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Massanova M, Barone B, Caputo VF, Napolitano L, Ponsiglione A, Del Giudice F, Ferro M, Lucarelli G, Lasorsa F, Busetto GM, Robertson S, Trama F, Imbimbo C, Crocetto F. The detection rate for prostate cancer in systematic and targeted prostate biopsy in biopsy-naive patients, according to the localization of the lesion at the mpMRI: A single-center retrospective observational study. Prostate 2024; 84:1234-1243. [PMID: 38924146 DOI: 10.1002/pros.24761] [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: 03/21/2024] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Evaluate the detection rates of systematic, targeted and combined cores at biopsy according to tumor positions in biopsy-naïve patients. MATERIAL AND METHODS A retrospective analysis of a single-center patient cohort (n = 501) that underwent transrectal prostate biopsy between January 2017 and December 2019 was performed. Multi-parametric MRI was executed as a prebiopsy investigation. Biopsy protocol included, for each patient, 12 systematic cores plus 3 to 5 targeted cores per lesion identified at the mpMRI. Pearson and McNemar chi-squared tests were used for statistical analysis to compare tumor location-related detection rates of systematic, targeted and combined (systematic + targeted) cores at biopsy. RESULTS Median age of patients was 70 years (IQR 62-72), with a median PSA of 8.5 ng/ml (IQR 5.7-15.6). Positive biopsies were obtained in 67.7% of cases. Overall, targeted cores obtained higher detection rates compared to systematic cores (54.3% vs. 43.1%, p < 0.0001). Differences in detection rates were, however, higher for tumors located at the apex (61.1% vs. 26.3%, p < 0.05) and anteriorly (44.4% vs. 19.3%, p < 0.05). Targeted cores similarly obtained higher detection rates in the posterior zone of the prostate gland for clinically significant prostate cancer. A poor agreement was reported between targeted and systematic cores for the apex and anterior zone of the prostate with, respectively κ = 0.028 and κ = -0.018. CONCLUSION A combined approach of targeted and systematic biopsy delivers the highest detection rate in prostate cancer (PCa). The location of the tumor could however greatly influence overall detection rates, indicating the possibility to omit (as for the base or posterior zone of the gland) or add (as for the apex or anterior zone of the gland) further targeted cores.
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Affiliation(s)
- Matteo Massanova
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
- Urology Department, Southend-On-Sea University Hospital, Southend-On-Sea, UK
| | - Biagio Barone
- Department of Surgical Sciences, Urology Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Vincenzo Francesco Caputo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Luigi Napolitano
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Andrea Ponsiglione
- Advanced Biomedical Sciences, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Lasorsa
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Sophie Robertson
- Urology Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Francesco Trama
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Ciro Imbimbo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
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Hough VA, Wycislo KL, Hofmeister EH, Piech TL, Maki LC, Shaver SL. Effect of Romanowsky-Stained Concentrated Preparations versus Direct Smears on Veterinary Students' Ability to Identify Bacterial Sepsis in Fluid Cytology Samples from Dogs, Cats, and Horses. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023; 50:228-233. [PMID: 35439102 DOI: 10.3138/jvme-2021-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Veterinary students' accuracy, confidence, and time required to diagnose bacterial sepsis in fluid cytology samples was evaluated using two different slide preparation methods: direct smears and cytocentrifuged concentrated preparations. We hypothesized veterinary students would diagnose fluids as septic on concentrated preparations more accurately and quickly than on direct smears. Thirty third- and fourth-year students who had previously participated in a clinical pathology course completed a survey regarding general cytology experience and reviewed 40 randomized Romanowsky-stained slides via microscopy. Slides consisted of 10 septic and 10 non-septic samples with matched direct and concentrated slides, prepared from fluids from dogs, cats, and a horse. Participants' slide evaluation time, diagnosis, confidence, and slide photographs of areas considered septic were recorded. No difference in diagnostic accuracy between direct and concentrated samples was identified (area under the curve: 57% for both preparations, p = 0.77), although students agreed with pathologist-determined diagnoses more often when viewing concentrated samples (M = 63%, SD = 11% for concentrated; M = 56%, SD = 21% for direct, p = .012). A positive relationship existed between accuracy of diagnosis (R2 = .59) and senior status (p = .002), comfort interpreting cytology slides (p < .03), and if the student had taken the senior pathology rotation (p = .02). Only 38% (121/319) of participant photographs correctly identified sepsis. Under experimental conditions, concentrated preparations did not increase the accuracy of veterinary students' bacterial sepsis diagnosis; however, since accuracy did increase with cytology experience and comfort level, additional pre-clinical and clinical cytology training may benefit students before entering practice.
