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Wu T, Xing Y. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates. Open Med (Wars) 2024; 19:20241039. [PMID: 39381428 PMCID: PMC11459270 DOI: 10.1515/med-2024-1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/19/2024] [Accepted: 08/21/2024] [Indexed: 10/10/2024] Open
Abstract
Objectives We conducted a systematic review to compare the diagnostic utility of ultrasound-guided transperineal (TP) and transrectal (TR) prostate biopsy methods for prostate cancer detection. Methods We searched PubMed, Embase, Web of Science, and Cochrane databases up to October 30, 2023, for relevant studies, screening the literature and assessing bias independently. Results Eleven trials were analyzed using relative risk and 95% confidence intervals, with no evidence of publication bias. Diagnostic rates showed no significant difference between TP and TR biopsies (mean difference [MD]: 1.03, 95% confidence interval [CI]: 0.91-1.14, P = 0.56). Prostate volume analysis also showed no significant difference (MD: -0.07, 95% CI: -0.73 to 0.59, P < 0.0001, combined effect size P = 0.83). Similarly, PSA levels were comparable between TP and TR biopsies (MD: 0.93, 95% CI: -0.44 to 2.30, P < 0.0001, combined effect size P = 0.18). Conclusion Both biopsy methods exhibit similar diagnostic accuracy; however, TP has a lower risk of biopsy.
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Affiliation(s)
- Tao Wu
- Department of Urology, Huangshan City People’s Hospital, Huangshan, 245000, China
| | - Yanchun Xing
- Department of Medicine, Huangshan Vocational Technical College, Huangshan, 245000, China
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Zang S, Jiang C, Zhang L, Fu J, Meng Q, Wu W, Shao G, Sun H, Jia R, Wang F. Deep learning based on 68Ga-PSMA-11 PET/CT for predicting pathological upgrading in patients with prostate cancer. Front Oncol 2024; 13:1273414. [PMID: 38260839 PMCID: PMC10800856 DOI: 10.3389/fonc.2023.1273414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Objectives To explore the feasibility and importance of deep learning (DL) based on 68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT in predicting pathological upgrading from biopsy to radical prostatectomy (RP) in patients with prostate cancer (PCa). Methods In this retrospective study, all patients underwent 68Ga-PSMA-11 PET/CT, transrectal ultrasound (TRUS)-guided systematic biopsy, and RP for PCa sequentially between January 2017 and December 2022. Two DL models (three-dimensional [3D] ResNet-18 and 3D DenseNet-121) based on 68Ga-PSMA-11 PET and support vector machine (SVM) models integrating clinical data with DL signature were constructed. The model performance was evaluated using area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. Results Of 109 patients, 87 (44 upgrading, 43 non-upgrading) were included in the training set and 22 (11 upgrading, 11 non-upgrading) in the test set. The combined SVM model, incorporating clinical features and signature of 3D ResNet-18 model, demonstrated satisfactory prediction in the test set with an AUC value of 0.628 (95% confidence interval [CI]: 0.365, 0.891) and accuracy of 0.727 (95% CI: 0.498, 0.893). Conclusion A DL method based on 68Ga-PSMA-11 PET may have a role in predicting pathological upgrading from biopsy to RP in patients with PCa.
