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Araújo D, Gromicho A, Dias J, Bastos S, Maciel RM, Sabença A, Xambre L. Predictors of prostate cancer detection in MRI PI-RADS 3 lesions - Reality of a tertiary center. Arch Ital Urol Androl 2023; 95:11830. [PMID: 38117217 DOI: 10.4081/aiua.2023.11830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. METHODS Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. RESULTS A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy, 41 patients would have avoided biopsy (31.5%), but 5 cases of CsPCa would not have been detected (3.4%). We could not identify any statistical significance between other clinical and imagiological variables and CsPCa detection. CONCLUSIONS PI-RADS 3 lesions were associated with a low likelihood of CsPCa detection. A systematic biopsy associated or not with target biopsy is essential in PI-RADS 3 lesions, and targeted biopsy did not demonstrate to be superior in the detection of CsPCa. The presence of abnormal DRE and lesions localized in PZ potentially predict the presence of CsPCa in biopsied PI-RADS 3 lesions.
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Affiliation(s)
- Débora Araújo
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | | | - Jorge Dias
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | - Samuel Bastos
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | - Rui Miguel Maciel
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | - Ana Sabença
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
| | - Luís Xambre
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia.
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Kornienko K, Reuter M, Maxeiner A, Günzel K, Kittner B, Reimann M, Hofbauer SL, Wiemer LE, Heckmann R, Asbach P, Wendler JJ, Schostak M, Schlomm T, Friedersdorff F, Cash H. Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy. Sci Rep 2022; 12:13603. [PMID: 35948575 PMCID: PMC9365776 DOI: 10.1038/s41598-022-17260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance imaging/Ultrasound (MRI/US) fusion targeted biopsy (TB) in combination with a systematic biopsy (SB) improves cancer detection but limited data is available how to manage patients with a Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 4 lesion and a negative biopsy. We evaluate the real-world management and the rate of clinically significant Prostate Cancer (csPCa) during follow-up. 1546 patients with a multi-parametric MRI (mpMRI) and a PI-RADS ≥ 3 who underwent SB and TB between January 2012 and May 2017 were retrospectively analyzed. 222 men with a PI-RADS ≥ 4 and a negative biopsy were included until 2019. For 177/222 (80%) complete follow-up data was obtained. 66/84 (78%) had an initial PI-RADS 4 and 18 (22%) a PI-RADS 5 lesion. 48% (84/177) received a repeat mpMRI; in the follow-up mpMRI, 39/84 (46%) lesions were downgraded to PI-RADS 2 and 11 (13%) to PI-RADS 3; three cases were upgraded and 28 lesions remained consistent. 18% (32/177) men underwent repeated TB and csPCa was detected in 44% (14/32). Our study presents real world data on the management of men with a negative TB biopsy. Men with a positive mpMRI and lesions with high suspicion (PI-RADS4/5) and a negative targeted biopsy should be critically reviewed and considered for repeat biopsy or strict surveillance. The optimal clinical risk assessment remains to be further evaluated.
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Affiliation(s)
- Kira Kornienko
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Miriam Reuter
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Vivantes Am Urban, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Sebastian L Hofbauer
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Laura E Wiemer
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Robin Heckmann
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Patrick Asbach
- Clinic for Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Schostak
- Department of Urology, University Magdeburg, Magdeburg, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany.
- Department of Urology, University Magdeburg, Magdeburg, Germany.
- PROURO, Berlin, Germany.
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Kamitani N, Miyaji Y, Tamada T, Yoden E, Kawata Y, Watanabe K, Tokiya R, Nagai A, Katsui K. Feasibility of magnetic resonance imaging-ultrasound guided high-dose-rate brachytherapy for localized prostate cancer: Preliminary results from a prospective study. Int J Urol 2022; 29:725-732. [PMID: 35355325 DOI: 10.1111/iju.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate preliminary outcomes of a prospective trial of magnetic resonance imaging-ultrasound fusion-guided ultrafocal high-dose-rate brachytherapy in localized prostate cancer. METHODS In our prospective study, data from patients who underwent this treatment between April 1, 2020 and March 31, 2021 were analyzed. In the procedure, the applicator needle was inserted through the perineum to target the lesion on the multiparametric magnetic resonance imaging, which was fused onto the transrectal ultrasound image. The prescription dose was set at a single fraction of 19 Gy. Data from patients who received whole-gland high-dose-rate brachytherapy were extracted and compared with data from patients who received ultrafocal high-dose-rate brachytherapy, to evaluate the frequency of acute adverse events. RESULTS Eight patients underwent ultrafocal high-dose-rate brachytherapy with a median observation period of 7.75 months (range 5.96-15.36 months). No acute genitourinary or gastrointestinal adverse events were observed in this cohort. The planned procedure was completed in all patients, and no unexpected adverse events were observed; however, prostate-specific antigen failure was detected in one patient. In the 25 patients who underwent whole-gland high-dose-rate brachytherapy, acute genitourinary and gastrointestinal adverse events were observed in 88% and 20% of the patients, respectively. Ultrafocal high-dose-rate brachytherapy was a significant factor in avoiding acute adverse genitourinary events in univariate and multivariate analyses (P < 0.001 and P = 0.032, respectively). CONCLUSIONS Magnetic resonance imaging-ultrasound fusion-guided ultrafocal high-dose-rate brachytherapy in localized prostate cancer is a safe and feasible treatment without acute genitourinary and gastrointestinal adverse events. Long-term observation and further investigation are warranted.