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Affiliation(s)
- Veronica A Hough
- VetMED Emergency and Specialty Care, 20612 North Cave Creek Road, Phoenix, AZ 85024 USA
| | - Kathryn L Wycislo
- Department of Pathology, College of Veterinary Medicine, Midwestern University, 19555 North 59th Avenue, Glendale, AZ 85308 USA
| | - Erik H Hofmeister
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1130 Wire Road, Auburn, AL 36849 USA
| | - Tara L Piech
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Long Island University, 720 Northern Boulevard, Brookville, NY 11548 USA
| | - Lynn C Maki
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, 19555 North 59th Avenue, Glendale, AZ 85308 USA
| | - Stephanie L Shaver
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, 19555 North 59th Avenue, Glendale, AZ 85308 USA
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van Riel LA, Jager A, Meijer D, Postema AW, Smit RS, Vis AN, de Reijke TM, Beerlage HP, Oddens JR. Predictors of clinically significant prostate cancer in biopsy-naïve and prior negative biopsy men with a negative prostate MRI: improving MRI-based screening with a novel risk calculator. Ther Adv Urol 2022; 14:17562872221088536. [PMID: 35356754 PMCID: PMC8958520 DOI: 10.1177/17562872221088536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/03/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose: A pre-biopsy decision aid is needed to counsel men with a clinical suspicion for clinically significant prostate cancer (csPCa), despite normal prostate magnetic resonance imaging (MRI). Methods: A risk calculator (RC) for csPCa (International Society of Urological Pathology grade group (ISUP) ⩾ 2) presence in men with a negative-MRI (Prostate Imaging–Reporting and Data System (PI-RADS) ⩽ 2) was developed, and its performance was compared with RCs of the European Randomized Study of Screening for Prostate Cancer (ERSPC), Prostate Biopsy Collaborative Group (PBCG), and Prospective Loyola University mpMRI (PLUM). All biopsy-naïve and prior negative biopsy men with a negative-MRI followed by systematic prostate biopsy were included from October 2015 to September 2021. The RC was developed using multivariable logistic regression with the following parameters: age (years), family history of PCa (first- or second-degree family member), ancestry (African Caribbean/other), digital rectal exam (benign/malignant), MRI field strength (1.5/3.0 Tesla), prior negative biopsy status, and prostate-specific antigen (PSA) density (ng/ml/cc). Performance of RCs was compared using receiver operating characteristic (ROC) curve analysis. Results: A total of 232 men were included for analysis, of which 18.1% had csPCa. Parameters associated with csPCa were family history of PCa (p < 0.0001), African Caribbean ancestry (p = 0.005), PSA density (p = 0.002), prior negative biopsy (p = 0.06), and age at biopsy (p = 0.157). The area under the curve (AUC) of the developed RC was 0.76 (95% CI 0.68–0.85). This was significantly better than the RCs of the ERSPC (AUC: 0.59; p = 0.001) and PBCG (AUC: 0.60; p = 0.002), yet similar to PLUM (AUC: 0.69; p = 0.09). Conclusion: The developed RC (Prostate Biopsy Cohort Amsterdam (‘PROBA’ RC), integrated predictors for csPCa at prostate biopsy in negative-MRI men and outperformed other widely used RCs. These findings require external validation before introduction in daily practice.