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Affiliation(s)
- Shiming Zang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cuiping Jiang
- Department of Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lele Zhang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jingjing Fu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qingle Meng
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wenyu Wu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guoqiang Shao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongbin Sun
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ruipeng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Weinstein IC, Wu X, Hill A, Brennan D, Omil-Lima D, Basourakos S, Brant A, Lewicki P, Al Hussein Al Awamlh B, Spratt D, Bittencourt LK, Scherr D, Zaorsky NG, Nagar H, Hu J, Barbieri C, Ponsky L, Vickers AJ, Shoag JE. Impact of Magnetic Resonance Imaging Targeting on Pathologic Upgrading and Downgrading at Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Oncol 2023:S2588-9311(23)00080-9. [PMID: 37236832 DOI: 10.1016/j.euo.2023.04.004] [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: 11/19/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/28/2023]
Abstract
CONTEXT The evidence supporting multiparametric magnetic resonance imaging (MRI) targeting for biopsy is nearly exclusively based on biopsy pathologic outcomes. This is problematic, as targeting likely allows preferential identification of small high-grade areas of questionable oncologic significance, raising the likelihood of overdiagnosis and overtreatment. OBJECTIVE To estimate the impact of MRI-targeted, systematic, and combined biopsies on radical prostatectomy (RP) grade group concordance. EVIDENCE ACQUISITION PubMed MEDLINE and Cochrane Library were searched from July 2018 to January 2022. Studies that conducted systematic and MRI-targeted prostate biopsies and compared biopsy results with pathology after RP were included. We performed a meta-analysis to assess whether pathologic upgrading and downgrading were influenced by biopsy type and a net-benefit analysis using pooled risk difference estimates. EVIDENCE SYNTHESIS Both targeted only and combined biopsies were less likely to result in upgrading (odds ratio [OR] vs systematic of 0.70, 95% confidence interval [CI] 0.63-0.77, p < 0.001, and 0.50, 95% CI 0.45-0.55, p < 0.001), respectively). Targeted only and combined biopsies increased the odds of downgrading (1.24 (95% CI 1.05-1.46), p = 0.012, and 1.96 (95% CI 1.68-2.27, p < 0.001) compared with systematic biopsies, respectively. The net benefit of targeted and combined biopsies is 8 and 7 per 100 if harms of up- and downgrading are considered equal, but 7 and -1 per 100 if the harm of downgrading is considered twice that of upgrading. CONCLUSIONS The addition of MRI-targeting results in lower rates of upgrading as compared to systematic biopsy at RP (27% vs 42%). However, combined MRI-targeted and systematic biopsies are associated with more downgrading at RP (19% v 11% for combined vs systematic). Strong heterogeneity suggests further research into factors that influence the rates of up- and downgrading and that distinguishes clinically relevant from irrelevant grade changes is needed. Until then, the benefits and harms of combined MRI-targeted and systematic biopsies cannot be fully assessed. PATIENT SUMMARY We reviewed the ability of magnetic resonance imaging (MRI)-targeted biopsies to predict cancer grade at prostatectomy. We found that combined MRI-targeted and systematic biopsies result in more cancers being downgraded than systematic biopsies.
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Affiliation(s)
- Ilon C Weinstein
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Xian Wu
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alexander Hill
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Donald Brennan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Danly Omil-Lima
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Spyridon Basourakos
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Aaron Brant
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Patrick Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | | | - Daniel Spratt
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Leonardo Kayat Bittencourt
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Doug Scherr
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Himanshu Nagar
- Department of Radiation Oncology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Jim Hu
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Christopher Barbieri
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Lee Ponsky
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
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Adverse Pathology after Radical Prostatectomy of Patients Eligible for Active Surveillance-A Summary 7 Years after Introducing mpMRI-Guided Biopsy in a Real-World Setting. Bioengineering (Basel) 2023; 10:bioengineering10020247. [PMID: 36829741 PMCID: PMC9952076 DOI: 10.3390/bioengineering10020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Over the last decade, active surveillance (AS) of low-risk prostate cancer has been increasing. The mpMRI fusion-guided biopsy of the prostate (FBx) is considered to be the gold standard in preoperative risk stratification. However, the role of FBx remains unclear in terms of risk stratification of low-risk prostate cancer outside high-volume centers. The aim of this study was to evaluate adverse pathology after radical prostatectomy (RP) in a real-world setting, focusing on patients diagnosed with Gleason score (GS) 6 prostate cancer (PCa) and eligible for AS by FBx. SUBJECTS AND METHODS Between March 2015 and March 2022, 1297 patients underwent FBx at the Department of Urology, Ludwig-Maximilians-University of Munich, Germany. MpMRI for FBx was performed by 111 different radiology centers. FBx was performed by 14 urologists from our department with different levels of experience. In total, 997/1297 (77%) patients were diagnosed with prostate cancer; 492/997 (49%) of these patients decided to undergo RP in our clinic and were retrospectively included. Univariate and multivariable logistic regression analyses were performed to evaluate clinical and histopathological parameters associated with adverse pathology comparing FBx and RP specimens. To compare FBx and systematic randomized biopsies performed in our clinic before introducing FBx (SBx, n = 2309), we performed a propensity score matching on a 1:1 ratio, adjusting for age, number of positive biopsy cores, and initial PSA (iPSA). RESULTS A total of 492 patients undergoing FBx or SBx was matched. In total, 55% of patients diagnosed with GS 6 by FBx were upgraded to clinically significant PCa (defined as GS ≥ 7a) after RP, compared to 52% of patients diagnosed by SBx (p = 0.76). A time delay between FBx and RP was identified as the only correlate associated with upgrading. A total of 5.9% of all FBx patients and 6.1% of all SBx patients would have been eligible for AS (p > 0.99) but decided to undergo RP. The positive predictive value of AS eligibility (diagnosis of low-risk PCa after biopsy and after RP) was 17% for FBx and 6.7% for SBx (p = 0.39). CONCLUSIONS In this study, we show, in a real-world setting, that introducing FBx did not lead to significant change in ratio of adverse pathology for low-risk PCa patients after RP compared to SBx.
