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Pellegrino F, Stabile A, Sorce G, Mazzone E, Cannoletta D, Cirulli GO, Quarta L, Leni R, Robesti D, Brembilla G, Gandaglia G, De Cobelli F, Montorsi F, Briganti A. Variability of mpMRI diagnostic performance according to the upfront individual patient risk of having clinically significant prostate cancer. Prostate 2024; 84:473-478. [PMID: 38149793 DOI: 10.1002/pros.24665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND To assess the variation of multiparametric magnetic resonance imaging (mpMRI) positive predictive value (PPV) according to each patient's risk of clinically significant prostate cancer (csPCa) based exclusively on clinical factors. METHODS We evaluated 999 patients with positive mpMRI (PI-RADS ≥ 3) receiving targeted (TBx) plus systematic prostate biopsy. We built a multivariable logistic regression analysis (MVA) using clinical risk factors to calculate the individual patients' risk of harboring csPCa at TBx. A second MVA tested the association between individual patients' clinical risk and mpMRI PPV accounting for the PI-RADS score. Finally, we plotted the PPV of each PI-RADS score by the individual patient pretest probability of csPCa using a LOWESS approach. RESULTS Overall, TBx found csPCa in 21%, 51%, and 80% of patients with PI-RADS 3, 4, and 5 lesions, respectively. At MVA, age, PSA, digital rectal examination (DRE), and prostate volume were significantly associated with the risk of csPCa at biopsy. DRE yielded the highest odds ratio (OR: 2.88; p < 0.001). The individual patient's clinical risk was significantly associated with mpMRI PPV (OR: 2.49; p < 0.001) using MVA. Plotting the mpMRI PPV according to the predicted clinical risks, we observed that for patients with clinical risk close to 0 versus patients with risk higher than 90%, the mpMRI PPV of PI-RADS 3, 4, and 5 ranged from 0% to 75%, from 0% to 96%, and from 45% to 100%, respectively. CONCLUSION mpMRI PPV varies according to the individual pretest patient's risk based on clinical factors. These findings should be considered in the decision-making process for patients with suspect MRI findings referred for a prostate biopsy. Moreover, our data support the need for further studies to create an individualized risk prediction tool.
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Affiliation(s)
- Francesco Pellegrino
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Sorce
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Donato Cannoletta
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Leonardo Quarta
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Ortner G, Mavridis C, Fritz V, Schachtner J, Mamoulakis C, Nagele U, Tokas T. The Added Value of MRI-Based Targeted Biopsy in Biopsy-Naïve Patients: A Propensity-Score Matched Comparison. J Clin Med 2024; 13:1355. [PMID: 38592166 PMCID: PMC10931596 DOI: 10.3390/jcm13051355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Multiparametric Magnetic Resonance Imaging (mpMRI)-based targeted biopsy has shown to be beneficial in detecting Clinically Significant Prostate Cancer (csPCa) and avoiding diagnosis of Non-csPCa (ncsPCa); however, its role in the treatment of biopsy-naïve patients is still under discussion. METHODS After identifying predictors for the diagnosis of csPCa via Multivariate Logistic Regression Analysis (MLRA), a propensity-score (1:1 nearest neighbor) matched comparison was performed between a Systematic-Only Biopsy (SOB) cohort and a mpMRI-based Combined (systematic + targeted) Biopsy (CB) cohort from two tertiary urologic centers (SOB: Department of Urology, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Crete, Greece; CB: LKH Hall in Tirol, Austria). Only biopsy-naïve patients were included in the study. The study period for the included patients was from February 2018 to July 2023 for the SOB group and from July 2017 to June 2023 for the CB group. The primary outcome was the diagnosis of csPCa (≥ISUP 2); secondary outcomes were overall cancer detection, the added value of targeted biopsy in csPCa detection, and the reduction in ncsPCa diagnosis with CB compared to SOB. To estimate the Average Treatment effect of the Treated groups (ATT), cluster-robust standard errors were used to perform g-computation in the matched sample. p-values < 0.05 with a two-sided 95% confidence interval were considered statistically significant. RESULTS Matching achieved well-balanced groups (each n = 140 for CB and SOB). In the CB group, 65/140 (46.4%) patients were diagnosed with csPCa compared to 44/140 (31.4%) in the SOB group (RR 1.48, 95%-CI: 1.09-2.0, p = 0.01). In the CB group, 4.3% (6/140) and 1.4% (2/140) of csPCa cases were detected with targeted-only and systematic-only biopsy cores, respectively. In the CB group, 22/140 (15.7%) patients were diagnosed with ncsPCa compared to 33/140 (23.6%) in the SOB group (RR = 0.67, 95% CI: 0.41-1.08, p = 0.1). When comparing SOB to CB (ATT), the marginal OR was 0.56 (95% CI: 0.38-0.82, p = 0.003) for the diagnosis of csPCa and 0.75 (95% CI: 0.47-1.05, p = 0.085) for the diagnosis of overall cancer (≥ISUP 1). CONCLUSION The CB approach was superior to the SOB approach in detecting csPCa, while no additional detection of ncsPCa was seen. Our results support the application of mpMRI for biopsy-naïve patients with suspicions of prostate cancer.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Charalampos Mavridis
- Department of Urology, University General Hospital of Heraklion, 71110 Heraklion, Greece;
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Veronika Fritz
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Jörg Schachtner
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, 71110 Heraklion, Greece;
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria; (G.O.); (V.F.); (J.S.); (U.N.)
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria;
- Department of Urology, University General Hospital of Heraklion, 71110 Heraklion, Greece;
- School of Medicine, University of Crete, 71003 Heraklion, Greece
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Kurokawa G, Mori K, Sasaki H, Nakano J, Takahashi Y, Iwatani K, Urabe F, Tsuzuki S, Koike Y, Sato S, Takahashi H, Miki K, Kimura T. Effectiveness of Magnetic Resonance Imaging/Ultrasound-guided Target Biopsy in Detecting Clinically Significant Prostate Cancer. Anticancer Res 2024; 44:679-686. [PMID: 38307559 DOI: 10.21873/anticanres.16858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM To evaluate the effectiveness of magnetic resonance imaging/ultrasound (MRI-US)-guided fusion biopsy in the detection of clinically significant prostate cancer (CSPC) and analyze the clinical features of patients highly suspected of having prostate cancer (PCa) but shown to be negative in target biopsies (TB) among patients with prostate imaging reporting and data system (PI-RADS) 4 or 5 lesions on multiparametric MRI (mpMRI) evaluations. PATIENTS AND METHODS We retrospectively evaluated all patients who underwent MRI/transrectal ultrasound (TRUS)-guided fusion biopsies at our institution between April 2018 and April 2022. All patients with at least one PI-RADS 3 or higher lesion and prostate-specific antigen (PSA) ≤20 ng/ml were enrolled in our study and subjected to TB in the region of interest (ROI). CSPC was defined as grade group (GG) ≥2 (equivalent to a Gleason score of 3+4). RESULTS The detection rates of CSPC were higher in patients who underwent systematic biopsy (SB) and TB (54%; 177/328) than in those who underwent SB alone (39%; 128/328). Significant differences were noted in the detection of CSPC depending on age, prostate volume, PI-RADS score, PSA density (PSAD), number of biopsies obtained, lesion location, and ROI. CONCLUSION MRI/TRUS-guided fusion prostate biopsy increased the detection rate of CSPC. PCa was less likely to be detected in patients with a low PSAD, large prostate volume and no family history among those with PI-RADS 4 or 5 lesions and should be considered in such patients and addressed by performing additional SB for improving CSPC detection rate.
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Affiliation(s)
- Gaku Kurokawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan;
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Juria Nakano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Guan T, Sidana A, Rao MB. Reliability of Systematic and Targeted Biopsies versus Prostatectomy. Bioengineering (Basel) 2023; 10:1395. [PMID: 38135986 PMCID: PMC10740569 DOI: 10.3390/bioengineering10121395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Systematic Biopsy (SBx) has been and continues to be the standard staple for detecting prostate cancer. The more expensive MRI guided biopsy (MRITBx) is a better way of detecting cancer. The prostatectomy can provide an accurate condition of the prostate. The goal is to assess how reliable SBx and MRITBx are vis à vis prostatectomy. Graded Gleason scores are used for comparison. Cohen's Kappa index and logistic regression after binarization of the graded Gleason scores are some of the methods used to achieve our goals. Machine learning methods, such as classification trees, are employed to improve predictability clinically. The Cohen's Kappa index is 0.31 for SBx versus prostatectomy, which means a fair agreement. The index is 0.34 for MRITBx versus prostatectomy, which again means a fair agreement. A direct comparison of SBx versus prostatectomy via binarized graded scores gives sensitivity 0.83 and specificity 0.50. On the other hand, a direct comparison of MRITBx versus prostatectomy gives sensitivity 0.78 and specificity 0.67, putting MRITBx on a higher level of accuracy. The SBx and MRITBx do not yet match the findings of prostatectomy completely, but they are useful. We have developed new biomarkers, considering other pieces of information from the patients, to improve the accuracy of SBx and MRITBx. From a clinical point of view, we provide a prediction model for prostatectomy Gleason grades using classification tree methodology.
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Affiliation(s)
- Tianyuan Guan
- College of Public Health, Kent State University, Kent, OH 44240, USA
| | - Abhinav Sidana
- Division of the Biological Sciences, The University of Chicago, 5841 S Maryland Avenue, Chicago, IL 60637, USA;
| | - Marepalli B. Rao
- Division of Biostatistics and Bioinformatics, University of Cincinnati, Cincinnati, OH 45219, USA;
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Inoue T, Shin T. Current magnetic resonance imaging-based diagnostic strategies for prostate cancer. Int J Urol 2023; 30:1078-1086. [PMID: 37592819 DOI: 10.1111/iju.15281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
Recent developments in multiparametric MRI and MRI-targeted biopsy have made it possible to detect clinically significant cancers more accurately and efficiently than ever before. Furthermore, software that enables easy MRI/US image fusion has been developed and is already available on the market, and this has provided a tailwind for the spread of MRI-based prostate cancer diagnostic strategies. Such precise diagnosis of prostate cancer localization is essential for highly accurate focal therapy. In addition, a recent large-scale study applying MRI to community screening for prostate cancer has reported its usefulness. By contrast, concerns about overdiagnosis and overtreatment, the existence of inter-reader variability in MRI diagnosis, and issues with current MRI-targeted biopsy have emerged. In this article, we review the development of multiparametric MRI and MRI-targeted biopsy to date and the current issues and discuss future directions.
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Affiliation(s)
- Toru Inoue
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
| | - Toshitaka Shin
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
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Yuan C, Li D, Wu J, Shen Q, Wang X, Xiao J, He Z, Zhou L, Li X, Liu Y, Zhao Z. Comparison of Targeted Biopsy and Combined Biopsy to Avoid Unnecessary Systematic Biopsy in Patients with PI-RADS 5 Lesions. Biomedicines 2023; 11:3163. [PMID: 38137384 PMCID: PMC10740524 DOI: 10.3390/biomedicines11123163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/10/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To evaluate the detection rates of prostate cancer (PCa) and clinically significant prostate cancer (CSPCa) detection via target biopsy (TB), systematic biopsy (SB), and combined biopsy (CB) in patients with PI-RADS 5 lesions. METHODS Patients with at least one PI-RADS 5 lesion were retrospectively enrolled in a prospectively collected database. The patients underwent multiparametric magnetic resonance imaging (mpMRI) followed by transrectal TB of PI-RADS 5 lesions and SB. The PCa and CSPCa detection rates and cores of TB and SB were compared with those of CB. RESULTS In 585 patients, prostate biopsy revealed PCa in 560 cases (95.73%) and CSPCa in 549 cases (93.85%). PCa was detected in T2 patients (93.13%, 217/233) and in T3/4 patients (97.44%, 343/352). CSPCa was detected in T2 patients (89.27%, 208/233) and in T3/4 patients (96.87%, 341/352). The positive rates of TB for T2/3/4, T3/4, and T2 were 94.02%, 96.21%, and 90.56%, respectively. SB added 1.71% (10/585) PCa and 1.37% (8/585) CSPCa detection to TB. There was no difference between TB and SB in detecting different stages of cancer (p > 0.05). In the biopsy core analysis, TB had fewer biopsy cores and a higher detection rate than SB (all p < 0.05). CONCLUSIONS In patients with PI-RADS score 5 lesions, TB can achieve the same detection rate as, with fewer biopsy cores than, CB. SB adds minimal clinical value and can be omitted for these patients.
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Affiliation(s)
- Changwei Yuan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
| | - Derun Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
| | - Jingyun Wu
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku St., Beijing 100034, China; (J.W.); (X.W.); (J.X.)
| | - Qi Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku St., Beijing 100034, China; (J.W.); (X.W.); (J.X.)
| | - Jiangxi Xiao
- Department of Radiology, Peking University First Hospital, No. 8 Xishiku St., Beijing 100034, China; (J.W.); (X.W.); (J.X.)
| | - Zhisong He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
| | - Yi Liu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
| | - Zheng Zhao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St., Beijing 100034, China; (C.Y.); (D.L.); (Q.S.); (Z.H.); (L.Z.); (X.L.)
