Laniado M, Montgomery B, Nigam R, Punwani S, Sinclair A, Winkler M, Allen C, Ahmed HU. A Multicentre Analysis of the Detection of Clinically Significant Prostate Cancer Following Transperineal Image-fusion Targeted and Nontargeted Systematic Prostate Biopsy in Men at Risk. Eur Urol Oncol 2020; 3:262-269. [PMID: 31411968 DOI: 10.1016/j.euo.2019.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prostate biopsy guided by magnetic resonance imaging (MRI) is increasingly used to obtain tissue from men with suspected prostate cancer (PC). OBJECTIVE To report a multicentre series of image-fusion transperineal prostate biopsies and compare the diagnostic yield of clinically significant PC (csPC) between targeted and nontargeted biopsies. DESIGN, SETTING, AND PARTICIPANTS The study included 640 consecutive patients with elevated prostate specific antigen (PSA) presenting for first biopsy or following a previous negative transrectal biopsy under the care of 13 urologists in 11 centres in the UK (April 2014-June 2017). INTERVENTION Multiparametric MRI was carried out in 61 approved prostate MRI centres with transperineal targeted alone (n=283) or targeted plus nontargeted (n=357) transperineal rigid image-fusion targeted biopsy (MIM-Symphony-DX). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Rates of csPC and insignificant cancer detection in targeted and nontargeted biopsies were measured using a number of thresholds to define clinical significance. The primary definition was Gleason≥4+3 or any grade ≥6mm. RESULTS AND LIMITATIONS The mean age, median PSA, and median prostate volume for the cohort were 63.8yr (standard deviation [SD] 8.4), 6.3 ng/ml (SD 5.8), and 42.0cm3 (SD 24.7), respectively. Overall, 276/640 men (43.1%) were diagnosed with csPC. csPC was detected from targeted biopsies alone in 263/640 cases (41.1%). Of the 357 men who underwent nontargeted biopsies, three (0.8%) had csPC exclusively in nontargeted cores, with no evidence of cancer in targeted cores. Overall, 32/357 (9.0%) had csPC in nontargeted biopsies regardless of the targeted biopsy findings. Clinically insignificant disease in nontargeted biopsies was detected in 93/357 men (26.1%). Our findings were consistent across all other thresholds of clinical significance. Limitations include the lack of nontargeted biopsies in all men. CONCLUSIONS In this large multicentre series, nontargeted prostate biopsy cores had a low yield of csPC and a high yield of clinically insignificant PC. An image-fusion targeted-biopsy-only approach maintains high detection for csPC and low detection of clinically insignificant cancers. PATIENT SUMMARY In this report, we found that following prostate multiparametric magnetic resonance imaging and targeted transperineal biopsies of suspicious areas, the clinical value of performing additional extensive unguided biopsies of nonsuspicious areas is limited and can often find insignificant cancers that do not need treatment.
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Affiliation(s)
- Saiful Miah
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Feargus Hosking-Jervis
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Martin J Connor
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - David Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Taimur T Shah
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospital, London, UK
| | - Neil Barber
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | | | - Simon Bott
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - Daniel Burke
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - Alan Doherty
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | | | - Alex Freeman
- Department of Pathology, University College London Hospital, London, UK
| | | | | | - Omer Karim
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | - Marc Laniado
- The Prostate Unit, BUPA Cromwell Hospital, London, UK
| | | | - Raj Nigam
- Department of Urology, University College London Hospital, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital, London, UK
| | | | - Mathias Winkler
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospital, London, UK
| | - Hashim U Ahmed
- Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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12
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Shen WW, Cui LG, Ran WQ, Sun Y, Jiang J, Pei XL, Chen W. Targeted Biopsy With Reduced Number of Cores: Optimal Sampling Scheme in Patients Undergoing Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Prostate Biopsy. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1197-1207. [PMID: 32107089 DOI: 10.1016/j.ultrasmedbio.2020.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
The 3 Tesla (3T) magnetic resonance imaging (MRI) combined ultrasound (TRUS) targeted biopsy plus 12-core systematic biopsy (TBx + 12-SBx) was considered a reliable method for prostate cancer (PCa) diagnosis. To find another optimal sampling scheme with fewer cores and the same efficiency as TBx + 12-SBx for prostate biopsy, 113 patients who underwent five different hypothetical sampling schemes were analyzed and compared with TBx + 12-SBx. The detection rates of targeted biopsy plus 6-core lateral systematic biopsy (TBx + lateral 6-SBx) for PCa and clinically significant prostate cancer (csPCa) (99.1% and 96.4%, respectively) were higher than other schemes, and the area under the receiver operating characteristic curve of TBx + lateral 6-SBx for PCa and csPCa (0.991 and 0.990, respectively) were also significantly higher than other sampling schemes except TBx plus 6-core ipsilateral systematic biopsy (TBx + ipsilateral 6-SBx). Additionally, TBx + lateral 6-SBx had the lowest missed diagnosis rate. Thus, the TBx + lateral 6-SBx may be the optimal scheme for patients undergoing MRI/TRUS fusion prostate biopsy.