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Guimarães T, Gil M, Medeiros M, Andrade V, Guerra J, Pinheiro H, Fernandes F, Pina J, Lopes Dias J, Campos Pinheiro L. Magnetic resonance imaging target fusion biopsy vs. transrectal ultrasound-guided biopsy - A comparative study of ISUP score upgrading risk in the final radical prostatectomy specimen. Arch Ital Urol Androl 2022; 94:278-284. [DOI: 10.4081/aiua.2022.3.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The aim of this study was to com-pare the risk of International Society of Urological Pathology (ISUP) score upgrading between magnetic resonance imaging targeted fusion biopsy (MRI-TB) and tran-srectal ultrasound-guided biopsy (TRUS-B) in the final radical prostatectomy (RP) specimen pathological report.Materials and methods: This retrospective single center study included 51 patients with prostate cancer (PCa) diagnosed with MRI-TB and 83 patients diagnosed with TRUS-B between October/2019 and July/2021. We compared the rates of ISUP score upgrading between both groups after robotic-assisted radi-cal prostatectomy (RARP) and the specific transition of each ISUP score based on biopsy modality. The rate of ISUP score concordance and downgrading were also assessed. To define the intra and interobserver concordance for each ISUP score in biopsy and RP specimen for each biopsy modality, the Cohen’s Kappa coefficient was calculated. ISUP scores and biopsy modal-ity were selected for multivariate analysis and a logistic regres-sion model was built to provide independent risk factors of ISUP score upgrading.Results: The difference of the rate of upgrading between MRI-TB group and TRUS-B group was statistically significant (p = 0.007) with 42.2% of patients of TRUS-B group experiencing an upgrade in their ISUP score while only 19.6% in MRI-TB group. Concordance and downgrading rates did not statistically differ between the two groups. Strength of concordance using Cohen’s Kappa coefficient was fair in both groups but higher in MRI-TB group (TRUS-B group k = 0.230; p < 0.001; concordance: 47%vs. MRI/TB group k = 0.438; p < 0.001; concordance: 62.7%). Biopsy modality and ISUP 1 on biopsy were independent predic-tors of ISUP upgrading after RP.Conclusions: MRI-TB is highly accurate with lower risk of PCa upgrading after RP than TRUS-B. Patients with ISUP 1 on biopsy have greater susceptibility to upgrading their ISUP score.