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Arafa MA, Farhat KH, Rabah DM, Khan FK, Mokhtar A, Al-Taweel W. Prostate-specific Antigen Density as a Proxy for Predicting Prostate Cancer Severity: Is There Any Difference between Systematic and Targeted Biopsy? Saudi J Med Med Sci 2023; 11:299-304. [PMID: 37970462 PMCID: PMC10634460 DOI: 10.4103/sjmms.sjmms_49_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 11/17/2023]
Abstract
Background Prostate cancer screening with prostate-specific antigen (PSA) can result in unnecessary biopsies and overdiagnosis. Alternately, PSA density (PSAD) calculation may help support biopsy decisions; however, evidence of its usefulness is not concrete. Objective To evaluate the predictive value of PSAD for clinically significant prostate cancer detection by systematic and MRI-targeted biopsies. Methods This prospective study was conducted at two tertiary hospitals in Riyadh, Saudi Arabia, between December 2018 and November 2021. Patients suspected of prostate cancer were subjected to multi-parametric MRI, and for those with positive findings, systematic and targeted biopsies were performed. Clinically non-significant and significant prostate cancer cases were classified based on histopathology-defined ISUP grade or Gleason score. The PSAD was measured using the prostate volume determined by the MRI and categorized into ≤0.15, 0.16-0.20, and >0.20 ng/ml2 subgroups. Results Systematic and targeted biopsies were carried out for 284 patients. The discriminant ability of PSAD is higher in MRI-targeted biopsy compared with systematic biopsy (AUC: 0.77 vs. 0.73). The highest sensitivity (97%) and specificity (87%) were detected at 0.07 ng/ml2 in targeted biopsy. More than half of the clinically significant cases were detected in the >0.2 ng/ml2 PSAD category (systematic: 52.4%; targeted: 51.1%). The CHAID methodology found that the probability of having clinically significant cancer (CSC) in patients with PSAD >0.15 ng/ml2 was more than threefold than that in patients with PSAD ≤0.15 ng/ml2 (64% vs. 20.2%). When considered by age, in PSAD ≤0.15 ng/ml2 subgroup, the percentage of CSC detection rate increased from 20.2% to 24.6% in patients aged ≥60 years. Conclusion PSAD has good discriminant power for predicting clinically significant prostate cancer. A cutoff of 0.07 ng/ml2 should be adopted, but should be interpreted with caution and by considering other parameters such as age.
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Affiliation(s)
- Mostafa A. Arafa
- Surgery Department, The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Karim Hamda Farhat
- Surgery Department, The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Danny M. Rabah
- Surgery Department, The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Farrukh K. Khan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alaa Mokhtar
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed Al-Taweel
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero MV, Celma A, Manuel GGD, Aisian I, Servian P, Abascal JM. A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies. Cancers (Basel) 2023; 15:4543. [PMID: 37760511 PMCID: PMC10526349 DOI: 10.3390/cancers15184543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/16/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721-0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Natàlia Picola
- Department of Urology, Hospital Universitari de Bellvitge, 08907 Hospitalet de Llobregat, Spain;
| | | | | | - Xavier Ruiz-Plazas
- Department of Urology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain;
| | | | - Anna Celma
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | | | - Ignacio Aisian
- Department of Urology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Pol Servian
- Department of Urology, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - José M. Abascal
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain;
- Department of Medicine and Health Science, Universitat Pompeu Fabra, 08003 Barcelona, Spain
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9
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Yusim I, Mazor E, Frumkin E, Jabareen M, Hefer B, Elsaraya N, Li S, Rouvinov K, Novack V, Mabjeesh NJ. Evaluation of the optimal strategy in men with a single unilateral suspicious lesion on MRI undergoing transperineal MRI/ultrasound fusion prostate biopsy. Prostate 2023; 83:1255-1262. [PMID: 37263774 DOI: 10.1002/pros.24585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Targeting biopsy (TBx) of suspicious lesions combined with random systematic biopsy (SBx) improves detection rates of prostate cancer (PCa) during magnetic resonance imaging (MRI)/ultrasound (US) fusion prostate biopsy. However, this combination increases the number of biopsy cores, prolongs the procedure time, and increases complications and costs, leading to the overdiagnosis of clinically insignificant PCa (ciPCa). This study aims to evaluate the optimal sampling design to achieve a detection rate of clinically significant PCa (csPCa) equal to standard TBx with SBx with fewer biopsy cores. MATERIALS AND METHODS Of 508 consecutive men who underwent transperineal MRI/US fusion prostate biopsy at our center between January 2020 and December 2022, 364 patients with a single unilateral suspicious lesion on MRI were included in the study. Three biopsy strategies were randomly selected to evaluate the diagnostic accuracy of PCa detection: (1) TBx with ipsilateral SBx, (2) TBx with contralateral SBx, and (3) TBx only. The PCa detection sensitivity for selected biopsy strategies was compared with the reference standards. The significance of differences in cancer detection between sampling schemes was determined using McNemar's test. RESULTS PCa was diagnosed in 182 of 364 men using TBx with bilateral SBx. International Society of Urological Pathology grade group (ISUP GG) ≥ 2 and ISUP GG ≥ 3 PCa was detected in 84/364 (23.1%) and 42/364 (11.5%), respectively, while ISUP GG 1 PCa was diagnosed in 98/364 (26.9%). Combining TBx with ipsilateral SBx detected 94.5% of all, 98.8% of ISUP GG ≥ 2, 100% of ISUP GG ≥ 3, and 89.8% of ISUP GG 1 PCa. TBx with contralateral SBx detected fewer csPCa (91.7% vs. 98.8%, p = 0.03), as did TBx alone (90.5 vs. 98.8, p = 0.008). CONCLUSIONS Our study demonstrates that TBx with ipsilateral SBx performed around the multiparametric MRI-suspected lesion in transperineal MRI/US biopsy of the prostate achieves a very high detection rate for csPCa (ISUP ≥ 2) without compromising the detection of increased risk PCa (ISUP ≥ 3). In addition, this strategy reduces the number of biopsy cores by 8-10 per patient, procedure time, and pathology processing costs and decreases ciPCa detection.
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Affiliation(s)
- Igor Yusim
- Department of Urology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Elad Mazor
- Department of Urology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Einat Frumkin
- Soroka Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Muhammad Jabareen
- Department of Urology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Ben Hefer
- Department of Urology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Nimer Elsaraya
- Department of Urology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Sveta Li
- Division of Diagnostic and Interventional Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Keren Rouvinov
- The Legacy Heritage Oncology Center and Dr. Larry Norton Institute, Soroka Medical Center and Ben Gurion University, Beer Sheva, Israel
| | - Victor Novack
- Soroka Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Nicola J Mabjeesh
- Department of Urology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
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10
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Malewski W, Milecki T, Szempliński S, Tayara O, Kuncman Ł, Kryst P, Nyk Ł. Prostate Biopsy in the Case of PIRADS 5-Is Systematic Biopsy Mandatory? J Clin Med 2023; 12:5612. [PMID: 37685679 PMCID: PMC10488368 DOI: 10.3390/jcm12175612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically significant prostate cancer (csPC) detection in TB. Potentially, omitting SB in the case of PIRADS 5 may have a marginal impact on the csPC detection rate. The aim of this study was to determine whether SB can be avoided in the case of PIRADS 5 and to identify potential factors allowing for performing TB only. This cohort study involved n = 225 patients with PIRADS 5 on mpMRI (PIRADS 2.0/2.1) who underwent transperineal or transrectal combined biopsy (CB). CsPC was diagnosed in 51.6% (n = 116/225) of cases. TB and SB resulted in the detection of csPC in 48% (n = 108/225) and 20.4% (n = 46/225) of cases, respectively (TB vs. SB, p < 0.001). When the TB was positive, SB detected csPC in n = 38 of the cases (38/108 = 35%). SB added to TB significantly improved csPC detection in 6.9% of cases in absolute terms (n = 8/116) (TB vs. CB, p = 0.008). The multivariate regression model proved that the significant predictors of csPC detection via SB were the densities of the prostate-specific antigen-PSAD > 0.17 ng/mL2 (OR = 4.038, 95%CI: 1.568-10.398); primary biopsy setting (OR = 2.818, 95%CI: 1.334-5.952); and abnormal digital rectal examination (DRE) (OR = 2.746, 95%CI: 1.328-5.678). In a primary biopsy setting (n = 103), SB detected 10% (n = 6/60) of the additional cases of csPC (p = 0.031), while in a repeat biopsy setting (n = 122), SB detected 3.5% (n = 2/56) of the additional cases of csPC (p = 0.5). In the case of PSAD > 0.17 ng/mL2 (n = 151), SB detected 7.4% (n = 7/95) of additional cases of csPC (p = 0.016), while in the case of PSAD < 0.17 ng/mL2 (n = 74), SB detected 4.8% (n = 1/21) of the additional cases of csPC (p = 1.0). The omission of SB had an impact on the csPC diagnosis rate in patients with PIRADS 5 score lesions. Patients who have already undergone prostate biopsy and those with low PSAD are at a lower risk of missing csPC when SB is avoided. However, performing TB only may result in missing other csPC foci located outside the index lesion, which can alter treatment decisions.
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Affiliation(s)
- Wojciech Malewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Tomasz Milecki
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Stanisław Szempliński
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Omar Tayara
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Łukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (W.M.); (P.K.)
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11
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Dadpour M, Soltani AM, Ghafoori M, Basiri A, Borumandnia N, Nayebzade A, Narouie B, Hasani H, Shakhssalim N. Ultrasound/MRI- targeted biopsy versus saturated trans-rectal ultrasound guided biopsy of prostate in patients with primary negative conventional biopsy and still elevated PSA: a prospective randomized clinical trial. Am J Clin Exp Urol 2023; 11:312-319. [PMID: 37645612 PMCID: PMC10461031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/05/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION To evaluate and compare the rate of cancer detection by two methods Saturated TRUS guided biopsy and ultrasound/magnetic resonance imaging (US/MRI)-targeted biopsy in patients with primary negative prostate cancer in standard 12 cores biopsy evaluation but still have elevated prostate specific antigen (PSA). MATERIALS AND METHODS From 105 patients who met our inclusion criteria, 53 patients underwent US/MRI-targeted biopsy and 52 remaining patients underwent Saturated 20 core TRUS guided biopsy in a prospective randomized clinical trial. RESULTS The mean age (±SD) was 62.2 (±8.2) year. The mean PSA (±SD) was 11.8 (±7.5) ng/ml. The mean prostate volume was 56.1 (±24.8) ml. Adenocarcinoma of prostate was detected in 9/52 (17.3%) patients in groups saturated biopsy and 14/53 (26.4%) patients in US/MRI-targeted biopsy group and there was no difference in cancer detection rate between 2 groups (P=0.252). except four patients with fever (two in each group), there was no other serious complication (Clavien grade 3 or higher) occurred in the patients. In the multivariate analysis, higher pre-procedure PSA, lower size of the prostate, pathology of ASAP and presence of nodule in DRE were independent predictors for cancer detection in second biopsy (P=0.036, P<0.001, P=0.013 and P=0.031, respectively). CONCLUSION We didn't find any superiority in cancer detection rate and any different in complication rate between these two methods saturated TRUS guided biopsy and US/MRI-targeted biopsy.
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Affiliation(s)
- Mehdi Dadpour
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center The Center of Excellence in UrologyTehran, Iran
| | - Amir Mohammad Soltani
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical SciencesTehran, Iran
| | | | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical SciencesTehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical SciencesTehran, Iran
| | - Amirhossein Nayebzade
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical SciencesTehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical SciencesZahedan, Iran
| | - Hamed Hasani
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center The Center of Excellence in UrologyTehran, Iran
| | - Nasser Shakhssalim
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical SciencesTehran, Iran
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12
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Tomioka M, Seike K, Uno H, Asano N, Watanabe H, Tomioka-Inagawa R, Kawase M, Kato D, Takai M, Iinuma K, Tobisawa Y, Nakane K, Tsuchiya K, Ito T, Koie T. Perilesional Targeted Biopsy Combined with MRI-TRUS Image Fusion-Guided Targeted Prostate Biopsy: An Analysis According to PI-RADS Scores. Diagnostics (Basel) 2023; 13:2608. [PMID: 37568971 PMCID: PMC10417101 DOI: 10.3390/diagnostics13152608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/29/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
A prostate-targeted biopsy (TB) core is usually collected from a site where magnetic resonance imaging (MRI) indicates possible cancer. However, the extent of the lesion is difficult to accurately predict using MRI or TB alone. Therefore, we performed several biopsies around the TB site (perilesional [p] TB) and analyzed the association between the positive cores obtained using TB and pTB and the Prostate Imaging Reporting and Data System (PI-RADS) scores. This retrospective study included patients who underwent prostate biopsies. The extent of pTB was defined as the area within 10 mm of a TB site. A total of 162 eligible patients were enrolled. Prostate cancer (PCa) was diagnosed in 75.2% of patients undergoing TB, with a positivity rate of 50.7% for a PI-RADS score of 3, 95.8% for a PI-RADS score of 4, and 100% for a PI-RADS score of 5. Patients diagnosed with PCa according to both TB and pTB had significantly higher positivity rates for PI-RADS scores of 4 and 5 than for a PI-RADS score of 3 (p < 0.0001 and p = 0.0009, respectively). Additional pTB may be performed in patients with PI-RADS ≥ 4 regions of interest for assessing PCa malignancy.
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Affiliation(s)
- Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | - Kensaku Seike
- Department of Urology, Chuno Kousei Hospital, 5-1 Wakakusadori, Seki 5013802, Japan; (K.S.); (H.U.)
| | - Hiromi Uno
- Department of Urology, Chuno Kousei Hospital, 5-1 Wakakusadori, Seki 5013802, Japan; (K.S.); (H.U.)
| | - Nami Asano
- Department of Pathology, Chuno Kousei Hospital, 5-1 Wakakusadori, Seki 5013802, Japan;
| | - Haruo Watanabe
- Department of Radiology, Chuno Kousei Hospital, 5-1 Wakakusadori, Seki 5013802, Japan;
| | - Risa Tomioka-Inagawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
| | | | - Takayasu Ito
- Center for Clinical Training and Career Development, Gifu University Graduate School of Medicine, Gifu 5011194, Japan;
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (M.T.); (R.T.-I.); (M.K.); (D.K.); (M.T.); (K.I.); (Y.T.); (K.N.)