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Affiliation(s)
- Wei-Wei Shen
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China.
| | - Wei-Qiang Ran
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Yan Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Jie Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Xin-Long Pei
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
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13
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Essid MA, Chakroun M, Nouhaud FX, Lair M, Gobet F, Pfister C. Evolution of prostate cancer diagnosis: retrospective analysis of magnetic resonance imaging/ultrasound fusion guided biopsies protocol in routine practice and patients management. Transl Androl Urol 2020; 9:629-636. [PMID: 32420169 PMCID: PMC7215024 DOI: 10.21037/tau.2020.02.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is today strongly recommended in prostate cancer (PCa) diagnosis. Therefore, MRI/ultrasound (MRI/US) fusion-guided biopsy is becoming the new standard patients management. Methods We report our experience during the last 4 years using this technique, with a protocol of 6 random cores (instead of the most used 12 cores protocol) associated to the target cores (2 to 3 per lesion). Our study involved 236 patients including real life routine practice: biopsy naïve patients (n=107), patients with previous negative standard prostate biopsies (n=67) and patients in PCa active surveillance (n=62). Finally, 76 patients have a robotic radical prostatectomy. Results Mean age of the population was 66 years. Median PSA was 8.5 ng/mL. Overall and significant cancer detection were respectively 66.6% and 38.5%, with a large difference considering biopsy history: 63.5% in biopsy naïve patient, 53.7% in patient with previous negative biopsies and 82.3% in patients under active surveillance. Targeted biopsies missed 28 cancers among 8 were significant and standard biopsies missed 33 cancers among 14 were significant. Moreover, concordance between biopsy samples and radical prostatectomy specimens was evaluated at 80%. Conclusions Comparing to literature data, similar results were observed in our retrospective study, even with reduced random cores, suggesting a real change in patients management in particular in active surveillance group with a reclassification rate of 56.4% using the Epstein criteria.
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Affiliation(s)
| | | | | | - Michael Lair
- Department of Radiology, Rouen University Hospital, Rouen, France
| | - Françoise Gobet
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Christian Pfister
- Department of Urology, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 6204, Onco-Urology, Rouen, France
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14
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[Initial results of perineal MRI/ultrasound fusion biopsies under local anesthesia without standard perioperative antibiotic prophylaxis]. Urologe A 2020; 59:1225-1230. [PMID: 32161979 DOI: 10.1007/s00120-020-01164-2] [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: 10/24/2022]
Abstract
The perineal approach for prostate biopsy (PB) is a sterile alternative to conventional transrectal PB. Targeted local anesthesia allows perineal prostate biopsy (pPB) to be performed without general anesthesia. This paper presents the first results after establishing perineal MRI/ultrasound fusion biopsy (pFB) under local anesthesia without standard perioperative antibiotic prophylaxis. For this purpose, 144 patients were included in the study after pFB at the Vivantes Klinikum am Urban. No peri-interventional antibiotic prophylaxis was applied. Peri- and postoperatively, the pain sensation, measured using an analogue pain scale from 0-10, and complications were recorded. The median patient age was 68 and the median prostate-specific antigen (PSA) value 7.07 ng/ml. In all, 49% of the patients received primary PB. The overall detection rate for prostate cancer (PCa) was 71% and for PI-RADS 3, 4 and 5 was 44, 71 and 92%, respectively. The median pain sensation during biopsy was 2. Furthermore, 63% of patients with a transrectal prebiopsy considered this to be more painful and another 20% expressed similar pain levels. Only 1 patient developed a febrile urinary tract infection. The pFB of the prostate under local anesthesia without antibiotic, perioperative prophylaxis is a suitable alternative to the transrectal PB with regard to the detection rate of PCa, the side effect profile and the subjective pain perception of the patients during the intervention.