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[Interactions between radical prostatovesiculectomy and diagnosis of prostate cancer : A medical-historical inventory on the occasion of 20 years of robot-assisted treatment]. Urologe A 2021; 60:1039-1050. [PMID: 33201298 PMCID: PMC7670839 DOI: 10.1007/s00120-020-01389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Die Frage, was zuerst war – in diesem Falle die Diagnostik des Prostatakarzinoms oder seine Therapie – erscheint auf den ersten Blick widersinnig und erinnert an die klassische metapherartige Problemstellung, die schon den griechischen Schriftsteller Plutarch (45–125) beschäftigte. Ist es heute selbstverständlich, dass vor der Behandlung einer Erkrankung die sichere Diagnosestellung steht, so muss dies medizinhistorisch jedoch als nicht konsistent erachtet werden. Die Anfänge der radikalen Prostatektomie zur Behandlung des Prostatakarzinoms lassen sich, ähnlich wie die ersten operativen Therapien von Nieren- und Harnblasentumoren, in der Pionierzeit der Organchirurgie im Deutschen Kaiserreich (1871–1918) verorten. Die Etablierung dieses Eingriffs in seiner heutigen Form mit größeren Fallzahlen ist wiederum dem Nestor der US-amerikanischen Urologie, Hugh Hampton Young (1870–1945), zu verdanken, der 1904 die erste aus heutiger Sicht als vollumfänglich zu bezeichnende perineale Prostatovesikulektomie durchführte. Wenngleich die Indikation seither weitgehend unverändert geblieben ist, war dieser Eingriff in den letzten Jahrzehnten doch umfangreichen Veränderungen unterworfen. Wie aber hat sich die Diagnostik des Prostatakarzinoms in dieser Zeitspanne entwickelt? Naturgemäß sehr viel dynamischer! Denn als der Leiteingriff Prostatovesikulektomie bereits etabliert war, begann im Laufe des 20. Jahrhunderts erst langsam, dann dynamischer deren Entwicklung. Wir stellen anhand medizin(histor)ischer Originalquellen daher nicht nur die Grundlagen und Weiterentwicklungen des etablierten und zugleich immer wieder Innovationen unterworfenen Leiteingriffs der Urologie vor, sondern gehen vielmehr auch auf wesentliche Umfeldentwicklungen benachbarter medizinischer Disziplinen ein. Erst diese Entwicklungen schafften übrigens auch die Grundlage für die korrekte Indikationsstellung und das Aufzeigen von Alternativen zur radikalen Prostatovesikulektomie.
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Combined Systematic and MRI-US Fusion Prostate Biopsy Has the Highest Grading Accuracy When Compared to Final Pathology. ACTA ACUST UNITED AC 2021; 57:medicina57060519. [PMID: 34067302 PMCID: PMC8224801 DOI: 10.3390/medicina57060519] [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] [Received: 03/24/2021] [Revised: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 02/05/2023]
Abstract
Background and objectives: Systematic prostate biopsy (SB) has a low Gleason group (GG) accuracy when compared to final pathology. This may negatively impact the inclusion of patients into specific risk groups and treatment choice. The aim of our study was to assess the GG accuracy of magnetic resonance imaging-ultrasound (MRI-US) fusion prostate biopsy. Materials and Methods: Of a cohort of minimally invasive radical prostatectomy (RP), we selected all patients who were diagnosed with prostate cancer (PCa) via MRI-US fusion biopsy (n = 115). Results: Combined biopsy had the highest rate for GG concordance (61.7% vs. 60.4% for SB vs. 45.3% for MRI-US fusion biopsy) and the lowest for upgrading (20.9% vs. 24.5% for SB vs. 34.9% for MRI-US fusion biopsy), p < 0.0001. No clinical data were predictive for upgrading or downgrading at final pathology. Locally advanced PCa was associated with a high Prostate Imaging-Reporting and Data System (PIRADS) score (p = 0.0014) and higher percentages of positive biopsy cores (PBC)/targeted (p = 0.0002) and PBC/total (p = 0.01). Positive surgical margins were correlated with higher percentages of PBC/systematic (p = 0.003) and PBC/total (p = 0.009). Conclusions: Pre-biopsy prostate MRI improves GG concordance between biopsy and RP. Combined biopsy provides the highest grading accuracy when compared to final pathology. Targeted and systematic biopsy data are predictive for adverse pathologic outcomes.