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13
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Thompson A, Eguru V, Moosa S, Ng Y. Do Concomitant Systematic Biopsies Add to Fusion Targeted Biopsies in the Diagnosis and Management of Clinically Significant Prostate Cancer? Urol Res Pract 2023; 49:169-177. [PMID: 37877866 PMCID: PMC10346108 DOI: 10.5152/tud.2023.22221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/15/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Magnetic resonance imaging targeted biopsy clearly detects more clinically significant prostate cancer than systematic biopsy. Whether concomitant systematic biopsy adds to targeted biopsy in the detection of clinically significant prostate cancer remains uncertain. The primary outcome measure of this study was to ascertain the percentage of clinically significant prostate cancer on systematic biopsy missed by targeted biopsy. Furthermore, we sought to determine whether systematic biopsy results influenced the clinical management of patients. MATERIALS AND METHODS This prospective observational study included all men undergoing Fusion targeted biopsy in our Health Board. All men had PI-RADS scores of 3-5 on magnetic resonance imaging. Histology from targeted biopsy and systematic biopsy was reviewed to determine any additional benefit of performing systematic biopsy. Clinical outcomes were also reviewed. Clinically significant prostate cancer was defined by (i) International Society of Urological Pathology ≥ 2 and (ii) UCL criteria of any primary Gleason 4 or core length ≥ 6 mm. RESULTS A total of 104 men were included in the study of whom 18 patients were biopsy naïve, 65 had at least 1 previous negative biopsy, and 20 had previous biopsies that showed clinically insignificant cancer. The percentage of clinically significant prostate cancer missed on targeted biopsy was between 9.1% and 11.1%. Moreover, 17.1% of patients with clinically significant prostate cancer would not have proceeded to radical treatment if the systematic biopsy had not been performed. CONCLUSION Our data support a growing field of evidence that although magnetic resonance imaging targeted biopsy is more sensitive than systematic biopsy at detecting clinically significant prostate cancer, systematic biopsy adds to the number of patients diagnosed with clinically significant prostate cancer in those already undergoing prostate biopsy.
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Affiliation(s)
- Alice Thompson
- University Hospital of Wales Healthcare NHS Trust, Northern Ireland, UK
| | - Venkat Eguru
- Hywel Dda University Health Board, Northern Ireland, UK
| | - Sohail Moosa
- Hywel Dda University Health Board, Northern Ireland, UK
| | - Yeung Ng
- Hywel Dda University Health Board, Northern Ireland, UK
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14
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Eldred-Evans D, Connor MJ, Bertoncelli Tanaka M, Bass E, Reddy D, Walters U, Stroman L, Espinosa E, Das R, Khosla N, Tam H, Pegers E, Qazi H, Gordon S, Winkler M, Ahmed HU. The rapid assessment for prostate imaging and diagnosis (RAPID) prostate cancer diagnostic pathway. BJU Int 2023; 131:461-470. [PMID: 36134435 DOI: 10.1111/bju.15899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report outcomes within the Rapid Assessment for Prostate Imaging and Diagnosis (RAPID) diagnostic pathway, introduced to reduce patient and healthcare burdens and standardize delivery of pre-biopsy multiparametric magnetic resonance imaging (MRI) and transperineal biopsy. PATIENTS AND METHODS A total of 2130 patients from three centres who completed the RAPID pathway (3 April 2017 to 31 March 2020) were consecutively entered as a prospective registry. These patients were also compared to a pre-RAPID cohort of 2435 patients. Patients on the RAPID pathway with an MRI score 4 or 5 and those with PSA density ≥0.12 and an MRI score 3 were advised to undergo a biopsy. Primary outcomes were rates of biopsy and cancer detection. Secondary outcomes included comparison of transperineal biopsy techniques, patient acceptability and changes in time to diagnosis before and after the introduction of RAPID. RESULTS The median patient age and PSA level were 66 years and 6.6 ng/mL, respectively. Biopsy could be omitted in 43% of patients (920/2130). A further 7.9% of patients (168/2130) declined a recommendation for biopsy. The percentage of biopsies avoided among sites varied (45% vs 36% vs 51%; P < 0.001). In all, 30% (221/742) had a local anaesthetic (grid and stepper) transperineal biopsy. Clinically significant cancer detection (any Gleason score ≥3 + 4) was 26% (560/2130) and detection of Gleason score 3 + 3 alone constituted 5.8% (124/2130); detection of Gleason score 3 + 3 did not significantly vary among sites (P = 0.7). Among participants who received a transperineal targeted biopsy, there was no difference in cancer detection rates among local anaesthetic, sedation and general anaesthetic groups. In the 2435 patients from the pre-RAPID cohor, time to diagnosis was 32.1 days (95% confidence interval [CI] 29.3-34.9) compared to 15.9 days (95% CI 12.9-34.9) in the RAPID group. A total of 141 consecutive patient satisfaction surveys indicated a high satisfaction rate with the pathway; 50% indicated a preference for having all tests on a single day. CONCLUSIONS The RAPID prostate cancer diagnostic pathway allows 43% of men to avoid a biopsy while preserving good detection of clinically significant cancers and low detection of insignificant cancers, although there were some centre-level variations.
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Affiliation(s)
- David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Mariana Bertoncelli Tanaka
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Uma Walters
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Luke Stroman
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Raj Das
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nalin Khosla
- Epsom and St Helier University Hospitals, London, UK
| | - Henry Tam
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Hasan Qazi
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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15
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Ren J, Melamed J, Taneja SS, Wysock JS, Huang WC, Lepor H, Deng FM. Prostate magnetic resonance imaging- targeted biopsy global grade correlates better than highest grade with prostatectomy grade. Prostate 2023; 83:323-330. [PMID: 36461793 DOI: 10.1002/pros.24464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-targeted prostate biopsy has become an increasingly common method of diagnosing prostate cancer. A previous study from our institution demonstrated that the biopsy global Grade Group (gGG, aggregate GG of all positive cores) and highest Grade Group (hGG in any core) both show substantial concordance with the Grade Group at radical prostatectomy (RPGG) while the discordance predominantly consists of upgrading in gGG and downgrading in hGG. We performed a larger cohort study focused on biopsy cases in which gGG and hGG differ, to determine their relative concordance with RPGG. METHODS We conducted a retrospective review of radical prostatectomy specimens with prior MRI-targeted biopsies from our institution between 2016 and 2020. Separate gGG and hGG were assigned to each MRI-targeted lesion. Targeted lesions with different gGG versus hGG were segregated from those with identical gGG and hGG. The concordance of biopsy GG with RPGG was evaluated using κ coefficient analysis. RESULTS Of the 489 lesions with MRI-targeted biopsies, 82 (17%) differed in gGG versus hGG. The gGG of 46 (56%), 33 (40%), and 3 (4%) lesions were unchanged, upgraded, and downgraded at radical prostatectomy, respectively (κ= 0.302, weighted κ = 0.334). The hGG of 24 (29%), 9 (11%), and 49 (60%) lesions were unchanged, upgraded, and downgraded at radical prostatectomy, respectively (κ = 0.040, weighted κ = 0.198). When stratified by the biopsy GG, gGG showed the highest concordance in GG2 (61%) and GG3 (54%) lesions. The hGG resulted in substantial downgrading (60%) with less optimal concordance regardless of the biopsy GG. Neither the prebiopsy prostate specific antigen level nor the PI-RADS score was predictive of upgrading of gGG. CONCLUSIONS When gGG and hGG differ, gGG method more accurately predicts the RPGG than hGG, particularly in GG2 and GG3 lesions which comprised the majority of targeted lesions.
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Affiliation(s)
- Joyce Ren
- Department of Pathology, New York University Langone School of Medicine, New York, New York, USA
| | - Jonathan Melamed
- Department of Pathology, New York University Langone School of Medicine, New York, New York, USA
| | - Samir S Taneja
- Department of Urology, New York University Langone School of Medicine, New York, New York, USA
| | - James S Wysock
- Department of Urology, New York University Langone School of Medicine, New York, New York, USA
| | - William C Huang
- Department of Urology, New York University Langone School of Medicine, New York, New York, USA
| | - Herbert Lepor
- Department of Urology, New York University Langone School of Medicine, New York, New York, USA
| | - Fang-Ming Deng
- Department of Pathology, New York University Langone School of Medicine, New York, New York, USA
- Department of Urology, New York University Langone School of Medicine, New York, New York, USA
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Zhang C, Tu X, Dai J, Xiong X, Cai D, Yang L, Zhang M, Qiu S, Lin T, Liu Z, Yang L, Wei Q. Efficacy and safety of the new biopsy strategy combining 6-core systematic and 3-core MRI- targeted biopsy in the detection of prostate cancer: Study protocol for a randomized controlled trial. Front Surg 2023; 9:1058288. [PMID: 36684126 PMCID: PMC9852774 DOI: 10.3389/fsurg.2022.1058288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background Recent EAU guideline strongly recommended combined targeted biopsy (TBx) with systematic biopsy (SBx) for biopsy naïve patients with suspected multiparametric magnetic resonance imaging (mpMRI) lesions; However, the clinical goal is to find out how to determine the optimal SBx and TBx cores for biopsy in order to maximize the detection of csPCa and minimize the associated defects. This study aims to assess the efficacy and safety of the new biopsy strategy combining 6-core systematic and 3-core MRI- TBx compared to 12-core systematic and 3-core MRI-TBx strategy. Methods This is a single-center, prospectively randomized controlled clinical trial. 280 men meeting inclusion criteria will be recruited and will be randomly allocated to either 6-core systematic plus 3-core MRI-TBx group (Group A) or 12-core systematic plus 3-core MRI-TBx group (Group B). The primary outcome compares the detection rate of PCa and clinically significant prostate cancer(csPCa) between group A and group B. The secondary outcomes compare the participant-reported pain score immediate post biopsy using pain measurement scale; proportion of men with post-biopsy complications and adverse events (Time frame: 7 days post biopsy, 30 days post biopsy); proportion of the men who undergo radical prostatectomy and have cancer upgraded histopathology from the biopsy to the radical prostatectomy. Results and Discussion A new biopsy strategy should be developed with the goal of minimizing procedure invasion, our study will provide the results of efficacy and safety of the new biopsy strategy (6-core systematic and 3-core MRI-TBx) in biopsy naïve men with suspicious mpMRI lesion in comparison with 12-core systematic and 3-core MRI-TBx. Trial registration Chinese Clinical Trial Registry, ChiCTR2200056437; http://www.chictr.org.cn/edit.aspx?pid=151413&htm=4.
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Affiliation(s)
- Chichen Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Tu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingyu Xiong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Diming Cai
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengni Zhang
- Department of Pathology and Laboratory of Pathology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Qiang Wei Lu Yang
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Qiang Wei Lu Yang
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Szempliński S, Kamecki H, Dębowska M, Zagożdżon B, Mokrzyś M, Zawadzki M, Sosnowski R, Tokarczyk A, Poletajew S, Kryst P, Nyk Ł. Predictors of Clinically Significant Prostate Cancer in Patients with PIRADS Categories 3-5 Undergoing Magnetic Resonance Imaging-Ultrasound Fusion Biopsy of the Prostate. J Clin Med 2022; 12. [PMID: 36614957 DOI: 10.3390/jcm12010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Prostate biopsy is recommended in cases of positive magnetic resonance imaging (MRI), defined as Prostate Imaging Reporting and Data System (PIRADS) category ≥ 3. However, most men with positive MRIs will not be diagnosed with clinically significant prostate cancer (csPC). Our goal was to evaluate pre-biopsy characteristics that influence the probability of a csPC diagnosis in these patients. We retrospectively analyzed 740 consecutive men with a positive MRI and no prior PC diagnosis who underwent MRI-ultrasound fusion biopsies of the prostate in three centers. csPC detection rates (CDRs) for each PIRADS category were calculated. Patient, disease, and lesion characteristics were studied for interdependencies with the csPC diagnosis. The CDR in patients with PIRADS categories 3, 4, and 5 was 10.5%, 30.7%, and 54.6%, respectively. On both uni- and multivariable regression models, older age, being biopsy-naïve, prostate specific antigen ≥ 10 ng/mL, smaller prostate volume, PIRADS > 3, a larger maximum lesion size, a lesion in the peripheral zone, and a positive digital rectal examination were associated with csPC. In this large, multicenter study, we provide new data regarding CDRs in particular PIRADS categories. In addition, we present several strong predictors that further alter the risk of csPC in MRI-positive patients. Our results could help in refining individual risk assessment, especially in PIRADS 3 patients, in whom the risk of csPC is substantially low.
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18
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He Y, Shen Q, Fu W, Wang H, Song G. Optimized grade group for reporting prostate cancer grade in systematic and MRI-targeted biopsies. Prostate 2022; 82:1125-1132. [PMID: 35538399 DOI: 10.1002/pros.24365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To explore an optimized grade group (oGG) criterion from systematic biopsies (SB) and targeted biopsies (TB) and offer a better prediction of radical prostatectomy (RP) grade group (GG). METHODS Positive needles were collected from 146 patients who underwent SB + TB followed by RP. The grade was assigned for two different kinds of biopsies with five GG criteria: (1) global GG (gGG); (2) most common GG (most common GG from SB + TB, mGG); (3) highest GG (highest numerical GG from SB + TB, hGG); (4) largest volume/linear length cancer GG (defined as GG from the SB + TB with the largest length of cancer in a needle, lGG). These biopsy grades were compared (equivalence, upgrade, or downgrade) with the final grade of the RP lesion, using weighted κ coefficients; (5) Then the best agreement of the (2) (3) (4) grading scores from SB or TB was combined to introduce an oGG. RESULTS In this study, gGG showed generally poor agreement (47.2%) with RP GG (weighted κ: 0.43). Using the three criteria (mGG, hGG, and lGG) of SB, mGG had the best agreement (55.5%, weighted κ: 0.46), while hGG and lGG had a lower agreement (48.6% and 48.6%, weighted κ: 0.42 and 0.38). Using the three criteria (mGG, hGG and lGG) of TB: lGG had the best agreement (56.8%, weighted κ: 0.43), while mGG and hGG had lower agreement (50.0% and 49.3%, weighted κ: 0.40 and 0.40); Then oGG was generated (higher GG between mGG of SB and lGG of TB) and the agreement of oGG increased to 59.6% and weighted κ was 0.49. Additionally, oGG had a lower upgrade rate than gGG, while the downgrade rate remained unchanged. CONCLUSIONS oGG showed better agreement with RP GG than gGG. oGG had a lower upgrade rate than gGG, while downgrade rate remained unchanged.