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15
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Marra G, Marquis A, Tappero S, D'Agate D, Oderda M, Calleris G, Falcone M, Faletti R, Molinaro L, Zitella A, Bergamasco L, Gontero P. Transperineal Free-hand mpMRI Fusion-targeted Biopsies Under Local Anesthesia: Technique and Feasibility From a Single-center Prospective Study. Urology 2020; 140:122-131. [PMID: 32061825 DOI: 10.1016/j.urology.2019.11.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the feasibility of "in-office" TPFBx under local anesthesia (LA). MATERIALS AND METHODS We prospectively screened for eligibility data of 724 consecutive men undergoing either TPFBx (target and systematic cores) or TPSBx (systematic cores only) from September 2016 to June 2018 due to suspicion of prostate cancer (CaP), according to predefined exclusion criteria. RESULTS We included 459 men (TPFBx n = 279 including n = 338 mpMRI lesions, Pi-RADS 4 in 63.6%; TPSBx n = 180). Median procedural time and maximum pain were 19 minutes and 5 numeric rating scale (NRS) points; pain was highest at the time of LA. Only 1 major complication occurred (Clavien 3a). Hematuria and hematospermia were frequent (72.6% and 54.2%). Vaso-vagal reactions and AUR were rare (0.7% and 0.4%). No cases of UTI and 1 case of fever were recorded. No significant changes in erectile and urinary functions were noted from baseline compared to 40 days after TPFBx (P = .86 and P = .89). In comparison with TPSBx the sole differences were pain during prostatic sampling (P = .03), duration of hematospermia (P <.0001) and procedural time (P <.001) all higher for TPFBx. Clinically significant (cs) CaP was detected in n = 150 (53.8%) patients in the TPFBx group (34.9%, 51.7%, and 75% of Pirads 3, 4, and 5, respectively). Addition of systematic cores detected n = 25 csCaP that were missed by targeted cores (17.4% of all csCaP). CONCLUSION TPFBx under LA are feasible, yielding high tolerability, low complications, no impact on erectile and urinary function and good csCaP detection. Addition of systematic to targeted cores remains recommended. Further studies are needed to confirm our findings.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy.
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Stefano Tappero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Daniele D'Agate
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Marco Falcone
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Riccardo Faletti
- Department of Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Luca Molinaro
- Department of Pathology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Andrea Zitella
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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16
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Ukimura O. Editorial Comment from Dr Ukimura to Magnetic resonance imaging/transrectal ultrasonography fusion targeted prostate biopsy finds more significant prostate cancer in biopsy‐naïve Japanese men compared with the standard biopsy. Int J Urol 2020; 27:146-147. [DOI: 10.1111/iju.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Osamu Ukimura
- Department of Urology Kyoto Prefectural University of Medicine Kyoto Japan
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17
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Wajswol E, Winoker JS, Anastos H, Falagario U, Okhawere K, Martini A, Treacy P, Voutsinas N, Knauer CJ, Sfakianos JP, Lewis SC, Taouli BA, Rastinehad AR. A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection. BJU Int 2019; 125:531-540. [DOI: 10.1111/bju.14957] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ethan Wajswol
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Jared S. Winoker
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Harry Anastos
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ugo Falagario
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Kennedy Okhawere
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Alberto Martini
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Nicholas Voutsinas
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Cynthia J Knauer
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - John P. Sfakianos
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Sara C. Lewis
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Bachir A. Taouli
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Ardeshir R. Rastinehad
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Radiology Icahn School of Medicine at Mount Sinai New York NY USA
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18
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Oderda M, Marra G, Albisinni S, Altobelli E, Baco E, Beatrici V, Dellabella M, Descotes JL, Eldred-Evans D, Fasolis G, Ferriero M, Fiard G, Giacobbe A, Kumar P, Lacetera V, Mozer P, Muto G, Papalia R, Peltier A, Piechaud T, Pierangeli T, Simone G, Roche JB, Roupret M, Gontero P. Elastic fusion biopsy versus systematic biopsy for prostate cancer detection: Results of a multicentric study on 1,119 patients. Actas Urol Esp 2019; 43:431-438. [PMID: 31155373 DOI: 10.1016/j.acuro.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the accuracy of targeted and systematic biopsies for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in the everyday practice, evaluating the need for additional systematic biopsies at the time of targeted biopsy. PATIENTS AND METHODS From our multicentric database gathering data on 2,115 patients who underwent fusion biopsy with Koelis™ system between 2010 and 2017, we selected 1,119 patients who received targeted biopsies (a median of 3 for each target), followed by systematic sampling of the prostate (12 to 14 cores). Overall and clinically significant cancer detection rate (CDR) of Koelis™ fusion biopsies were assessed, comparing target and systematic biopsies. Secondary endpoint was the identification of predictors of PCa detection. RESULTS The CDR of targeted biopsies only was 48% for all cancers and 33% for csPCa. The performance of additional, systematic prostate sampling improved the CDR of 15% for all cancers and of 12% for csPCa. PCa was detected in 35%, 69%, and 92% of patients with lesions scored as PI-RADS 3, 4 and 5, respectively. Elevated PI-RADS score and positive digital rectal examination were predictors of PCa, whereas biopsy-naïve status was associated with csPCa. CONCLUSION In the everyday practice target biopsy with Koelis™ achieves a good CDR for all PCa and csPCa, which is significantly improved by subsequent systematic sampling of the prostate. The outstanding outcomes of fusion biopsy are confirmed also in biopsy-naïve patients. Elevated PI-RADS score and positive digital rectal examination are strongly associated with presence of PCa.