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Wenzel M, Preisser F, Wittler C, Hoeh B, Wild PJ, Tschäbunin A, Bodelle B, Würnschimmel C, Tilki D, Graefen M, Becker A, Karakiewicz PI, Chun FKH, Kluth LA, Köllermann J, Mandel P. Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy. Diagnostics (Basel) 2021; 11:882. [PMID: 34063557 PMCID: PMC8155831 DOI: 10.3390/diagnostics11050882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The impact of MRI-lesion targeted (TB) and systematic biopsy (SB) Gleason score (GS) as a predictor for final pathological GS still remains unclear. METHODS All patients with TB + SB, and subsequent radical prostatectomy (RP) between 01/2014-12/2020 were analyzed. Rank correlation coefficient predicted concordance with pathological GS for patients' TB and SB GS, as well as for the combined effect of SB + TB. RESULTS Of 159 eligible patients, 77% were biopsy naïve. For SB taken in addition to TB, a Spearman's correlation of +0.33 was observed regarding final GS. Rates of concordance, upgrading, and downgrading were 37.1, 37.1 and 25.8%, respectively. For TB, a +0.52 correlation was computed regarding final GS. Rates of concordance, upgrading and downgrading for TB biopsy GS were 45.9, 33.3, and 20.8%, respectively. For the combination of SB + TB, a correlation of +0.59 was observed. Rates of concordance, upgrading and downgrading were 49.7, 15.1 and 35.2%, respectively. The combined effect of SB + TB resulted in a lower upgrading rate, relative to TB and SB (both p < 0.001), but a higher downgrading rate, relative to TB (p < 0.01). CONCLUSIONS GS obtained from TB provided higher concordance and lower upgrading and downgrading rates, relative to SB GS with regard to final pathology. The combined effect of SB + TB led to the highest concordance rate and the lowest upgrading rate.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Peter J. Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
- Frankfurt Institute for Advanced Studies (FIAS), 60590 Frankfurt, Germany
- Wildlab, University Hospital Frankfurt MVZ GmbH, 60590 Frankfurt, Germany
| | - Alexandra Tschäbunin
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
- Department of Urology, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
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The role of multiparametric resonance and biopsy in prostate cancer detection: comparison with definitive histological report after laparoscopic/robotic radical prostatectomy. Abdom Radiol (NY) 2020; 45:4178-4184. [PMID: 33048224 PMCID: PMC7716945 DOI: 10.1007/s00261-020-02798-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/20/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022]
Abstract
Purpose Magnetic Resonance Imaging (MRI) targeted biopsy increases overall detection rates and decreases the risk of clinically insignificant PCa detection. The aim of this retrospective study is to compare concordance rates regarding side of lesion and Gleason Score at fusion targeted/systematic biopsy and MRI with the definitive histologic report of prostatectomy specimen. Methods 115 patients underwent multiparametric (mp) MRI and successively fusion targeted/systematic biopsy. 107 patients, with a positive biopsy for PCa, further underwent laparoscopic/robotic radical prostatectomy. We compared surgical histologic report with biopsy histologic report for side of lesion and Gleason Score. We further compared PIRADS score at mpMRI with Gleason Score of both histologic reports. Results Concordance rate for mpMRI lesion side was 74% compared to biopsy and 52.3% compared to surgical histologic report (p < 0.0001). Fusion targeted/systematic biopsy reported a concordance rate with surgical histologic report of 67.3% for side of the lesion, while Gleason Score was concordant for 73.6% for clinically significant cancer (Gleason Score ≥ 7) (p < 0.0001). PIRADS score ≥ 3 was further associated with clinically significant cancer at surgical histologic report in 92.4% of cases (p = 0.359). Conclusion Multiparametric MRI of the prostate reaches a good and improvable accuracy in the detection of suspicious PCa before biopsy. A combined approach of fusion targeted and systematic biopsy could further increase the overall accuracy in PCa diagnosis, especially in biopsy-naïve patients, reaching concordance rates with definitive histologic report up to 52.3% and 85.5%.
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Targeted and Systematic Biopsy for the Diagnosis and Management of Prostate Cancer - A Case for Lesion Targeted-Only Biopsies. Clin Oncol (R Coll Radiol) 2020; 32:136-143. [PMID: 32035580 DOI: 10.1016/j.clon.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/11/2019] [Accepted: 01/07/2020] [Indexed: 11/23/2022]
Abstract
For much of the 1990s, transrectal ultrasound systematic biopsy was the standard approach for prostate cancer diagnosis. However, in the past decade multiparametric magnetic resonance imaging, multiparametric ultrasound and image fusion targeting have come to the fore. Here we present the state-of-the-art diagnostic strategies in prostate cancer detection and examine the case for target-only biopsy, as well as the benefits and limitations.