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Affiliation(s)
- Yang He
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Qi Shen
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Weixiao Fu
- Department of Urology, Peking University First Hospital, Beijing, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Gang Song
- Department of Urology, Peking University First Hospital, Beijing, China
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19
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Xie J, Jin C, Liu M, Sun K, Jin Z, Ding Z, Gong X. MRI/Transrectal Ultrasound Fusion-Guided Targeted Biopsy and Transrectal Ultrasound-Guided Systematic Biopsy for Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis. Front Oncol 2022; 12:880336. [PMID: 35677152 PMCID: PMC9169152 DOI: 10.3389/fonc.2022.880336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose For men suspected of having prostate cancer (PCa), the transrectal ultrasound (TRUS)-guided systematic biopsy (SB) was performed. MRI/TRUS fusion guided-targeted biopsy (MRI-TB) could enhance PCa detection, allowing sampling of sites at higher risk which were not obvious with TRUS alone. The aim of this systematic review and meta-analysis was to compare the detection rates of prostate cancer by MRI-TB or MRI-TB plus SB versus SB, mainly for diagnosis of high-risk PCa. Methods A literature Search was performed on PubMed, Cochrane Library, and Embase databases. We searched from inception of the databases up to January 2021. Results A total of 5831 patients from 26 studies were included in the present meta-analysis. Compared to traditional TRUS-guided biopsy, MRI-TB had a significantly higher detection rate of clinically significant PCa (RR=1.27; 95%CI 1.15-1.40; p<0.001) and high-risk PCa (RR=1.41; 95% CI 1.22-1.64; p<0.001), while the detection rate of clinically insignificant PCa was lower (RR=0.65; 95%CI 0.55-0.77; p<0.001). MRI-TB and SB did not significantly differ in the detection of overall prostate cancer (RR=1.04; 95%CI 0.95-1.12; p=0.41). Compared with SB alone, we found that MRI-TB plus SB diagnosed more cases of overall, clinically significant and high-risk PCa (p<0.001). Conclusion Compared with systematic protocols, MRI-TB detects more clinically significant and high-risk PCa cases, and fewer clinically insignificant PCa cases. MRI-TB combined with SB enhances PCa detection in contrast with either alone but did not reduce the diagnosis rate of clinically insignificant PCa. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#searchadvanced, CRD42021218475.
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Affiliation(s)
- Jianfeng Xie
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Mengmeng Liu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Kun Sun
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhanqiang Jin
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhimin Ding
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Xuehao Gong
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Koparal MY, Sözen TS, Karşıyakalı N, Aslan G, Akdoğan B, Şahin B, Türkeri L. Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association. Prostate 2022; 82:425-432. [PMID: 34927740 DOI: 10.1002/pros.24288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. PATIENTS AND METHODS This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with ≥3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. RESULTS The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). CONCLUSION Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.
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Affiliation(s)
| | - Tevfik Sinan Sözen
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
| | - Nejdet Karşıyakalı
- Department of Urology, School of Medicine, Acıbadem University, İstanbul, Turkey
| | - Güven Aslan
- Department of Urology, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bülent Akdoğan
- Department of Urology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bahadır Şahin
- Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Levent Türkeri
- Department of Urology, School of Medicine, Acıbadem University, İstanbul, Turkey
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21
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Harsanto A, Satjakoesoemah AI, Sumardi R, Matondang SB, Saraswati M. Case Report: High-grade anterior prostate cancer previously undetected by transrectal biopsy, diagnosed with MRI-US fusion transperineal robotic prostate biopsy. F1000Res 2022; 11:247. [PMID: 37638134 PMCID: PMC10450259 DOI: 10.12688/f1000research.109546.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 08/29/2023] Open
Abstract
Seventy percent of anterior prostate cancer cases are diagnosed during rebiopsy. MRI-US fusion transperineal robotic prostate biopsy is an emerging diagnostic method and might be an effective one in diagnosing prostate cancers in difficult sites such as the anterior zone. We report a case of a high grade anterior prostate cancer previously undetected by transrectal biopsy, diagnosed with MRI-US fusion transperineal robotic prostate biopsy. This case report suggests that MRI-US fusion transperineal robotic prostate biopsy might be valuable in diagnosing prostate cancer especially in difficult sites - the anterior region in this case - and might be an imperative diagnostic method in suspicious cases with prior negative biopsy.
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Affiliation(s)
- Andrian Harsanto
- Department of Urology, Abdi Waluyo Hospital, Central Jakarta, DKI Jakarta, 10350, Indonesia
| | | | - Rochani Sumardi
- Department of Urology, Abdi Waluyo Hospital, Central Jakarta, DKI Jakarta, 10350, Indonesia
| | - Sahat B.R.E Matondang
- Department of Radiology, Abdi Waluyo Hospital, Central Jakarta, DKI Jakarta, 10350, Indonesia
| | - Meilania Saraswati
- Department of Anatomical Pathology, Dr. Cipto Mangunkusumo Hospital, Central Jakarta, DKI Jakarta, 10430, Indonesia
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22
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Hanske J, Risse Y, Roghmann F, Pucheril D, Berg S, Tully KH, von Landenberg N, Wald J, Noldus J, Brock M. Comparison of prostate cancer detection rates in patients undergoing MRI/TRUS fusion prostate biopsy with two different software-based systems. Prostate 2022; 82:227-234. [PMID: 34734428 DOI: 10.1002/pros.24264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-targeted prostate biopsy is a routinely used diagnostic tool for prostate cancer (PCa) detection. However, a clear superiority of the optimal approach for software-based MRI processing during biopsy procedures is still unanswered. To investigate the impact of robotic approach and software-based image processing (rigid vs. elastic) during MRI/transrectal ultrasound (TRUS) fusion prostate biopsy (FBx) on overall and clinically significant (cs) PCa detection. METHODS The study relied on the instructional retrospective biopsy data collected data between September 2013 and August 2017. Overall, 241 men with at least one suspicious lesion (PI-RADS ≥ 3) on multiparametric MRI underwent FBx. The study protocol contains a systematic 12-core sextant biopsy plus 2 cores per targeted lesion. One experienced urologist performed 1048 targeted biopsy cores; 467 (45%) cores were obtained using rigid processing, while the remaining 581 (55%) cores relied on elastic image processing. CsPCa was defined as International Society of Urological Pathology (ISUP) grade ≥ 2. The effect of rigid versus elastic FBx on overall and csPCa detection rates was determined. Propensity score weighting and multivariable regression models were used to account for potential biases inherent to the retrospective study design. RESULTS In multivariable regression analyses, age, prostate-specific antigen (PSA), and PIRADS ≥ 3 lesion were related to higher odds of finding csPCa. Elastic software-based image processing was independently associated with a higher overall PCa (odds ratio [OR] = 3.6 [2.2-6.1], p < 0.001) and csPCa (OR = 4.8 [2.6-8.8], p < 0.001) detection, respectively. CONCLUSIONS Contrary to existing literature, our results suggest that the robotic-driven software registration with elastic fusion might have a substantial effect on PCa detection.
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Affiliation(s)
- Julian Hanske
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Yannic Risse
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Daniel Pucheril
- Department of Urology, Kettering Medical Center, Kettering Physician Network, Dayton, Ohio, USA
| | - Sebastian Berg
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl H Tully
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | | | - Jan Wald
- Department of Radiology and Nuclear Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Marko Brock
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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Abstract
PURPOSE OF REVIEW Prostate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the transrectal technique for prostate biopsy remains the gold standard, there is increasing interest in the transperineal approach as it offers a clean, percutaneous approach that significantly decreases the risk for infection. In this review, we discuss emerging developments in transperineal prostate biopsy that may optimize the way biopsies are performed in clinical practice. RECENT FINDINGS Similarly, to transrectal biopsy, the transperineal approach also allows for the performance of systematic and MRI-targeted biopsy cores. As transperineal biopsy obviates the translocation of rectal bacteria to the prostate or bloodstream, in contrast to transrectal biopsy, it is feasible to forgo peri-procedural antibiotics in accordance with professional guidelines. This may attenuate antimicrobial resistance that may be associated with augmented prophylaxis. In addition, although transperineal biopsy may be traditionally performed under general anesthesia using a template grid, it may also be performed freehand under local anesthesia or sedation. Avoiding prophylactic antibiotics and general anesthesia as well as reducing infections/hospitalizations for transperineal biopsy scaled nationally will likely result in significant healthcare savings. SUMMARY Transperineal biopsy with combined systematic and MRI-targeted cores, offers several advantages over conventional transrectal biopsy. Transperineal biopsy under local anesthesia and without periprocedural antibiotic is emerging as a promising method for prostate cancer diagnosis and surveillance.
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Affiliation(s)
- Emily Cheng
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Meenakshi Davuluri
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Patrick J. Lewicki
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Jim C. Hu
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
| | - Spyridon P. Basourakos
- Department of Urology, NewYork Presbyterian Hospital/Weil Cornell Medicine, New York, NY, USA
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Natale C, Koller CR, Greenberg JW, Pincus J, Krane LS. Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions. Life (Basel) 2021; 11:1432. [PMID: 34947963 DOI: 10.3390/life11121432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
The use of multi-parametric magnetic resonance imaging (mpMRI) in conjunction with the Prostate Imaging Reporting and Data System (PI-RADS) is standard practice in the diagnosis, surveillance, and staging of prostate cancer. The risk associated with lesions graded at a PI-RADS score of 3 is ambiguous. Further characterization of the risk associated with PI-RADS 3 lesions would be useful in guiding further work-up and intervention. This study aims to better characterize the utility of PI-RADS 3 and associated risk factors in detecting clinically significant prostate cancer. From a prospectively maintained IRB-approved dataset of all veterans undergoing mpMRI fusion biopsy at the Southeastern Louisiana Veterans Healthcare System, we identified a cohort of 230 PI-RADS 3 lesions from a dataset of 283 consecutive UroNav-guided biopsies in 263 patients from October 2017 to July 2020. Clinically significant prostate cancer (Gleason Grade ≥ 2) was detected in 18 of the biopsied PI-RADS 3 lesions, representing 7.8% of the overall sample. Based on binomial analysis, PSA densities of 0.15 or greater were predictive of clinically significant disease, as was PSA. The location of the lesion within the prostate was not shown to be a statistically significant predictor of prostate cancer overall (p = 0.87), or of clinically significant disease (p = 0.16). The majority of PI-RADS 3 lesions do not represent clinically significant disease; therefore, it is possible to reduce morbidity through biopsy. PSA density is a potential adjunctive factor in deciding which patients with PI-RADS 3 lesions require biopsy. Furthermore, while the risk of prostate cancer for African-American men has been debated in the literature, our findings indicate that race is not predictive of identifying prostate cancer, with comparable Gleason grade distributions on histology between races.
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Demirtaş T, Gur A, Golbasi A, Sönmez G, Tombul ŞT, Demirtaş A. A Prospective Study and Single-Center Experience: Effectivity of Fusion Prostate Biopsy in Biopsy-Naïve Patients. Cureus 2021; 13:e19002. [PMID: 34824923 PMCID: PMC8610438 DOI: 10.7759/cureus.19002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 12/09/2022] Open
Abstract
Objective Fusion prostate biopsy (FPB) has become a popular technique in biopsy-naïve patients, though not accepted as a standard approach (yet). In this study, we aimed to present the clinical outcomes of biopsy-naïve patients who underwent FPB. Material and methods The study included 400 biopsy-naïve patients aged 45-75 years who had a prostate-specific antigen (PSA) level of 2-10 ng/ml and were detected with a Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion on multiparametric prostate magnetic resonance imaging (mpMRI)-guided FPB. A combined biopsy (CB) was performed in each patient, in which 2-4 cores were obtained for suspicious lesions by targeted biopsy (TB) and then 12-core standard prostate biopsy (SPB) was conducted in the same session. Cancer detection rates, clinically significant prostate cancer (csPCa) detection rates, histological upgrading rates, and false negative rates were determined. Results The 400 patients had a mean age of 62.01±7.00 years and a mean PSA value of 6.84±1.87 ng/ml. Overall PCa detection rate was 50% (200/400). The csPCa detection rates for TB, SPB, and CB were 25.0%, 31.8%, and 44.0%, respectively (p<0.001). In PIRADS 3, 4, and 5 lesions, CB had a csPCa detection rate of 29.2%, 54%, and 64.8%, respectively (p<0.001). The ratio of false negativity was significantly higher for TB compared to SPB (43.2% vs. 27.8%, p=0.003), whereas no significant difference was found between these two techniques with regard to upgrading rates although TB had a higher rate (19.6% vs. 13.7%, p=0.144). Conclusion FPB, a combined approach involving TB and SPB, was revealed as the most successful technique in biopsy-naïve patients with PSA<10 ng/ml due to its high cancer detection rates and low false negative rates.