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Affiliation(s)
- M Oderda
- Departamento de Ciencias Quirúrgicas, Urología, Universitad de Turín, Turín, Italia; Departamento de Urología, Hospital San Lázaro, Alba, Italia.
| | - G Marra
- Departamento de Ciencias Quirúrgicas, Urología, Universitad de Turín, Turín, Italia
| | - S Albisinni
- Departamento de Urología, Hospital Eraste, Universidad Libre de Bruselas, Bruselas, Bélgica
| | - E Altobelli
- Departamento de Urología, Campus Biomédico Universidad, Roma, Italia
| | - E Baco
- Departamento de Urología, Hospital Universitario de Oslo, Oslo, Noruega
| | - V Beatrici
- Departamento de Urología, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italia
| | - M Dellabella
- Departamento de Urología, INRCA-IRCCS, Ancona, Italia
| | - J L Descotes
- Departamento de Urología, Centre Hospitalier Universitaire de Grenoble, Grenoble, Francia
| | - D Eldred-Evans
- Departamento de Urología, Hospital Royal Marsden, Londres, Reino Unido
| | - G Fasolis
- Departamento de Urología, Hospital San Lázaro, Alba, Italia
| | - M Ferriero
- Departamento de Urología, Regina Elena National Cancer Institute, Roma, Italia
| | - G Fiard
- Departamento de Urología, Centre Hospitalier Universitaire de Grenoble, Grenoble, Francia
| | - A Giacobbe
- Departamento de Urología, Humanitas Gradenigo Hospital, Turín, Italia
| | - P Kumar
- Departamento de Urología, Hospital Royal Marsden, Londres, Reino Unido
| | - V Lacetera
- Departamento de Urología, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italia
| | - P Mozer
- Departamento de Urología, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, París, Francia
| | - G Muto
- Departamento de Urología, Humanitas Gradenigo Hospital, Turín, Italia
| | - R Papalia
- Departamento de Urología, Campus Biomédico Universidad, Roma, Italia
| | - A Peltier
- Departamento de Urología, Instituto Jules Bordet, Universidad Libre de Bruselas, Bruselas, Bélgica
| | - T Piechaud
- Departamento de Urología, Clinique Saint Augustin, Burdeos, Francia
| | - T Pierangeli
- Unidad de Cáncer de Próstata, INRCA-IRCCS, Ancona, Italia
| | - G Simone
- Departamento de Urología, Regina Elena National Cancer Institute, Roma, Italia
| | - J B Roche
- Departamento de Urología, Clinique Saint Augustin, Burdeos, Francia
| | - M Roupret
- Departamento de Urología, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, París, Francia
| | - P Gontero
- Departamento de Ciencias Quirúrgicas, Urología, Universitad de Turín, Turín, Italia
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19
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Marra G, Ploussard G, Futterer J, Valerio M. Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach? World J Urol 2019; 37:277-287. [PMID: 30610359 DOI: 10.1007/s00345-018-02622-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP). METHODS We performed a literature search of peer-reviewed English language articles using PubMed and the words "prostate" AND "biopsy". Web search was implemented by manual search. RESULTS Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx-TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues. CONCLUSION The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy.
| | - Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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