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Affiliation(s)
- Luigi A.M.J.G. van Riel
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Auke Jager
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Dennie Meijer
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W. Postema
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth S. Smit
- Department of Radiology, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - André N. Vis
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo M. de Reijke
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Harrie P. Beerlage
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jorg R. Oddens
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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4
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Jager A, Vilanova JC, Michi M, Wijkstra H, Oddens JR. The challenge of prostate biopsy guidance in the era of mpMRI detected lesion: ultrasound-guided versus in-bore biopsy. Br J Radiol 2022; 95:20210363. [PMID: 34324383 PMCID: PMC8978231 DOI: 10.1259/bjr.20210363] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The current recommendation in patients with a clinical suspicion for prostate cancer is to perform systematic biopsies extended with targeted biopsies, depending on mpMRI results. Following a positive mpMRI [i.e. Prostate Imaging Reporting and Data System (PI-RADS) ≥3], three targeted biopsy approaches can be performed: visual registration of the MRI images with real-time ultrasound imaging; software-assisted fusion of the MRI images and real-time ultrasound images, and in-bore biopsy within the MR scanner. This collaborative review discusses the advantages and disadvantages of each targeting approach and elaborates on future developments. Cancer detection rates seem to mostly depend on practitioner experience and selection criteria (biopsy naïve, previous negative biopsy, prostate-specific antigen (PSA) selection criteria, presence of a lesion on MRI), and to a lesser extent dependent on biopsy technique. There is no clear consensus on the optimal targeting approach. The choice of technique depends on local experience and availability of equipment, individual patient characteristics, and onsite cost-benefit analysis. Innovations in imaging techniques and software-based algorithms may lead to further improvements in this field.
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Affiliation(s)
- Auke Jager
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joan C Vilanova
- Department of Radiology, Clinica Girona, Diagnostic Imaging Institute (IDI), University of Girona, Girona, Spain
| | - Massimo Michi
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Jager A, van Riel LA, Postema AW, de Reijke TM, van der Sluis TM, Oddens JR. An optimized prostate biopsy strategy in patients with a unilateral lesion on prostate magnetic resonance imaging avoids unnecessary biopsies. Ther Adv Urol 2022; 14:17562872221111410. [PMID: 35924207 PMCID: PMC9340407 DOI: 10.1177/17562872221111410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: The introduction of magnetic resonance imaging (MRI)-targeted biopsy (TBx)
besides systematic prostate biopsies has resulted in a discussion on what
the optimal prostate biopsy strategy is. The ideal template has high
sensitivity for clinically significant prostate cancer (csPCa), while
reducing the detection rate of clinically insignificant prostate cancer
(iPCa). This study evaluates different biopsy strategies in patients with a
unilateral prostate MRI lesion. Methods: Retrospective subgroup analysis of a prospectively managed database
consisting of patients undergoing prostate biopsy in two academic centres.
Patients with a unilateral lesion (PI-RADS ⩾ 3) on MRI were included for
analysis. The primary objective was to evaluate the diagnostic performance
for different biopsy approaches compared with bilateral systematic prostate
biopsy (SBx) and TBx. Detection rates for csPCa (ISUP ⩾ 2), adjusted csPCa
(ISUP ⩾ 3) and iPCa (ISUP = 1) were determined for SBx alone, TBx alone,
contralateral SBx combined with TBx and ipsilateral SBx combined with TBx. A
subgroup analysis was performed for biopsy-naive patients. Results: A total of 228 patients were included from October 2015 to September 2021.
Prostate cancer (PCa) detection rate of combined SBx and TBx was 63.5% for
csPCa, 35.5% for adjusted csPCa, and 14% for iPCa. The best performing
alternative biopsy strategy was TBx and ipsilateral SBx, which reached a
sensitivity of 98.6% (95% CI: 95.1–99.6) for csPCa and 98.8% (95% CI:
96.3–99.9) for adjusted csPCa, missing only 1.4% of csPCa, while reducing
iPCa detection by 15.6% compared with SBx and TBx. TBx or SBx alone missed a
significant amount of csPCa, with sensitivities of 90.3% (95% CI: 84.4–94.2)
and 86.8% (95% CI: 80.4–91.4) for csPCa. Subgroup analysis on biopsy-naive
patients showed similar results as the overall group. Conclusion: This study shows that performing TBx with ipsilateral SBx and omitting
contralateral SBx is the optimal biopsy strategy in patients with a
unilateral MRI lesion. With this strategy, a very limited amount of csPCa is
missed and iPCa detection is reduced.