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Affiliation(s)
- Türev Demirtaş
- History of Medicine and Ethics, Erciyes University, Kayseri, TUR
| | - Ahmet Gur
- Urology, Kayseri City Hospital, Kayseri, TUR
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Hofbauer SL, Luger F, Harland N, Plage H, Reimann M, Hollenbach M, Gusenleitner A, Stenzl A, Schlomm T, Wiemer L, Cash H. A non-inferiority comparative analysis of micro-ultrasonography and MRI- targeted biopsy in men at risk of prostate cancer. BJU Int 2021; 129:648-654. [PMID: 34773679 DOI: 10.1111/bju.15635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare the efficacy of multiparametric magnetic resonance imaging (mpMRI)-directed and micro-ultrasonography (micro-US)-directed biopsy for detecting clinically significant (Grade Group >1) prostate cancer (csPCa). MATERIALS AND METHODS A total of 203 patients were prospectively enrolled at three institutions across Germany and Austria in the period from January 2019 to December 2019. During each biopsy, the urologist was blinded to the mpMRI report until after the micro-US targets had been assessed. After unblinding, targets were then sampled using software-assisted fusion, followed by systematic samples. The primary outcome measure was non-inferiority of micro-US to detect csPCa, with a detection ratio of at least 80% that of mpMRI. RESULTS A total of 79 csPCa cases were detected overall (39%). Micro-US-targeted biopsy detected 58/79 cases (73%), while mpMRI-targeted biopsy detected 60/79 (76%) and non-targeted (completion sampling) samples detected 45/79 cases (57%). mpMRI-targeted samples alone detected 7/79 (9%) csPCa cases which were missed by micro-US-targeted and non-targeted samples. Three of these seven were anterior lesions with 2/7 in the transition zone. Micro-US-targeted samples alone detected 5/79 (6%) and completion sampling alone detected 4/79 cases (5%). Micro-US was non-inferior to mpMRI and detected 97% of the csPCa cases detected by mpMRI-targeted biopsy (95% CI 80-116%; P = 0.023). CONCLUSIONS This is the first multicentre prospective study comparing micro-US-targeted biopsy with mpMRI-targeted biopsy. The study provides further evidence that micro-US can reliably detect cancer lesions and suggests that micro-US biopsy might be as effective as mpMRI for detection of csPCA. This result has significant implications for increasing accessibility, reducing costs and expediting diagnosis.
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Affiliation(s)
| | - Ferdinand Luger
- Department of Urology, Ordensklinikum Linz, Elisabethinen, Austria
| | - Niklas Harland
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Henning Plage
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximillian Reimann
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Hollenbach
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Wiemer
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Prouro, Urology Berlin, Berlin, Germany.,Department of Urology, University of Magdeburg, Magdeburg, Germany
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27
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Chernysheva DY, Popov SV, Orlov IN, Malevich SM, Neradovskiy VA. [Ultrasound-based techniques of targeted prostate biopsy]. Urologiia 2021:105-110. [PMID: 34743442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The article is devoted to the multiparametric ultrasound techniques for prostate biopsy targeting. This literature review illustrates the variety of ultrasound-based targeting procedures and presents data concerning the diagnostic value of each. A special attention is given to every targeted technique limitations and the opportunity for the MTI-fusion.
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Affiliation(s)
- D Yu Chernysheva
- St. Lukes Clinical Hospital, Saint-Petersburg, Russia
- Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russia
- Military Medical Academy named after S.M. Kirova, Saint-Petersburg, Russia
- North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - S V Popov
- St. Lukes Clinical Hospital, Saint-Petersburg, Russia
- Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russia
- Military Medical Academy named after S.M. Kirova, Saint-Petersburg, Russia
- North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - I N Orlov
- St. Lukes Clinical Hospital, Saint-Petersburg, Russia
- Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russia
- Military Medical Academy named after S.M. Kirova, Saint-Petersburg, Russia
- North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - S M Malevich
- St. Lukes Clinical Hospital, Saint-Petersburg, Russia
- Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russia
- Military Medical Academy named after S.M. Kirova, Saint-Petersburg, Russia
- North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - V A Neradovskiy
- St. Lukes Clinical Hospital, Saint-Petersburg, Russia
- Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russia
- Military Medical Academy named after S.M. Kirova, Saint-Petersburg, Russia
- North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
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28
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Popov SV, Orlov IN, Malevich SM, Sushina IV, Grin' EA, Topuzov TM, Vjazovcev PV, Chernysheva DY, Neradovskiy VA. [Current approaches to targeted prostate biopsy]. Urologiia 2021:112-117. [PMID: 34743443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Currently, prostate cancer (PCa) is the second most common malignancy in men after lung cancer and the fifth leading cause of death worldwide. According to world and national statistics, over the past 20 years, there has been a steady increase in both incidence and mortality from PCa. Prostate biopsy is the cornerstone of the PCa diagnosis. However, recently, systematic transrectal biopsy as a standard approach has been questioned, since it has significant drawbacks that reduce the quality of PCa diagnosis. Considering the clinical importance of accurate PCa staging, MRI-guided targeted biopsy has been developed, which is currently the most accurate technique for taking a sample of tissue from suspicious areas. The optimal approaches to targeted prostate biopsy and the potential possibilities of including multiparametric MRI in the primary diagnostic algorithm are highlighted in this review, based on the results of large studies. The method allows to increase the overall PCa detection rate, the detection rates of clinically significant PCa, reduce the frequency of diagnosis of low-risk tumors and increase the overall accuracy of PCa detection, which has an outmost importance for the patient selection for active surveillance and to control disease progression.
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Affiliation(s)
- S V Popov
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - I N Orlov
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - S M Malevich
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - I V Sushina
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - E A Grin'
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - T M Topuzov
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - P V Vjazovcev
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - D Yu Chernysheva
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
| | - V A Neradovskiy
- SPb GBUZ City Hospital Saint Luka, Saint Petersburg, Russia
- Department of Urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- Department of Hospital Surgery of Medical Faculty of SPbGU, Saint Petersburg, Russia
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Lee CU, Choi J, Sung SH, Chung JH, Song W, Kang M, Sung HH, Jeong BC, Seo SI, Jeon SS, Lee HM, Jeon HG. The Role of Prostate Combination Biopsy Consisting of Targeted and Additional Systematic Biopsy. J Clin Med 2021; 10:4804. [PMID: 34768322 PMCID: PMC8584506 DOI: 10.3390/jcm10214804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/02/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To identify the role of combination biopsy, which consists of both targeted and additional systematic cores, in the diagnosis of clinically significant prostate cancer (csPCa). METHODS We retrospectively reviewed patients with PSA levels 2.5-15 ng/mL who have a suspicious prostate lesion (with the Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3) on multiparametric MRI (mpMRI) between January 2016 and December 2018. We analyzed biopsy results by PI-RADS score and biopsy methods (systematic, targeted, and combination biopsy). RESULTS Of the 711 total patients, an average of 4.0 ± 1.8 targeted and 8.6 ± 3.1 additional systematic biopsies were performed. The additional systematic biopsies were sampled outside the targeted biopsy area. The combination biopsies detected more csPCa (201 patients, 28.3%) than did the targeted (175 patients, 24.6%) or systematic (124 patients, 17.4%) biopsies alone (p < 0.001). In the initial biopsy samples, there was a 7% increase in the detection of csPCa than in targeted biopsy (62% to 69%). It increased by 11% in repeat biopsy (46% to 57%). There was no statistical significance in both groups (p = 0.3174). CONCLUSIONS Combination biopsy has the benefit of detecting csPCa in both initial and repeat biopsy when there is a suspicious lesion on mpMRI.
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Affiliation(s)
- Chung Un Lee
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Joongwon Choi
- Department of Urology, VHS Medical Center, Seoul 05368, Korea;
| | - Si Hyun Sung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Jae Hoon Chung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Wan Song
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Minyong Kang
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hyun Hwan Sung
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Byong Chang Jeong
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Seong Il Seo
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Seong Soo Jeon
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hyun Moo Lee
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
| | - Hwang Gyun Jeon
- Samsung Medical Center, Department of Urology, School of Medicine Sungkyunkwan University, Seoul 06351, Korea; (C.U.L.); (S.H.S.); (J.H.C.); (W.S.); (M.K.); (H.H.S.); (B.C.J.); (S.I.S.); (S.S.J.); (H.M.L.)
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30
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Hajelssedig OE, Zorron Cheng Tao Pu L, Thompson JY, Lord A, El Sayed I, Meyer C, Shaukat Ali F, Abdulazeem HM, Kheir AO, Siepmann T, Singh R. Diagnostic accuracy of narrow-band imaging endoscopy with targeted biopsies compared with standard endoscopy with random biopsies in patients with Barrett's esophagus: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:2659-2671. [PMID: 34121232 DOI: 10.1111/jgh.15577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/09/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Endoscopic surveillance for dysplasia in Barrett's esophagus (BE) with random biopsies is the primary diagnostic tool for monitoring clinical progression into esophageal adenocarcinoma. As an alternative, narrow-band imaging (NBI) endoscopy offers targeted biopsies that can improve dysplasia detection. This study aimed to evaluate NBI-guided targeted biopsies' diagnostic accuracy for detecting dysplasia in patients undergoing endoscopic BE surveillance compared with the widely used Seattle protocol. METHODS Cochrane DTA Register, MEDLINE/PubMed, EMBASE, OpenGrey, and bibliographies of identified papers were searched until 2018. Two independent investigators resolved discrepancies by consensus, study selection, data extraction, and quality assessment. Data on sensitivity, specificity, and predictive values were pooled and analyzed using a random-effects model. RESULTS Of 9528 identified articles, six studies comprising 493 participants were eligible for quantitative synthesis. NBI-targeted biopsy showed high diagnostic accuracy in detection of dysplasia in BE with a sensitivity of 76% (95% confidence interval [CI]: 0.61-0.91), specificity of 99% (95% CI: 0.99-1.00), positive predictive value of 97% (95% CI: 0.96-0.99), and negative predictive value of 84% (95% CI: 0.69-0.99) for detection of all grades of dysplasia. The receiver-operating characteristic curve for NBI model performance was 0.8550 for detecting all dysplasia. CONCLUSION Narrow-band imaging-guided biopsy demonstrated high diagnostic accuracy and might constitute a valid substitute for random biopsies during endoscopic surveillance for dysplasia in BE.
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Affiliation(s)
- Omer Eljyli Hajelssedig
- Master Program of Clinical Research, Dresden International University, Dresden, Germany.,DRESDEN INTERNATIONAL UNIVERSITAET (Freiberger Str. 37, 01067 Dresden, Germany)
| | | | | | - Anton Lord
- Gut Health Lab, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Chase Meyer
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Faisal Shaukat Ali
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA
| | | | - Ammar O Kheir
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | - Rajvinder Singh
- Department of Gastroenterology, The Lyell McEwin Hospital, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
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Uno H, Taniguchi T, Seike K, Kato D, Takai M, Iinuma K, Horie K, Nakane K, Koie T. The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy. Transl Androl Urol 2021; 10:2982-2989. [PMID: 34430401 PMCID: PMC8350232 DOI: 10.21037/tau-21-250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to estimate whether multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion biopsy (FUS-TB) increases the detection rates of clinically significant prostate cancer (csPCa) compared with TRUS-guided systematic biopsy (TRUS-GB). Methods This retrospective study focused on patients who underwent mpMRI before prostate biopsy (PB) with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) scores ≥3 and prostate-specific antigen (PSA) level between 2.5 and 20 ng/mL. Before FUS-TB, the biopsy needle position was checked virtually using three-dimensional mapping. After confirming the position of the target within the prostate, biopsy needle was inserted and PB was performed. Suspicious lesions were generally targeted with 2 to 4 cores. Subsequently, 10–12 cores were biopsied for TRUS-GB. The primary endpoint was the PCa detection rate (PCDR) for patients with PCa who underwent combined FUS-TB and TRUS-GB. Results According to PI-RADS v2, 76.7% of the patients with PI-RADS v2 score ≥3 were diagnosed with PCa. The PCDRs in patients with PI-RADS v2 score of 4 or 5 were significantly higher than those in patients with PI-RADS v2 score of 3 (3 vs. 4, P<0.001; 3 vs. 5, P<0.001; 4 vs. 5, P=0.073). According to PCDR, the detection rates of PCa and csPCa in the FUS-TB were significantly higher than that in the TRUS-GB. Conclusions Following detection of suspicious tumor lesions on mpMRI, FUS-TB use detects a higher number of PCa cases compared with TRUS-GB.
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Affiliation(s)
- Hiromi Uno
- Department of Urology, Chuno Kosei Hospital, Seki, Japan
| | | | - Kensaku Seike
- Department of Urology, Chuno Kosei Hospital, Seki, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kengo Horie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
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Haider MA, Brown J, Yao X, Chin J, Perlis N, Schieda N, Loblaw A. Multiparametric Magnetic Resonance Imaging in the Diagnosis of Clinically Significant Prostate Cancer: an Updated Systematic Review. Clin Oncol (R Coll Radiol) 2021; 33:e599-e612. [PMID: 34400038 DOI: 10.1016/j.clon.2021.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022]
Abstract
There has been growing utilisation of multiparametric magnetic resonance imaging (MPMRI) as a non-invasive tool to diagnose and localise clinically significant prostate cancer (CSPCa). This updated systematic review examines the use of MPMRI in patients with an elevated risk of CSPCa who have had a prior negative transrectal ultrasound systematic biopsy (TRUS-SB) and who were biopsy naïve. MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched for existing systematic reviews published up to September 2020. The literature search of the electronic databases combined disease-specific terms (prostate cancer, prostate carcinoma, etc.) and treatment-specific terms (magnetic resonance, etc.). Studies were included if they were randomised controlled trials (RCTs) comparing MPMRI to template transperineal mapping biopsy (TPMB) or to TRUS-SB. Thirty-six RCTs were eligible. For biopsy-naïve men, accuracy of diagnosis of CSPCa showed sensitivities from 87 to 96% and specificities ranging from 29 to 45%. Meta-analyses for CSPCa showed increased detection favouring MPMRI-targeted biopsy over TRUS-SB by 3% (95% confidence interval 0-7%, P = 0.03) and decreased detection of clinically insignificant prostate cancer (CISPCa) favouring MPMRI by 8% (95% confidence interval -11 to 5%, P < 0.00001). Accuracy of MPMRI for men with prior negative biopsy showed sensitivities of 78-100% and specificities of 30-100%. Meta-analyses comparing MPMRI to TRUS-SB showed increased detection of 5% (95% confidence interval 3-7%, P < 0.0001) with a reduction of CISPCa detection of 7% (95% confidence interval 4-9%, P < 0.00001). The growing acceptance of MPMRI utilisation internationally and the recent publication of several RCTs regarding MPMRI in reducing CISPCa detection rates, particularly in biopsy-naïve men, without loss of sensitivity for CSPCa necessitates the synthesis of updated evidence examining MPMRI in the diagnosis of CSPCa.