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11
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Angileri SA, Di Meglio L, Petrillo M, Arrichiello A, Pandolfi M, Rodà GM, Granata G, Ierardi AM, Donat D, Paolucci A, Carrafiello G. Software-assisted US/MRI fusion-targeted biopsy for prostate cancer. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020006. [PMID: 33245067 PMCID: PMC8023072 DOI: 10.23750/abm.v91i10-s.10273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prostate cancer is the first cancer diagnosis in men. European Association of Urology (EAU) Guidelines for Prostate Cancer underline the importance of screening, performed through PSA testing on all men with more than 50 years of age and before on men with risk factors. The diagnosis is still histopathologic, and it is done on the basis of the findings on biopsy samples. MATERIALS AND METHODS Fusion biopsy is a relatively new technique that allows the operator to perform the biopsies in office instead of the MRI gantry, without losing the detection capability of MRI. The T2-wighted images obtained during a previous mpMRI are merged with the real-time ones of the TRUS. RESULTS Fusion biopsy in comparison with the systematic standard biopsy has a better detection rate of clinically significant cancers and of any cancers. CONCLUSION EAU 2020 guidelines still do offer a list of indications of when the biopsy should be performed, but it still appeared to be overperformed. The aim of our study is to underline how, in accordance with the recent literature result, fusion biopsy has showed a better detection rate of any cancer and clinically significant disease with a reduced numbers of samplings, and no substantial difference between the multiple software.
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Affiliation(s)
- Salvatore Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
| | - Mario Petrillo
- ASST Rhodense, Garbagnate Hospital, Garbagnate Milanese, Italy.
| | - Antonio Arrichiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
| | - Marco Pandolfi
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Giovanni Maria Rodà
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
| | - Giuseppe Granata
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
| | - Anna Maria Ierardi
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Daniela Donat
- Clinical Center od Vojvodina, Center for Radiology, Serbia, Novi Sad, Hajduk Veljkova 1.
| | - Aldo Paolucci
- Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
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12
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Kotova ES, Savochkina YA, Doludin YV, Vasilyev AO, Prilepskay EA, Potoldykova NV, Babalyan KA, Kanygina AV, Morozov AO, Govorov AV, Enikeev DV, Kostryukova ES, Ilina EN, Govorun VM, Pushkar DY, Sharova EI. Identification of Clinically Significant Prostate Cancer by Combined PCA3 and AMACR mRNA Detection in Urine Samples. Res Rep Urol 2020; 12:403-413. [PMID: 32984088 PMCID: PMC7505712 DOI: 10.2147/rru.s262310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/19/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Preclinical evaluation of PCA3 and AMACR transcript simultaneous detection in urine to diagnose clinical significant prostate cancer (prostate cancer with Gleason score ≥7) in a Russian cohort. Patients and Methods We analyzed urine samples of patients with a total serum PSA ≥2 ng/mL: 31 men with prostate cancer scheduled for radical prostatectomy, 128 men scheduled for first diagnostic biopsy (prebiopsy cohort). PCA3, AMACR, PSA and GPI transcripts were detected by multiplex reverse transcription quantitative polymerase chain reaction, and the results were used for scores for calculation and statistical analysis. Results There was no significant difference between clinically significant and nonsignificant prostate cancer PCA3 scores. However, there was a significant difference in the AMACR score (patients scheduled for radical prostatectomy p=0.0088, prebiopsy cohort p=0.029). We estimated AUCs, optimal cutoffs, sensitivities and specificities for PCa and csPCa detection in the prebiopsy cohort by tPSA, PCA3 score, PCPT Risk Calculator and classification models based on tPSA, PCA3 score and AMACR score. In the clinically significant prostate cancer ROC analysis, the PCA3 score AUC was 0.632 (95%CI: 0.511–0.752), the AMACR score AUC was 0.711 (95%CI: 0.617–0.806) and AUC of classification model based on the PCA3 score, the AMACR score and total PSA was 0.72 (95%CI: 0.58–0.83). In addition, the correlation of the AMACR score with the ratio of total RNA and RNA of prostate cells in urine was shown (tau=0.347, p=6.542e–09). Significant amounts of nonprostate RNA in urine may be a limitation for the AMACR score use. Conclusion The AMACR score is a good predictor of clinically significant prostate cancer. Significant amounts of nonprostate RNA in urine may be a limitation for the AMACR score use. Evaluation of the AMACR score and classification models based on it for clinically significant prostate cancer detection with larger samples and a follow-up analysis is promising.