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Affiliation(s)
- Auke Jager
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Free University, Amsterdam, The Netherlands
| | - Luigi A.M.J.G. van Riel
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Free University, Amsterdam, The Netherlands
| | - Arnoud. W. Postema
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Free University, Amsterdam, The Netherlands
| | - Theo M. de Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Free University, Amsterdam, The Netherlands
| | - Tim M. van der Sluis
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Free University, Amsterdam, The Netherlands
| | - Jorg R. Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Free University, Amsterdam, The Netherlands
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6
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Zhang Z, Lampotang S, Yu Y, Acar YA, Wakim J, Mei V, Ahmad AE, Shenot P, Lee J, Perlis N, Moy L, Johnson WT, DeStephens A, Bigos AK, Lizdas DE, Stringer T. Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study. BJU Int 2021; 128:615-624. [PMID: 33961325 DOI: 10.1111/bju.15445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side-fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false-negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer. PARTICIPANTS AND METHODS Using a PBx simulator with real-time three-dimensional visualization, we devised a freehand, pitch-neutral (0°, horizontal plane), side-fire, transrectal ultrasonography (TRUS)-guided sPBx technique in the left lateral decubitus position. Thirty-four trainees on four Canadian and US urology programmes learned the technique on the same simulator, which recorded deviation from the intended template location in a double-sextant template as well as the TRUS probe pitch at the time of sampling. We defined deviation as the shortest distance in millimeters between a core centre and its intended template location, template deviation as the mean of all deviations in a template, and mastery as achieving a template deviation ≤5.0 mm. RESULTS All results are reported as mean ± sd. The mean absolute pitch and template deviation before learning the technique (baseline) were 8.2 ± 4.1° and 8.0 ± 2.7 mm, respectively, and after mastering the technique decreased to 4.5 ± 2.7° (P = 0.001) and 4.5 ± 0.6 mm (P < 0.001). Template deviation was related to mean absolute pitch (P < 0.001) and increased by 0.5 mm on average with each 1° increase in mean absolute pitch. Participants achieved mastery after practising 3.9 ± 2.9 double-sextant sets. There was no difference in time to perform a double-sextant set at baseline (277 ± 102 s) and mastery (283 ± 101 s; P = 0.39). CONCLUSION A pitch-neutral side-fire technique reduced template deviation during simulated freehand TRUS-guided sPBx, suggesting it may also reduce PBx false-negatives in patients in a future clinical trial. This pitch-neutral technique can be taught and learned; the University of Florida has been teaching it to all Urology residents for the last 2 years.
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Affiliation(s)
- Zhou Zhang
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Anaesthesiology, Chongqing General Hospital, Chongqing, China
| | - Samsun Lampotang
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.,Office of Educational Affairs/Office of Medical Education, University of Florida College of Medicine, Gainesville, FL, USA.,Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Yichao Yu
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yahya A Acar
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Jonathan Wakim
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Vincent Mei
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ardalan E Ahmad
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Patrick Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Lee
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Louis Moy
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - William T Johnson
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anthony DeStephens
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.,Office of Educational Affairs/Office of Medical Education, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andre K Bigos
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - David E Lizdas
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas Stringer
- Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
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7
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Wang JF, Knoedler MA, Maciolek KA, Posielski NM, Lopez V, Bushman WA, Best SL, Gralnek DR, Richards KA. Transrectal ultrasound guided prostate biopsy performed by supervised junior and senior residents is safe and does not result in inferior outcomes. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:150-156. [PMID: 33816703 PMCID: PMC8012825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To compare transrectal ultrasound guided prostate biopsy (TRUSBx) cancer detection and complication rates between residents at different levels of training and attending physicians at a single academic center. METHODS We performed a retrospective review of consecutive series of 623 men undergoing TRUSBx from June 2014 to February 2017. The procedure was performed either by resident physicians under direct supervision by an attending physician or by an attending physician. In total, junior residents, senior residents and attending physicians performed 244, 212, and 167 biopsies, respectively. Prostate cancer detection, 30-day complications, and 30-day hospitalizations rates were the outcomes of interest. We performed multivariable logistic regression analysis to identify predictors of these outcomes and examined the hypothesis that TRUSBx performed by trainees would not be associated with inferior outcomes. RESULTS There was no statistically significant difference in patient populations between the three groups when stratified by age, BMI, Charleston co-morbidity index, aspirin use, PSA level and palpable nodule on DRE. Prostate cancer was detected in 43.8% of the biopsies and there was no difference in detection rates (P = 0.53), Gleason score (P = 0.11), number of positive cores (P = 0.95), 30-day hospitalization (P = 0.86), and 30-day complication rates (P = 0.67) between TRUSBx performed by trainees and attending physicians. CONCLUSIONS TRUSBx performed by residents and attending physicians yielded equivalent rates of cancer detection with no significant difference in 30-day complications or 30-day hospitalizations rates. There was no difference in outcomes between junior and senior residents suggesting that with adequate faculty supervision, it is safe for trainees at all levels to perform prostate biopsies.