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Affiliation(s)
- M A Haider
- Sinai Health System and University of Toronto, Joint Department of Medical Imaging, Toronto, ON, Canada
| | - J Brown
- Program in Evidence-based Care, Ontario Health (Cancer Care Ontario), McMaster University, Hamilton, ON, Canada
| | - X Yao
- Program in Evidence-based Care, Ontario Health (Cancer Care Ontario), McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - J Chin
- London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - N Perlis
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - N Schieda
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - A Loblaw
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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33
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Wang HF, Chen R, He BM, Qu M, Wang Y, Lin HZ, Yang QS, Gao X, Sun YH. Initial experience with a novel method for cognitive transperineal magnetic resonance imaging-targeted prostate biopsy. Asian J Androl 2021; 22:432-436. [PMID: 31464205 PMCID: PMC7406104 DOI: 10.4103/aja.aja_83_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A cognitive magnetic resonance imaging (MRI)-targeted prostate biopsy conducted by an experienced clinician enhances the detection rate of (high-grade) prostate cancer; however, this method is less successful in the hands of inexperienced surgeons. Therefore, an alternative method of conducting a cognitive MRI-targeted biopsy that can be successfully performed by the inexperienced clinicians should be developed. Ninety-six males suspected of prostate cancer were analyzed using systematic biopsy and cognitive MRI-targeted biopsy based on our novel three-dimensional matrix positioning method. Typically, the core principle of the latter procedure was to put the MRI and ultrasound images into the same virtual coordinate system. Afterward, the targeted biopsy was transformed to target a coordinate for the suspected lesion in the MRI. Subsequently, patients were assessed for the presence/absence of prostate cancer or high-grade prostate cancer. According to our results, the overall detection rate of prostate cancer was 70.8% (68/96), and the detection rate of high-grade prostate cancer was 56.3% (54/96). Specifically, the detection rate of prostate cancer by systematic biopsy was 54.2% (52/96) and that by targeted biopsy was 59.4% (57/96; P = 0.560). Clearly, the combined application of targeted biopsy could remarkably increase the detection rates of prostate cancer (P = 0.025) and high-grade prostate cancer (P = 0.009). Taken together, the findings of this study suggest that the combination of systematic biopsy with our three-dimensional matrix positioning-driven cognitive-targeted biopsy is superior to systematic biopsy in detecting prostate cancer and high-grade prostate cancer.
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Affiliation(s)
- Hai-Feng Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Rui Chen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Bi-Ming He
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Min Qu
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yan Wang
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Heng-Zhi Lin
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Qing-Song Yang
- Department of Radiology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xu Gao
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Ying-Hao Sun
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Sorce G, Stabile A, Lucianò R, Motterle G, Scuderi S, Barletta F, Pellegrino F, Cucchiara V, Gandaglia G, Fossati N, De Cobelli F, Montorsi F, Jeffrey Karnes R, Guccini I, Briganti A. Multiparametric magnetic resonance imaging of the prostate underestimates tumour volume of small visible lesions. BJU Int 2021; 129:201-207. [PMID: 34038039 DOI: 10.1111/bju.15498] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 05/01/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the relationship between the volume of the index lesion (IL) measured at multiparametric magnetic resonance imaging (mpMRI; MRIvol) and at radical prostatectomy (RPvol), stratifying it according to Prostate Imaging-Reporting and Data System (PI-RADS) score. PATIENTS AND METHODS We identified 332 men with a positive mpMRI (single lesion with PI-RADS ≥3) who underwent systematic plus targeted biopsy and subsequent RP at two tertiary referral centres between 2013 and 2018. All mpMRIs were reviewed by experienced radiologists using PI-RADS scores. The study outcome was to assess the relationship between MRIvol (based on planimetry from MRI sequence best showing tumour) and RPvol (based on tumour involved area of each RP pathology slice). To achieve this endpoint, we performed a multivariable linear regression analysis (LRA) to predict RPvol using PI-RADS, prostate-specific antigen level, prostate volume, age, digital rectal examination, Gleason score at MRI-targeted biopsy, biopsy history and time from mpMRI to RP as covariates. Non-parametric locally estimated scatterplot smoothing (LOESS) function was used to graphically explore the relationship between MRIvol and RPvol, stratifying for PI-RADS score. RESULTS Overall, 24%, 49% and 27% of men had visible PI-RADS 3, 4 and 5 lesions at mpMRI. The median (interquartile range [IQR]) MRIvol and RPvol were 0.67 (0.29-1.76) mL and 1.39 (0.58-4.23) mL. At LRA, MRIvol was significantly correlated with a RPvol underestimation (slope: 2.4, 95% confidence interval [CI] 0.1-46.3). The non-parametric LOESS analysis showed a non-linear relationship between MRIvol and RPvol. Significant underestimation was reported across all volumes with the highest differences between MRIvol and RPvol in the low volume range (<2 mL), where RPvol almost doubled MRIvol. A similar effect was observed across all PI-RADS scores subgroups. CONCLUSIONS In the present study, mpMRI significantly underestimated the exact volume of the IL, especially for small visible lesions, regardless of PI-RADS score. This should be considered when planning tailored focal therapy approaches often delivered to men with smaller prostatic lesions.
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Affiliation(s)
- Gabriele Sorce
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Lucianò
- Department of Pathology, San Raffaele Hospital, San Raffaele University, Milan, Italy
| | | | - Simone Scuderi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Ilaria Guccini
- Institute of Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Haimovich S, Tanvir T. A Mini-Review of Office Hysteroscopic Techniques for Endometrial Tissue Sampling in Postmenopausal Bleeding. J Midlife Health 2021; 12:21-29. [PMID: 34188422 PMCID: PMC8189338 DOI: 10.4103/jmh.jmh_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/20/2021] [Accepted: 03/28/2021] [Indexed: 11/20/2022] Open
Abstract
Postmenopausal bleeding (PMB) is a common cause for a gynecological visit. Endometrial cancer risk varies from 3% to 25% in women with PMB. There is a significant concern of malignancy of the endometrium and the endocervical canal by a physician in postmenopausal women, and hence, most prefer operating room hysteroscopies with dilation and curettage (D & C) compared to in-office procedures. With increased availablility of miniaturized instruments such as mini- resectoscope and tissue removal systems, there is high likelihood of blind D & C being replaced by hysteroscopic- guided targetted biopsy or visual D & C. The cost-effectiveness of office hysteroscopy is also well demonstrated. In December 2020, an electronic search was performed of PubMed, MEDLINE, and Cochrane Library to look for articles on office hysteroscopic biopsy techniques in postmenopausal women from 2010 to 2020. Relevant studies were included where various office hysteroscopic techniques are used for endometrial sampling in PMB. Studies with 5 Fr scissors, biopsy forceps, crocodile forceps, cup forceps, bipolar electrode, in-office tissue removal system (morcellator), flexible hysteroscope, and mini-resectoscope were included. Standard reference was used as an adequate endometrial sample for histology. The objective of this review is to explore the current evidence on different office hysteroscopic techniques available for endometrial tissue sampling in PMB.
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Affiliation(s)
- Sergio Haimovich
- Department of Obstetrics and Gynecology, Del Mar University Hospital, Barcelona, Spain
| | - Tanvir Tanvir
- Department of Obstetrics and Gynecology, Tanvir Hospital, Hyderabad, Telangana, India
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Mazzone E, Stabile A, Sorce G, Pellegrino F, Barletta F, Motterle G, Scuderi S, Cirulli GO, Cucchiara V, Brembilla G, Esposito A, Gandaglia G, Fossati N, De Cobelli F, Montorsi F, Karnes RJ, Guccini I, Briganti A. Age and gleason score upgrading between prostate biopsy and radical prostatectomy: Is this still true in the multiparametric resonance imaging era? Urol Oncol 2021:S1078-1439(21)00124-1. [PMID: 33865687 DOI: 10.1016/j.urolonc.2021.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Several studies have invariably shown that the risk of Grade Group (GG) upgrading between biopsy and radical prostatectomy (RP) is higher in elderly men. Whether this is due to a real biological effect or to a diagnostic bias is still unknown. We hypothesized that the introduction of multiparametric magnetic resonance imaging (MRI) has improved the diagnostic accuracy of PCa detection in older men thus reducing the risk of GG upgrading at RP reported in the pre-MRI era. MATERIALS AND METHODS We selected 424 men who received a systematic plus targeted biopsy for a positive MRI and subsequent RP at two referral centers between 2013 and 2019. Upgrading was defined as an increase in GG at final pathology as compared to biopsy. Multivariable logistic regressions tested the risk of upgrading over increasing age according to any upgrading definition and after stratifying definitions according to GG group and biopsy type. Non-parametric functions explored the relationship between age and upgrading rate. RESULTS Median rate of upgrading was 17%. In multivariable models, while age was not associated with increased risk of GG upgrading (p=0.4). At non-parametric analyses, probability of upgrading slightly decreased with age, without reaching statistical significance. In subgroup analyses according to different upgrading definition and to biopsy type, age did not predict higher risk of upgrading regardless of outcome definitions (GG 1 to 2 P = 0.1; GG 2 to 3 P = 0.2; GG 3 to 4-5 P = 0.2) and in GG detected at TBx (OR 0.998, P = 0.8). CONCLUSIONS We showed that use of MRI has obliterated the association between older age and increased risk of upgrading mainly due to improved diagnostic approaches in this group of men. Therefore, it is likely that the effect of age and GG upgrading reported in previous studies in elderly men was due to misdiagnosis and lead-time bias in the pre-MRI era.
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Tanaka K, Sasaki A, Egashira H, Teshima S, Kimura K, Nishino T, Tazawa T, Tasaki J, Ichita C, Masuda S, Koizumi K, Kako M. A Targeted Biopsy during Menstruation for the Definitive Diagnosis of Rectovaginal Endometriosis: A Report of Two Cases. Intern Med 2021; 60:999-1004. [PMID: 33116009 PMCID: PMC8079915 DOI: 10.2169/internalmedicine.5430-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the definitive diagnosis of rectovaginal endometriosis in two cases. Case 1 involved a 46-year-old woman with abdominal pain and hematochezia. The diagnosis after the first and second examinations using lower gastrointestinal (GI) endoscopy was unclear. Differential diagnoses included mucosa-associated lymphoid tissue and colorectal cancer. The third lower GI endoscopy with a targeted biopsy, performed during menstruation, confirmed rectovaginal endometriosis. Case 2 involved a 38-year-old woman with hematochezia. Lower GI endoscopy during menstruation revealed rectovaginal endometriosis. When rectovaginal or bowel endometriosis is suspected, lower GI endoscopy and a targeted biopsy during menstruation can prevent unnecessary surgery.
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Affiliation(s)
- Kosuke Tanaka
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Hideto Egashira
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | | | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Tomohiko Tazawa
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
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Moreira P, Grimble J, Iftimia N, Bay CP, Tuncali K, Park J, Tokuda J. In vivo evaluation of angulated needle-guide template for MRI-guided transperineal prostate biopsy. Med Phys 2021; 48:2553-2565. [PMID: 33651407 DOI: 10.1002/mp.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI)-guided transperineal prostate biopsy has been practiced since the early 2000s. The technique often suffers from targeting error due to deviation of the needle as a result of physical interaction between the needle and inhomogeneous tissues. Existing needle guide devices, such as a grid template, do not allow choosing an alternative insertion path to mitigate the deviation because of their limited degree-of-freedom (DoF). This study evaluates how an angulated needle insertion path can reduce needle deviation and improve needle placement accuracy. METHODS We extended a robotic needle-guidance device (Smart Template) for in-bore MRI-guided transperineal prostate biopsy. The new Smart Template has a 4-DoF needle-guiding mechanism allowing a translational range of motion of 65 and 58 mm along the vertical and horizontal axis, and a needle rotational motion around the vertical and horizontal axis ± 30 ∘ and a vertical rotational range of - 30 ∘ , + 10 ∘ , respectively. We defined a path planning strategy, which chooses between straight and angulated insertion paths depending on the anatomical structures on the potential insertion path. We performed (a) a set of experiments to evaluate the device positioning accuracy outside the MR-bore, and (b) an in vivo experiment to evaluate the improvement of targeting accuracy combining straight and angulated insertions in animal models (swine, n = 3 ). RESULTS We analyzed 46 in vivo insertions using either straight or angulated insertions paths. The experiment showed that the proposed strategy of selecting straight or angulated insertions based on the subject's anatomy outperformed the conventional approach of just straight insertions in terms of targeting accuracy (2.4 mm [1.3-3.7] vs 3.9 mm [2.4-5.0] {Median IQR } ); p = 0.041 after the bias correction). CONCLUSION The in vivo experiment successfully demonstrated that an angulated needle insertion path could improve needle placement accuracy with a path planning strategy that takes account of the subject-specific anatomical structures.