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Affiliation(s)
- Elena S Kotova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | | | - Yuriy V Doludin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander O Vasilyev
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Elena A Prilepskay
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Konstantin A Babalyan
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Alexandra V Kanygina
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | | | - Alexander V Govorov
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Elena S Kostryukova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Elena N Ilina
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Vadim M Govorun
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Dmitry Y Pushkar
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Elena I Sharova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
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13
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Soenens C, Dekuyper P, De Coster G, Van Damme N, Van Eycken E, Quackels T, Roumeguère T, Van Cleynenbreugel B, Joniau S, Ameye F. Concordance Between Biopsy and Radical Prostatectomy Gleason Scores: Evaluation of Determinants in a Large-Scale Study of Patients Undergoing RARP in Belgium. Pathol Oncol Res 2020; 26:2605-2612. [PMID: 32632897 DOI: 10.1007/s12253-020-00860-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
To determine whether Gleason scores were concordant between prostate biopsies (bGS) and the definitive resection specimen (pGS) excised with robot-assisted radical prostatectomy (RARP); to identify clinical and pathological factors that might predict upgrading; and to evaluate how upgrading affected outcome. Between 2009 and 2016, 25 Belgian centers participated in collecting prospective data for patients that underwent RARP. We analyzed the concordance rate between the bGS and the pGS in 8021 patients with kappa statistics, and we compared concordance rates from different centers. We assessed the effect of several clinical and pathological factors on the concordance rate with logistic regression analysis. The concordance rate for the entire population was 62.9%. Upgrading from bGS to pGS occurred in 27.3% of patients. The number of biopsies was significantly associated with concordance. Older age (>60 y), a higher clinical T stage (≥cT2), a higher PSA value at the time of biopsy (>10 ng/ml), and more time between the biopsy and the radical prostatectomy were significantly associated with a higher risk of upgrading. Positive margins and PSA relapse occurred more frequently in upgraded patients. Center size did not significantly affect the concordance rate (p = 0.40).This prospective, nationwide analysis demonstrated a Gleason score concordance rate of 62.9%. Upgrading was most frequently observed in the non-concordant group. We identified clinical and pathological factors associated with (non)-concordance. Upgrading was associated with a worse oncological outcome. Center volume was not associated with pathological accuracy.
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Affiliation(s)
- C Soenens
- Department of Urology, AZ Maria Middelares, Ghent, Belgium.
| | - P Dekuyper
- Department of Urology, AZ Maria Middelares, Ghent, Belgium
| | | | | | | | - T Quackels
- Department of Urology, Erasmus Hospital, Brussels, Belgium
| | - T Roumeguère
- Department of Urology, Erasmus Hospital, Brussels, Belgium
| | | | - S Joniau
- Department of Urology, University Hospital of Leuven, Leuven, Belgium
| | - F Ameye
- Department of Urology, AZ Maria Middelares, Ghent, Belgium
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14
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Rührup J, Preisser F, Theißen L, Wenzel M, Roos FC, Becker A, Kluth LA, Bodelle B, Köllermann J, Chun FKH, Mandel P. MRI-Fusion Targeted vs. Systematic Prostate Biopsy-How Does the Biopsy Technique Affect Gleason Grade Concordance and Upgrading After Radical Prostatectomy? Front Surg 2019; 6:55. [PMID: 31620444 PMCID: PMC6759634 DOI: 10.3389/fsurg.2019.00055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction: MRI-targeted biopsy (TB) increases overall prostate-cancer (PCa) detection-rates and decreases the risk of insignificant PCa detection. However, the impact of these findings on the definite pathology after radical prostatectomy (RP) is under debate. Materials and Methods: Between 01/2014 and 12/2018, 366 patients undergoing prostate biopsy and RP were retrospectively analyzed. The correlation between biopsy Gleason-score (highest Gleason-score in a core) and the RP Gleason-score in patients undergoing systematic biopsy (SB-group) (n = 221) or TB+SB (TB-group, n = 