Pathologic correlation of transperineal in-bore 3-Tesla magnetic resonance imaging-guided prostate biopsy samples with radical prostatectomy specimen

Focal Prostate Stereotactic Body Radiation Therapy With Correlative Pathological and Radiographic-Based Treatment Planning

Introduction

Advances in multiparametric MRI (mpMRI) combining anatomic and functional imaging can accurately identify foci of adenocarcinoma within the prostate, offering the possibility of partial gland therapy. We performed tandem prospective pilot trials to investigate the feasibility of focal prostate SBRT (f-SBRT) based on correlating diagnostic mpMRI and biopsies with confirmatory pathology in treatment planning.

Materials and Methods

Patients with pathologic focal Gleason 6–7 disease and a corresponding PIRADS 4–5 lesion on mpMRI underwent targeted and comprehensive biopsies using MRI/ultrasound fusion under electromagnetic sensor navigation. After rigorous analysis for imaging biopsy concordance, five of 18 patients were eligible to proceed to f-SBRT. Chi-squared test was used for differences from expected outcomes, and concordance was estimated with binomial distribution theory and Wilson’s method.

Results

Six patients had Gleason 6 and 12 had Gleason 3 + 4 disease (mean PSA: 5.8 ng/ml, range: 2.2–8.4). Absolute concordance was 43.8% (95% CI: 0.20, 0.64). Patterns of discordance included additional sites of ipsilateral disease, bilateral disease, and negative target. Five were upstaged to a new NCCN risk category necessitating treatment escalation. The five patients with concordant pathology completed three-fraction f-SBRT with sparing of the surrounding normal structures (including contralateral neurovascular bundle), with no reported grade 2+ toxicities and favorable PSA responses (mean: 41% decrease).

Conclusions

On our pilot trials of f-SBRT planning using rigorous imaging and pathology concordance, image-guided confirmatory biopsies frequently revealed additional disease, suggesting the need for caution in partial-gland therapy. For truly focal disease, f-SBRT provided excellent dosimetry, minimal toxicity, and encouraging biochemical response. Clinical Trial Registration: www.clinicaltrials.gov, NCT02681614; NCT02163317.

Evolution of prostate cancer diagnosis: retrospective analysis of magnetic resonance imaging/ultrasound fusion guided biopsies protocol in routine practice and patients management

Background

Magnetic resonance imaging (MRI) is today strongly recommended in prostate cancer (PCa) diagnosis. Therefore, MRI/ultrasound (MRI/US) fusion-guided biopsy is becoming the new standard patients management.

Methods

We report our experience during the last 4 years using this technique, with a protocol of 6 random cores (instead of the most used 12 cores protocol) associated to the target cores (2 to 3 per lesion). Our study involved 236 patients including real life routine practice: biopsy naïve patients (n=107), patients with previous negative standard prostate biopsies (n=67) and patients in PCa active surveillance (n=62). Finally, 76 patients have a robotic radical prostatectomy.

Results

Mean age of the population was 66 years. Median PSA was 8.5 ng/mL. Overall and significant cancer detection were respectively 66.6% and 38.5%, with a large difference considering biopsy history: 63.5% in biopsy naïve patient, 53.7% in patient with previous negative biopsies and 82.3% in patients under active surveillance. Targeted biopsies missed 28 cancers among 8 were significant and standard biopsies missed 33 cancers among 14 were significant. Moreover, concordance between biopsy samples and radical prostatectomy specimens was evaluated at 80%.

Conclusions

Comparing to literature data, similar results were observed in our retrospective study, even with reduced random cores, suggesting a real change in patients management in particular in active surveillance group with a reclassification rate of 56.4% using the Epstein criteria.

The factors predicting upgrading of prostate cancer by using International Society for Urological Pathology (ISUP) 2014 Gleason grading system

OBJECTIVE

To investigate the factors to predict Gleason score upgrading (GSU) of patients with prostate cancer who were evaluated by using the International Society for Urological Pathology (ISUP) 2014 Gleason grading system.

MATERIAL AND METHODS

Between January 2008 and December 2015, we retrospectively investigated patients who had undergone radical prostatectomy and followed up in the uro-oncology outpatient clinic. The pathologic specimens of the patients were evaluated based on the ISUP 2014 classification system. The patients were divided into two groups with or without upgraded Gleason scores. Factors that could be effective in predicting upgrading such as age, prostate-specific antigen (PSA), prostate volume, D'Amico risk classification, PSA density, cancer of the prostate risk assessment (CAPRA) scores, biopsy tumor percentage, body mass index, and clinical stage parameters were compared between both groups.

RESULTS

Of the 265 patients who could be evaluated and followed up regularly, Gleason score upgrades were observed in 110 (41.5%) patients. Advanced age (p=0.009), PSA >20 ng/mL (p=0.036), PSA density >0.35 (p=0.005), high CAPRA score (p=0.031), and high biopsy tumor percentage (p=0.009) were discovered to be correlated with Gleason score upgrade in univariate logistic regression analysis. Advanced age alone was a predictor for GSU in multivariate logistic regression analysis (p=0.002). Five-year biochemical recurrence-free survival rate was 86% in the non-GSU group and 55% in the GSU group (p<0.001).

CONCLUSION

GSU risk should be taken into consideration in making therapeutic decisions for older patients with prostate cancer, and precautions should be taken against development of aggressive disease.

The potentiality of laparoscopic partial liver excisional biopsy using analysis of the liver surface based on preoperative 3D simulation imaging: A case report

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Ultrasonography or CT guided biopsy is useful for diagnosis of liver tumors.

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Some tumors were not detectable with any modality except only MRI.

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3D simulation liver imaging can be created with CT and MRI images.

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Excisional biopsy using preoperative 3D simulation could provide a certain biopsy.

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Present biopsy method is effective for tumors that cannot be detected by CT or US.

Introduction

The imaging diagnostics of liver tumor are difficult. There are no effective biopsy examinations for liver tumors that cannot be detected even by ultrasonography (US) and computed tomography (CT). We report a remarkably useful biopsy method for such tumors.

Presentation of case

A 67-year-old man with hepatitis C underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, and the images revealed multiple delayed enhanced masses that showed high signal intensity in the hepatobiliary phase. The possibility of malignancy could not be ruled out due to the trend towards increased size of the masses. Percutaneous liver biopsy was considered impossible because CT and US could not detect the masses. Laparoscopic liver biopsy with preoperative simulation using 3D imaging was performed. The 3D imaging provided accurate information of liver surface irregularities with cirrhosis change. The tumor location was confirmed, and adequate tumor excisional biopsy was performed. Histological assessment revealed the tumor to be a focal nodular hyperplasia-like nodule.

Discussion and conclusions

Laparoscopic liver biopsy has been widely used because of its safety and accuracy. It enables accurate resection of tumors that are undetectable with CT and US by employing preoperative 3D imaging while maintaining the less-invasiveness.