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Affiliation(s)
- Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - John Grimble
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Nicusor Iftimia
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Jesung Park
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
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Cheng X, Xu J, Chen Y, Liu Z, Sun G, Yang L, Yao J, Zeng H, Song B. Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI? Front Oncol 2021; 11:643051. [PMID: 33718240 PMCID: PMC7952882 DOI: 10.3389/fonc.2021.643051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose To determine whether additional systematic biopsy is necessary in all biopsy naïve patients with MRI visible lesions by taking PI-RADS score and prostate volume into consideration. Materials and Methods Patients who underwent combined systematic biopsy (SB) and cognitive MRI-targeted biopsy (TB) in our hospital between May 2018 and June 2020 were retrospectively reviewed. The detection rate of clinical significant prostate cancer (csPCa), biopsy grade group (GG) concordance, and disease upgrading rate on radical prostatectomy were compared between SB and TB and further stratified by PI-RADS v2.0 category and prostate volume. Results A total of 234 patients were analyzed in this study. TB alone detected more csPCa and less clinically insignificant prostate cancer (cisPCa) than SB alone in the whole cohort (57.3 vs 53%, P = 0.041; 3.8 vs 7.7%, P = 0.049 respectively). The additional SB indicated only a marginal increase of csPCa detection but a remarkable increase of cisPCa detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012). As stratified by PI-RADS category, the difference of csPCa detection rate between TB and SB was not significant either in PI-RADS 5 subgroup (83.8 vs 76.3%, P = 0.07) or in PI-RADS 3–4 subgroup (43.5 vs 40.9%, P = 1.0). Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than TB alone in PI-RADS 3–4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0). When stratified by prostate volume (PV), TB alone detected more csPCa than SB in small prostate (PV < 30 ml) group (81.0 vs 71.0%, P = 0.021) but not in large prostate (PV ≥ 30 ml) group (44.0 vs 42.7%, P = 0.754). The additional SB did not significantly decrease the rate of disease upgrading on RP than TB alone in either small or large prostate (6.4 vs 8.5%, P = 1.0; 13.8 vs 22.4%, P = 0.063). Conclusion The combination biopsy method was no superior than targeted biopsy alone in PI-RADS 5 or in small volume prostate subgroup.
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Affiliation(s)
- Xueqing Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinshun Xu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yuntian Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxi Sun
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Meyer HS, Liesche-Starnecker F, Mustafa M, Yakushev I, Wiestler B, Meyer B, Gempt J. [ 18F]FET PET Uptake Indicates High Tumor and Low Necrosis Content in Brain Metastasis. Cancers (Basel) 2021; 13:355. [PMID: 33478030 DOI: 10.3390/cancers13020355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Various types of cancers can lead to brain metastasis. Treatment strategies have improved substantially in the past decade, leading to longer survival in many cases, but also to new diagnostic challenges. Being able to locate those parts of a lesion suspicious for brain metastasis that contain the highest concentrations of viable tumor cells can be crucial, e.g., to obtain a precise diagnosis via targeted biopsies or to differentiate recurring tumor from dead tissue after treatment. Positron emission tomography (PET) imaging has the potential to provide this kind of information. However, studies relating PET findings to actual tissue properties are sparse. The aim of this study was to investigate the association of PET imaging with microscopic tissue properties in samples obtained neurosurgically from brain metastases. Our findings can improve the planning and yield of biopsies from brain metastases, and they may inform future studies aimed at improving the discrimination of recurring from dead tumor in treated brain metastases using PET. Abstract Amino acid positron emission tomography (PET) has been employed in the management of brain metastases. Yet, histopathological correlates of PET findings remain poorly understood. We investigated the relationship of O-(2-[18F]Fluoroethyl)-L-tyrosine ([18F]FET) PET, magnetic resonance imaging (MRI), and histology in brain metastases. Fifteen patients undergoing brain metastasis resection were included prospectively. Using intraoperative navigation, 39 targeted biopsies were obtained from parts of the metastases that were either PET-positive or negative and MRI-positive or negative. Tumor and necrosis content, proliferation index, lymphocyte infiltration, and vascularization were determined histopathologically. [18F]FET PET had higher specificity than MRI (66% vs. 56%) and increased sensitivity for tumor from 73% to 93% when combined with MRI. Tumor content per sample increased with PET uptake (rs = 0.3, p = 0.045), whereas necrosis content decreased (rs = −0.4, p = 0.014). PET-positive samples had more tumor (median: 75%; interquartile range: 10–97%; p = 0.016) than PET-negative samples. The other investigated histological properties were not correlated with [18F]FET PET intensity. Tumors were heterogeneous at the levels of imaging and histology. [18F]FET PET can be a valuable tool in the management of brain metastases. In biopsies, one should aim for PET hotspots to increase the chance for retrieval of samples with high tumor cell concentrations. Multiple biopsies should be performed to account for intra-tumor heterogeneity. PET could be useful for differentiating treatment-related changes (e.g., radiation necrosis) from tumor recurrence.
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Kamalov AA, Kadrev AV, Mitkova MD, Danilova NV, Kamalov DM, Sorokin NI, Mitkov VV. [Shear wave elastography guided targeted biopsy in the diagnosis of prostate cancer]. Urologiia 2020:106-113. [PMID: 33377687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE to compare the effectiveness of targeted biopsy guided by the shear wave elastography (SWE) and systematic biopsy in the diagnosis of prostate cancer (PCa). MATERIAL AND METHODS A total of 164 patients with suspected PCa were examined. Multiparametric TRUS, including SWE, was performed to all patients with the use of the Aixplorer ultrasound system (Supersonic Imagine, France), followed by TRUS guided 12-samples systematic prostate biopsy in combination with targeted biopsy from hypoechoic and/or stiff areas according to SWE data. Comparison of the results of histological examination and tissue stiffness measurements were carried out according to the specimens and patients. A total of 2 171 biopsy samples were analyzed (1 968 systematic and 203 targeted). After morphological evaluation all specimens were divided into groups of PCa+ (n=441) and PCa- (n=1 730), and patients to the group of PCa (n=74) and the control group (n=90). RESULTS PCa was found in 17.3% of systematic biopsy specimens and in 76.9% of SWE targeted biopsy specimens (P<0.0001). The significant moderate positive correlations of Youngs modulus and Gleason scores (rS=0.51, P<0.0001), Youngs modulus and% specimen involvement (rS=0.59, P<0.0001) were founded in the group of PCa+ biopsy specimens. The percentage of PCa+ specimens was significantly higher with any types of targeted biopsy, than with systematic biopsy. With SWE targeted biopsy the percentage of PCa+ specimens was significantly higher than with B-mode guided targeted biopsy. Similar regularities were observed when comparing these types of targeted biopsy according to morphological prognostic ISUP groups and perineural invasion. Performing of targeted biopsy increased the morphological prognostic group in 5.4% of patients, additionally revealed perineural invasion in 2.7% of patients with PCa, and transferred additional 9.5% of patients from the group of clinically insignificant to the group of clinically significant PCa. CONCLUSION SWE-guided targeted biopsy shows the significantly higher positive biopsy rate than conventional systematic biopsy. The use of SWE-guided targeted biopsy in addition to systematic biopsy can increase clinically significant PCa detection rate and improve the detection of perineural invasion.
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Affiliation(s)
- A A Kamalov
- Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia
| | - A V Kadrev
- Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M D Mitkova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - N V Danilova
- Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia
| | - D M Kamalov
- Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia
| | - N I Sorokin
- Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia
| | - V V Mitkov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Kudlackova S, Kurfurstova D, Kral M, Hruska F, Vidlar A, Student V. Do not underestimate anterior prostate cancer. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:198-202. [PMID: 33252117 DOI: 10.5507/bp.2020.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/10/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS With the introduction of magnetic resonance imaging in the diagnosis of prostate cancer and its use in targeted prostate biopsy, an increased incidence of anterior-predominant prostate cancer (APC) has been observed. METHODS We enrolled 200 patients who underwent radical prostatectomy at our department between 12/2017 and 04/2019. We evaluated tumour location in the individual segments of the prostate, index tumour location and volume, and compared the postoperative stage, Gleason score, grade group (GG), and the presence of extraprostatic extension (EPE) in APC and posterior prostate cancer (PPC). We assessed the rate of MRI scans prior to prostate surgery as well as the influence of family history and PSA on the presence of APC. RESULTS We found a significantly higher rate of anterior tumours than previously reported (37%) and confirmed that these tumours are diagnosed with a significantly larger index tumour volume (P=0.003). We also showed that a mere 6.76% of APCs were low-risk tumours not requiring radical treatment. Furthermore, anterior tumours were found significantly more often (P=0.001) in patients who underwent preoperative MRI. No differences were observed between PSA values, family history, presence of EPE, or locally advanced disease in APC vs. PPC. CONCLUSIONS The frequency of anterior tumours is higher than previously thought, and they include tumours requiring radical treatment. When these tumours are neglected, it may lead to patient undertreatment with impact on their life prognosis. Thus, we consider the use of MRI-targeted prostate biopsy to be a necessity both for ruling out APC in the case of repeatedly negative prostate biopsies and, in particular, before patient inclusion in active surveillance.
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Affiliation(s)
- Sarka Kudlackova
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Daniela Kurfurstova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milan Kral
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Frantisek Hruska
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Ales Vidlar
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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Cheng Y, Qi F, Liang L, Zhang L, Cao D, Hua L, Cheng G. Use of Prostate Systematic and Targeted Biopsy on the Basis of Bi-Parametric Magnetic Resonance Imaging in Biopsy-Naïve Patients. J INVEST SURG 2020; 35:92-97. [PMID: 32996795 DOI: 10.1080/08941939.2020.1825884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To explore the performance of targeted biopsy (TB) in combination with systematic biopsy (SB) in the detection of prostate cancer (PCa) in biopsy naïve patients. METHODS From May 2018 to January 2020, 230 biopsy-naïve men with suspicious bi-parametric MRI [bpMRI; Prostate Imaging Reporting and Data System (PI-RADS) score ≥3] were enrolled. All patients had prostate-specific antigen (PSA) levels of 20 ng/ml or less. For each patient, transrectal ultrasound-guided prostate biopsy was performed. The primary endpoint was the detection rate of CSPC [clinically-significant PCa, International Society of Urological Pathology grade group (ISUP GG) 2 or higher tumors]. The secondary endpoints were the detection rates of CIPC (clinically insignificant PCa, ISUP GG 1 tumors). RESULTS CSPC was detected in 90 patients. Twelve (13.33%) of them were detected by TB only and 18 (20.00%) by SB only. Detection of CSPC by SB and TB did not differ significantly (p = .36). In 4.35% of 230 patients, CSPC would have been missed if we performed SB only, and in 6.09% of patients if we performed TB only. Moreover, combination of TB and SB did not increase the detection of CIPC. CONCLUSIONS No significant difference was found in the detection of CSPC between TB and SB; however, both techniques revealed substantial added value and combination of TB and SB could further improve this detection rate without increasing the detection of CIPC.
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Affiliation(s)
- Yifei Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Qi
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Linghui Liang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongliang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lixin Hua
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gong Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Lee AYM, Yang XY, Lee HJ, Law YM, Huang HH, Lau WKO, Lee LS, Ho HSS, Tay KJ, Cheng CWS, Yuen JSP, Chen K. Multiparametric MRI-ultrasonography software fusion prostate biopsy: initial results using a stereotactic robotic-assisted transperineal prostate biopsy platform comparing systematic vs targeted biopsy. BJU Int 2020; 126:568-576. [PMID: 32438463 DOI: 10.1111/bju.15118] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the detection rates of prostate cancer between systematic biopsy and targeted biopsy using a stereotactic robot-assisted transperineal prostate platform. MATERIALS AND METHODS We identified consecutive patients with suspicious lesion(s) on multiparametric magnetic resonance imaging (mpMRI), who underwent both systematic and MRI-transrectal ultrasonography (US) fusion targeted biopsy using our proprietary transperineal robot-assisted prostate biopsy platform between January 2015 and January 2019 at our institution, for retrospective analysis. Comparative analysis was performed between systematic and targeted biopsy using McNemar's test, and the cohort was further stratified by prior biopsy status and Prostate Imaging Reporting and Data System (PI-RADS) v2.0 score. International Society of Urological Pathology (ISUP) grade group (GG) ≥2 cancers (previously known as Gleason grade ≥7) were considered to be clinically significant. RESULTS A total of 500 patients were included in our final analysis, of whom 67 (13%) were patients with low-risk cancer on active surveillance. Of the 433 patients without prior diagnosis of cancer, 288 (67%) were biopsy-naïve. A total of 248 (57%) were diagnosed with prostate cancer, with 199 (46%) having clinically significant prostate cancer (ISUP GG ≥2). There were no statistically significant differences in the overall prostate cancer and clinically significant prostate cancer detection rate between systematic and targeted biopsy (51% vs 49% and 40% vs 38% respectively; P = 0.306 and P = 0.609). Of the 248 prostate cancers detected, 75% (187/248) were detected on both systematic and targeted biopsy, 14% (35/248) were detected on systematic biopsy alone and 11% (26/248) were detected on targeted biopsy alone. Of the 199 clinically significant cancers detected, 69% (138/199) were detected on both systematic and targeted biopsy, 17% (33/199) on systematic biopsy alone and 14% (28/199) on targeted biopsy alone. There were no statistically significant differences in the detection rate between systematic and targeted biopsy for both overall and clinically significant prostate cancer, even when the cohort was stratified by prior biopsy status and PI-RADS score. Targeted biopsy has greater sampling efficiency compared to systematic biopsy for both overall and clinically significant prostate cancer (23.2% vs 9.8%, P < 0.001 and 14.8% vs 5.6%, P < 0.001). CONCLUSIONS Using our robot-assisted transperineal prostate platform, combined MRI-US targeted biopsy with concurrent systematic prostate systematic biopsy probably represents the optimal method for the detection of clinically significant prostate cancer.