145) was tested using the ISUP Gleason-group grading (GGG, scale 1-5). Sub analyses focused on biopsy GGG 1 and GGG ≥ 2. Results: Proportions of biopsy GGG 1-5 in the SB-group and TB-group were 24.4, 37.6, 19, 10.9, 8.1% and 13.8, 43.4, 24.2, 13.8, 4.8%, respectively (p = 0.07). Biopsy and pathologic GGG were concordant in 108 of 221 (48.9%) in SB- and 74 of 145 (51.1%) in TB-group (p = 0.8). Gleason upgrading was recorded in 33.5 and 31.7% in SB- vs. TB-group (p = 0.8). Patients with biopsy GGG 1 undergoing RP showed an upgrading in 68.5%(37/54) in SB- and 75%(15/20) in TB-group (p = 0.8). In patients with biopsy GGG ≥ 2 concordance increased for both biopsy approaches (54.5 vs. 55.2% for SB- vs. TB-group, p = 0.9). Discussion: Irrespective of differences in PCa detection-rates between TB- and SB-groups, no significant differences in GGG concordance and upgrading between patients of both groups undergoing biopsy, followed by RP, were recorded. Concordance rates increased in men with biopsy GGG ≥ 2. TB seems to detect more patients with PCa without a difference in concordance with final pathology.
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Affiliation(s)
- Jessica Rührup
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Felix Preisser
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Lena Theißen
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Mike Wenzel
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Frederik C Roos
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Boris Bodelle
- Department of Radiology, University Clinic Frankfurt, Frankfurt, Germany
| | - Jens Köllermann
- Department of Pathology, University Clinic Frankfurt, Frankfurt, Germany
| | - Felix K H Chun
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Clinic Frankfurt, Frankfurt, Germany
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15
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Patel P, Wang S, Siddiqui MM. The Use of Multiparametric Magnetic Resonance Imaging (mpMRI) in the Detection, Evaluation, and Surveillance of Clinically Significant Prostate Cancer (csPCa). Curr Urol Rep 2019; 20:60. [PMID: 31478113 DOI: 10.1007/s11934-019-0926-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW With the long-standing controversy surrounding the use of prostate-specific antigen (PSA) for the detection, evaluation, and surveillance of prostate cancer, there is a need for a minimally invasive technique to identify and risk-stratify these patients. Additionally, in an effort to reduce the number of unnecessary biopsies and identify clinically significant prostate cancer (csPCa), there has been a shift in practice towards the use of multiparametric magnetic resonance imaging (mpMRI) in conjunction with decision-making regarding prostate cancer diagnosis and management. In the current review, we summarize the data regarding the use of mpMRI in the detection, evaluation, and surveillance of csPCa. RECENT FINDINGS Recent prospective clinical trials have determined that a pre-biopsy mpMRI may rule out insignificant prostate cancers, thereby reducing the number of patients who require a biopsy. The anatomic information gathered from these pre-biopsy mpMRI performed during MRI fusion biopsy in csPCa increases the accuracy of pathologic staging in terms of Gleason scores. In regard to active surveillance, prospective trials suggest little to no clinical utility for mpMRI and fusion biopsy in the surveillance of prostate cancer despite conflicting findings from retrospective studies. Recent trials suggest that mpMRI can play an important role in the detection and evaluation of csPCa. The ideal role for mpMRI in active surveillance remains limited.
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Affiliation(s)
- Parth Patel
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA
| | - Shu Wang
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA
| | - Mohummad Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland Medical Center, 29 S Greene St Suite 500, Baltimore, MD, 21201, USA.
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16
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Bozkurt IH, Sefik E, Basmaci I, Celik S. Re: Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer. Int Braz J Urol 2019; 45:646-647. [PMID: 30912891 PMCID: PMC6786120 DOI: 10.1590/s1677-5538.ibju.2019.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Ertugrul Sefik
- HSU Izmir Bozyaka Training and Research Hospital Urology Clinic, Izmir, Turkey
| | - Ismail Basmaci
- HSU Izmir Bozyaka Training and Research Hospital Urology Clinic, Izmir, Turkey
| | - Serdar Celik
- HSU Izmir Bozyaka Training and Research Hospital Urology Clinic, Izmir, Turkey
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