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Affiliation(s)
- Jesse F Wang
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Margaret A Knoedler
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Kimberly A Maciolek
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Natasza M Posielski
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Vania Lopez
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Wade A Bushman
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
- Department of Urology, William S. Middleton Memorial Veterans HospitalMadison, WI, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
- Department of Urology, William S. Middleton Memorial Veterans HospitalMadison, WI, USA
| | - Dan R Gralnek
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
- Department of Urology, William S. Middleton Memorial Veterans HospitalMadison, WI, USA
| | - Kyle A Richards
- Department of Urology, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
- Department of Urology, William S. Middleton Memorial Veterans HospitalMadison, WI, USA
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8
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Li Q, Duan Y, Baikpour M, Pierce TT, McCarthy CJ, Thabet A, Chan ST, Samir AE. Magnetic resonance imaging/transrectal ultrasonography fusion guided seed placement in a phantom: Accuracy between 2-seed versus 1-seed strategies. Eur J Radiol 2020; 129:109126. [PMID: 32544805 DOI: 10.1016/j.ejrad.2020.109126] [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: 01/30/2020] [Revised: 05/03/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate whether the 2-seed placement per Magnetic Resonance Imaging (MRI) suspicious lesion yields a higher seed placement accuracy than a 1-seed strategy on a phantom. METHODS Eight olives embedded in gelatin, each simulating a prostate, underwent MRI. Three virtual spherical lesions (3, 5, and 8 mm diameters) were marked in each olive on the MRI images and co-registered to the MRI/Transrectal Ultrasonography (TRUS) fusion biopsy system. Two radiologists placed 0.5 mm fiducials, targeting the center of each virtual lesion under fusion image guidance. Half of the 8 olives in each phantom were assigned either to the 1-seed or 2-seeds per lesion strategy. Post-procedure Computed Tomography (CT) images identified each seed and were fused with MR to localize each virtual lesion and collected the seed placement error - distance between the virtual target and the corresponding seed (using the closer seed for the 2-seed strategy). Seed placement success is defined as fiducial placement within a lesion boundary. RESULTS Each operator repeated the procedure on three different phantoms, and data from 209 seeds placed for 137 lesions were analyzed, with an overall error of 3.03 ± 1.52 mm. The operator skill, operator phantom procedural experience, lesion size, and number of seeds, were independently associated with the seed placement error. Seed placement success rate was higher for the 2-seed group compared to 1-seed, although the difference was not statistically significant. CONCLUSIONS Placing 2 seeds per MRI lesion yielded a significantly lower error compared to 1-seed strategy, although seed placement success rate was not significantly different.
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Affiliation(s)
- Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Yu Duan
- Department of Medical Ultrasonics, the First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong, 510080, China.