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Affiliation(s)
- Alvin Y M Lee
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Xin Yan Yang
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Han Jie Lee
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Hong Hong Huang
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Weber K O Lau
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore, Singapore
| | - Henry S S Ho
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | | | - John S P Yuen
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore, Singapore
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Li D, Liu Y, Li Z, Li S, Shan G, Yao L. [Magnetic resonance imaging-transrectal ultrasound cognitive fusion targeted biopsy on the diagnosis of prostate cancer: a research of 614 cases in single center]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2020; 37:225-229. [PMID: 32329273 DOI: 10.7507/1001-5515.201911076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study aims to compare the prostate cancer detection rate between magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy. A total of 614 patients who underwent transrectal prostate biopsy during 2016-2018 with multiparametric magnetic resonance imaging (mpMRI) were included. All patients with a PI-RADS V2 score ≥ 3 accepted both targeted biopsy and systematic biopsy, and those with a PI-RADS V2 score ≤ 2 only accepted systematic biopsy. Overall prostate cancer detection rate between the two biopsies was compared. MRI-TRUS cognitive fusion targeted biopsy identified 342 cases (75.7%) of prostate cancer while systematic biopsy identified 358 cases (79.2%). There was no significant difference in the detection rate between the two groups ( χ 2 = 1.621, P = 0.203). Targeted biopsy had significant fewer biopsy cores compared with systematic biopsy, reducing (9.3 ± 0.11) cores ( P < 0.001) in average. Targeted biopsy had about 10.8% ( P < 0.001) more tumor tissues in positive cores compared with systematic biopsy. The results show that both MRI-TRUS cognitive fusion targeted biopsy and systematic biopsy have good detection rate on prostate cancer. Cognitive targeted biopsy may reduce biopsy cores and provide more tumor tissues in positive cores.
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Affiliation(s)
- Derun Li
- Department of Urology, Peking University First Hospital, Beijing 100034, P.R.China;Institute of Urology, Peking University, Beijing 100034, P.R.China;National Urological Cancer Center, Beijing 100034, P.R.China
| | - Yi Liu
- Department of Urology, Peking University First Hospital, Beijing 100034, P.R.China;Institute of Urology, Peking University, Beijing 100034, P.R.China;National Urological Cancer Center, Beijing 100034, P.R.China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing 100034, P.R.China;Institute of Urology, Peking University, Beijing 100034, P.R.China;National Urological Cancer Center, Beijing 100034, P.R.China
| | - Shuqing Li
- Department of Urology, Peking University First Hospital, Beijing 100034, P.R.China;Institute of Urology, Peking University, Beijing 100034, P.R.China;National Urological Cancer Center, Beijing 100034, P.R.China
| | - Gangzhi Shan
- Department of Urology, Peking University First Hospital, Beijing 100034, P.R.China;Institute of Urology, Peking University, Beijing 100034, P.R.China;National Urological Cancer Center, Beijing 100034, P.R.China
| | - Lin Yao
- Department of Urology, Peking University First Hospital, Beijing 100034, P.R.China;Institute of Urology, Peking University, Beijing 100034, P.R.China;National Urological Cancer Center, Beijing 100034, P.R.China
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Patel MI, Muter S, Vladica P, Gillatt D. Robotic-assisted magnetic resonance imaging ultrasound fusion results in higher significant cancer detection compared to cognitive prostate targeting in biopsy naive men. Transl Androl Urol 2020; 9:601-608. [PMID: 32420165 PMCID: PMC7214998 DOI: 10.21037/tau.2020.01.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To determine differences in cancer detection rates (CDRs) of regions of interest (ROI) on magnetic resonance imaging (MRI) with robotic-assisted (RA) targeted biopsies (RA-TB) compared to cognitive targeted biopsies (C-TB). Methods In a two-centre, retrospective outcome study, a total of 92 consecutive men who had a pre-biopsy MRI, were biopsy naïve and had a transperineal (TP) prostate biopsy between 9/2015 and 7/2017 were included. The primary analysis consists of 39 men who had C-TB and 53 men who had RA-TB. Outcomes from targeted biopsies were reported as CDR for clinically significant prostate cancer (csPC) and for any cancer. Results Targeted csCDR was higher in RA-TB vs. C-TB (32.1% vs. 10.3%, P=0.014). Targeted CDR of any cancer with Prostate Imaging Reporting and Data System (PI-RADS) 3-5 ROIs was also significantly higher in RA-TB compared to C-TB (47.2% vs. 12.8%, P=0.001). On multivariable analysis significant factors which affected the CDR for csPC was prostate volume only [odds ratio (OR) 1.04, 95% confidence interval (CI): 1.01-1.07]. For any cancer, the CDR was related to prostate volume (OR 1.03, 95% CI: 1.01-1.06) and RA-TB (OR 5.97, 95% CI: 1.69-21.07). RA biopsy results in less acute urinary retention (1.9% vs. 12.8%, P=0.03), less prolonged haematuria (7.5% vs. 38.5%, P<0.01) and shortened biopsy times (24 vs. 32 min, P<0.001). Conclusions RA targeted biopsy results in higher CDR for clinically significant cancers and any cancer. It also suffers lower complications compared to cognitive directed TP biopsy. The ease of use and standardisation of the robotic procedure may reduce the learning curve and increase biopsy accuracy.
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Affiliation(s)
- Manish I Patel
- Discipline of Surgery, University of Sydney, Sydney, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, Australia
| | - Samir Muter
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
| | - Philip Vladica
- Department of Radiology, Westmead Hospital, Sydney, Australia
| | - David Gillatt
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
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Mamawala MK, Meyer AR, Landis PK, Macura KJ, Epstein JI, Partin AW, Carter BH, Gorin MA. Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance. BJU Int 2020; 125:861-866. [PMID: 32039537 DOI: 10.1111/bju.15033] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess if the adoption of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) has improved the identification of occult higher-grade prostate cancer (PCa). PATIENTS AND METHODS We retrospectively identified men from the Johns Hopkins AS registry enrolled since 2013 (year of mpMRI adoption) with Grade Group (GG) 1 PCa and who underwent a single mpMRI. Men in this group were dichotomised by the presence (n = 207) or absence (negative mpMRI, n = 225) of one or more lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of ≥ 3. Both groups were compared to a third cohort of men with GG1 PCa enrolled in AS prior to 2013 (pre-mpMRI era, n = 669). The risk of upgrading to GG ≥ 2 PCa on follow-up biopsies (performed with or without MRI targeting) was evaluated among the groups using survival analysis. RESULTS Men in both mpMRI groups underwent a median (interquartile range [IQR]) of 2 (2-3) biopsies separated by a median (IQR) interval of 13 (12-16) months, whereas men in the pre-MRI era underwent a median (IQR) of 3 (2-5) biopsies, separated by a median (IQR) interval of 12 (12-14) months. The 2- and 4-year upgrade-free survival rates were 93% and 83%, 74% and 59%; and, 87% and 76% for the negative mpMRI, PI-RADS ≥ 3, and pre-mpMRI-era groups, respectively (P < 0.001). On multivariable analysis, both mpMRI groups had significantly different risk of upgrading compared to pre-mpMRI-era group (negative mpMRI group: hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39-0.95, P = 0.03; PI-RADS ≥ 3 group: HR 1.96, 95% CI 1.36-2.82, P < 0.001). CONCLUSIONS mpMRI improves the risk stratification of men on AS and should be used to aid enrolment and monitoring decisions.
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Affiliation(s)
- Mufaddal K Mamawala
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alexa R Meyer
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Patricia K Landis
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Katarzyna J Macura
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jonathan I Epstein
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alan W Partin
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ballentine H Carter
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Wenzel M, Theissen L, Preisser F, Lauer B, Wittler C, Humke C, Bodelle B, Ilievski V, Kempf VAJ, Kluth LA, Chun FKH, Mandel P, Becker A. Complication Rates After TRUS Guided Transrectal Systematic and MRI-Targeted Prostate Biopsies in a High-Risk Region for Antibiotic Resistances. Front Surg 2020; 7:7. [PMID: 32185180 PMCID: PMC7059219 DOI: 10.3389/fsurg.2020.00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/14/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction: There is still an ongoing debate whether a transrectal ultrasound (TRUS) approach for prostate biopsies is associated with higher (infectious) complications rates compared to transperineal biopsies. This is especially of great interests in settings with elevated frequencies of multidrug resistant organisms (MDRO). Materials and Methods: Between 01/2018 and 05/2019 230 patients underwent a TRUS-guided prostate biopsy at the department of Urology at University Hospital Frankfurt. Patients were followed up within the clinical routine that was not conducted earlier than 6 weeks after the biopsy. Among 230 biopsies, 180 patients took part in the follow-up. No patients were excluded. Patients were analyzed retrospectively regarding complications, infections and underlying infectious agents or needed interventions. Results: Of all patients with follow up, 84 patients underwent a systematic biopsy (SB) and 96 a targeted biopsy (TB) after MRI of the prostate with additional SB. 74.8% of the patients were biopsy-naïve. The most frequent objective complications (classified by Clavien-Dindo) lasting longer than one day after biopsy were hematuria (17.9%, n = 32), hematospermia (13.9%, n = 25), rectal bleeding (2.8%, n = 5), and pain (2.2%, n = 4). Besides a known high MDRO prevalence in the Rhine-Main region, only one patient (0.6%) developed fever after biopsy. One patient each (0.6%) consulted a physician due to urinary retention, rectal bleeding or gross hematuria. There were no significant differences in complications seen between SB and SB + TB patients. The rate of patients who consulted a physician was significantly higher for patients with one or more prior biopsies compared to biopsy-naïve patients. Conclusion: Complications after transrectal prostate biopsies are rare and often self-limiting. Infections were seen in <1% of all patients, regardless of an elevated local prevalence of MDROs. Severe complications (Clavien-Dindo ≥ IIIa) were only seen in 3 (1.7%) of the patients. Repeated biopsy is associated with higher complication rates in general.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lena Theissen
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Boris Bodelle
- Department of Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Valentina Ilievski
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.,University Center of Competence for Infection Control of the State of Hesse, Frankfurt, Germany
| | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt, Germany.,University Center of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.,University Center of Competence for Infection Control of the State of Hesse, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
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Herz C, MacNeil K, Behringer PA, Tokuda J, Mehrtash A, Mousavi P, Kikinis R, Fennessy FM, Tempany CM, Tuncali K, Fedorov A. Open Source Platform for Transperineal In-Bore MRI-Guided Targeted Prostate Biopsy. IEEE Trans Biomed Eng 2020; 67:565-576. [PMID: 31135342 PMCID: PMC6874712 DOI: 10.1109/tbme.2019.2918731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Accurate biopsy sampling of the suspected lesions is critical for the diagnosis and clinical management of prostate cancer. Transperineal in-bore MRI-guided prostate biopsy (tpMRgBx) is a targeted biopsy technique that was shown to be safe, efficient, and accurate. Our goal was to develop an open source software platform to support evaluation, refinement, and translation of this biopsy approach. METHODS We developed SliceTracker, a 3D Slicer extension to support tpMRgBx. We followed modular design of the implementation to enable customization of the interface and interchange of image segmentation and registration components to assess their effect on the processing time, precision, and accuracy of the biopsy needle placement. The platform and supporting documentation were developed to enable the use of software by an operator with minimal technical training to facilitate translation. Retrospective evaluation studied registration accuracy, effect of the prostate segmentation approach, and re-identification time of biopsy targets. Prospective evaluation focused on the total procedure time and biopsy targeting error (BTE). RESULTS Evaluation utilized data from 73 retrospective and ten prospective tpMRgBx cases. Mean landmark registration error for retrospective evaluation was 1.88 ± 2.63 mm, and was not sensitive to the approach used for prostate gland segmentation. Prospectively, we observed target re-identification time of 4.60 ± 2.40 min and BTE of 2.40 ± 0.98 mm. CONCLUSION SliceTracker is modular and extensible open source platform for supporting image processing aspects of the tpMRgBx procedure. It has been successfully utilized to support clinical research procedures at our site.
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Roumiguié M, Ploussard G, Nogueira L, Bruguière E, Meyrignac O, Lesourd M, Péricart S, Malavaud B. Independent Evaluation of the Respective Predictive Values for High-Grade Prostate Cancer of Clinical Information and RNA Biomarkers after Upfront MRI and Image-Guided Biopsies. Cancers (Basel) 2020; 12:E285. [PMID: 31991591 DOI: 10.3390/cancers12020285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 11/16/2022] Open
Abstract
Upfront MRI is taking the lead in the diagnosis of clinically significant prostate cancer, while few image-guided biopsies (IGBs) fail to demonstrate clinically significant prostate cancer. The added value of innovative biomarkers is not confirmed in this context. We analysed SelectMDx-v2 (MDx-2) in a cohort of upfront MRI and image-guided biopsy patients. Participants included patients who received a trans-rectal elastic-fusion registration IGB on the basis of DRE, PSA, PCA3, and PCPT-2.0 risk evaluation. Pre-biopsy MRI DICOM archives were reviewed according to PI-RADS-v2. Post-massage first-void urine samples stored in the institutional registered bio-repository were commercially addressed to MDxHealth to obtain MDx-2 scores. Univariate and multivariate analyses were conducted with the detection on IGB of high-grade (ISUP 2 and higher) as the dependent variable. High-grade cancer was demonstrated in 32/117 (27.4%) patients (8/2010-8/2018). Age, prostate volume, biopsy history, MDx-2, and PI-RADS-v2 scores significantly related to the detection of high-grade cancer. MDx-2 scores and the clinical variables embedded into MDx-2 scores were analysed in multivariate analysis to complement PI-RADS-v2 scores. The two combinations outperformed PI-RADS-v2 alone (AUC-ROC 0.67 vs. 0.73 and 0.80, respectively, p < 0.05) and calibration curves confirmed an adequate prediction. Similar discrimination (C-statistics, p = 0.22) was observed in the prediction of high-grade cancer, thereby questioning the respective inputs and added values of biomarkers and clinical predictors in MDx-2 scores. Based on the results of this study, we can conclude that instruments of prediction developed for systematic prostate biopsies, including those that incorporate innovative biomarkers, must be reassessed and eventually confirmed in the context of upfront MRI and IGB.
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