| | - Masoud Baikpour
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Theodore T Pierce
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Colin J McCarthy
- Interventional Radiology, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX, 77030, USA
| | - Ashraf Thabet
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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Stabile A, Giganti F, Kasivisvanathan V, Giannarini G, Moore CM, Padhani AR, Panebianco V, Rosenkrantz AB, Salomon G, Turkbey B, Villeirs G, Barentsz JO. Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review. Eur Urol Oncol 2020; 3:145-167. [DOI: 10.1016/j.euo.2020.02.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 01/19/2023]
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DeWitt-Foy ME, Klein EA, ElShafei A, Coronado WM, Campbell S, Gong M, Berglund R, Ulchaker J, Fareed K, Abouassaly R. The Association of Urologic Oncology Fellowship Training and Diagnostic Yield of Prostate Biopsy. Urology 2019; 137:115-120. [PMID: 31785277 DOI: 10.1016/j.urology.2019.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/28/2019] [Accepted: 11/02/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the relationship between urologic oncology fellowship training (UOFT) and diagnostic yield of prostate biopsy. METHODS Retrospective review was conducted of patients who underwent prostate biopsy across the Cleveland Clinic between 2000 and 2018. Biopsies done by urologists with and without UOFT were detailed via descriptive statistics and appropriate (chi-square, Student t, Wilcoxon rank-sum) tests. Multivariate logistic regression was used to examine the association between UOFT and positive prostate biopsy, adjusting for relevant covariates. RESULTS A total of 11,241 biopsies by 129 urologists had complete information available for review. Sixteen urologists (12.4%) had UOFT; 113 either completed a different fellowship or no fellowship. Those with UOFT were more likely to use MRI-guided biopsy (7.80% vs 3.05%, P <.0001), more likely to get a positive biopsy (41.25% vs 32.72%, P <.0001), and more likely to obtain an adequate number (by ≥12) of cores (90.25% vs 74.53%, P <.0001). UOFT remained a significant predictor of positivity when adjusting for patient age and race, PSA, 5-alpha-reductase-inhibitor use, year of biopsy, years in practice, and type of biopsy (MRI or transrectal ultrasound guided). UOFT also predicted higher-risk biopsy (Gleason sum ≥7), adjusting for the same variables, though this association lost significance when adjusting for adequacy of biopsy. The learning curve to achieve a higher percentage of positive biopsies was steeper for nonurologic oncology fellowship trained than for UOFT urologists. CONCLUSION UOFT is associated with higher diagnostic yield on prostate biopsy, higher uptake of MRI-guided biopsy, and less steep learning curve. This may be due to patient selection, technique, or, as we demonstrate here, adherence to guidelines.
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Affiliation(s)
- Molly E DeWitt-Foy
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH.
| | - Eric A Klein
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmed ElShafei
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - W Melissa Coronado
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - Steven Campbell
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - Michael Gong
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan Berglund
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - James Ulchaker
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - Khaled Fareed
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - Robert Abouassaly
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
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Predictive factors of prostate cancer diagnosis with PSA 4.0-10.0 ng/ml in a multi-ethnic Asian population, Malaysia. Asian J Surg 2019; 43:87-94. [PMID: 30962017 DOI: 10.1016/j.asjsur.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/16/2019] [Accepted: 02/27/2019] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES To identify the associated factors determining prostate cancer detection using transrectal ultrasound (TRUS)-guided prostate biopsy, within a multi-ethnic Malaysian population with prostate specific antigen (PSA) between 4.0 and 10.0 ng/ml. METHODS Study subjects included men with initial PSA between 4.0 and 10.0 ng/ml that have undergone 12-core TRUS-guided prostate biopsy between 2009 and 2016. The prostate cancer detection rate was calculated, while potential factors associated with detection were investigated via univariable and multivariable analysis. RESULTS A total of 617 men from a multi-ethnic background encompassing Chinese (63.5%), Malay (23.1%) and Indian (13.3%) were studied. The overall cancer detection rate was 14.3% (88/617), which included cancers detected at biopsy 1 (first biopsy), biopsy 2 (second biopsy with previous negative biopsy) and biopsy ≥ 3 (third or more biopsies with prior negative biopsies). Indian men displayed higher detection rate (23.2%) and increased risk of prostate cancer development (OR 1.85, 95% CI 1.03-3.32, p < 0.05), compared to their Malay (9.8%) and Chinese (14.0%) counterparts. Multivariable analysis revealed that ethnicity and PSA density (PSAD) are independent factors associated with overall prostate cancer detection rate. A unit increase of PSAD reflected an increase in PSA after controlling for prostate volume. CONCLUSION Prostate cancer detection in Malaysia is comparatively lower. Our study suggests that ethnicity and PSA density should be considered when recommending first or repeat TRUS-guided prostate biopsy for prostate cancer detection in a multi-ethnic Malaysian population.
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