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Affiliation(s)
- Nobuhiko Kamitani
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Tsutomu Tamada
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Eisaku Yoden
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yujiro Kawata
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kenta Watanabe
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Ryouji Tokiya
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Atsushi Nagai
- Department of Urology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kuniaki Katsui
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Alqahtani S, Zhang X, Wei C, Zhang Y, Szewczyk-Bieda M, Wilson J, Huang Z, Nabi G. Predicting the Performance of Concurrent Systematic Random Biopsies during Image Fusion Targeted Sampling of Multi-Parametric MRI Detected Prostate Cancer. A Prospective Study (PRESET Study). Cancers (Basel) 2021; 14:cancers14010001. [PMID: 35008165 PMCID: PMC8750557 DOI: 10.3390/cancers14010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The study provides a predictive model by using clinical factors in selecting men who may benefit from the addition of systematic biopsies with an image fusion targeted approach. The approach is likely to improve the detection of csPCa and avoid unnecessary detection of indolent prostate cancers. Abstract The study was aimed to develop a predictive model to identify patients who may benefit from performing systematic random biopsies (SB) in addition to targeted biopsies (TB) in men suspected of having prostate cancer. A total of 198 patients with positive pre-biopsy MRI findings and who had undergone both TB and SB were prospectively recruited into this study. The primary outcome was detection rates of clinically significant prostate cancer (csPCa) in SB and TB approaches. The secondary outcome was net clinical benefits of SB in addition to TB. A logistic regression model and nomogram construction were used to perform a multivariate analysis. The detection rate of csPCa using SB was 51.0% (101/198) compared to a rate of 56.1% (111/198) for TB, using a patient-based biopsy approach. The detection rate of csPCa was higher using a combined biopsy (64.6%; 128/198) in comparison to TB (56.1%; 111/198) alone. This was statistically significant (p < 0.001). Age, PSA density and PIRADS score significantly predicted the detection of csPCa by SB in addition to TB. A nomogram based on the model showed good discriminative ability (C-index; 78%). The decision analysis curve confirmed a higher net clinical benefit at an acceptable threshold.
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Affiliation(s)
- Saeed Alqahtani
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK; (S.A.); (C.W.)
- School of Science and Engineering, University of Dundee, Dundee DD1 9SY, UK; (Y.Z.); (Z.H.)
- Department of Radiological sciences, College of Applied Medical Science, Najran University, Najran 11001, Saudi Arabia
| | - Xinyu Zhang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee DD1 9SY, UK;
| | - Cheng Wei
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK; (S.A.); (C.W.)
| | - Yilong Zhang
- School of Science and Engineering, University of Dundee, Dundee DD1 9SY, UK; (Y.Z.); (Z.H.)
| | | | - Jennifer Wilson
- Department of Pathology, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK;
| | - Zhihong Huang
- School of Science and Engineering, University of Dundee, Dundee DD1 9SY, UK; (Y.Z.); (Z.H.)
| | - Ghulam Nabi
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK; (S.A.); (C.W.)
- Correspondence:
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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] [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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Barletta F, Stabile A, Mazzone E, Brembilla G, Sorce G, Pellegrino F, Scuderi S, Cannoletta D, Cirulli GO, Cucchiara V, Gandaglia G, De Cobelli F, Montorsi F, Briganti A. How to optimize follow-up in patients with a suspicious multiparametric MRI and a subsequent negative targeted prostate biopsy. Results from a large, single-institution series. Urol Oncol 2021; 40:103.e17-103.e24. [PMID: 34688534 DOI: 10.1016/j.urolonc.2021.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/05/2021] [Accepted: 09/24/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aimed at optimizing the follow-up for patients with a positive multiparametric magnetic resonance of the prostate (mpMRI) and a subsequent negative targeted biopsy (TBx) plus systematic biopsy (SBx). MATERIALS AND METHODS A total of 308 men with a clinical suspicion of PCa and a positive mpMRI (PI-RADS ≥ 3) with concomitant negative systematic and targeted Bx performed at a single tertiary referral center. All patients were then followed with serial PSA measurements, digital rectal examination and eventual follow-up mpMRI and/or repeat Bx. The primary outcome was to evaluate the overall clinically significant PCa (csPCa)-free survival. The secondary outcome was to assess the role of a repeat mpMRI (Fu-mpMRI) and PSA density as predictors of csPCa diagnosis (defined as Gleason score ≥ 3 + 4) during follow-up. Kaplan Meier analysis and univariable Cox regression were used for survival and predictive analyses. RESULTS Median follow-up was 31 months (IQR: 23-43). During the study period 116 (37.7%) and 68 (22.1%) of men received a Fu-mpMRI and a Fu-Bx, respectively. Overall, 51 (16.6%) and 15 (4.9%) patients had a positive mpMRI and clinically significant (csPCa) diagnosis during follow-up, respectively. Among 68 men who received a Fu-Bx, the 2- and 3-years csPCa diagnosis-free survival in men with negative vs. positive Fu-mpMRI was 97% vs. 65% and 92% vs. 65%, respectively. At univariate Cox-regression analysis the presence of a positive Fu-mpMRI resulted to be significantly associated with the presence of csPCa at Fu-Bx (HR: 5.8, 95% CI: 1.3-26.6, P = 0.008). The 2- and 3-years csPCa diagnosis-free survival in men with PSAd <0.15 vs. ≥0.15 was 89% vs. 77%, and 86% vs. 66%, respectively (HR: 2.6, 95% CI: 0.75-8.87, P = 0.13). The combination of negative Fu-mpMRI and PSAd<0.15 furtherly reduced the probability of csPCa diagnosis at Fu-Bx at only 6% at 3years (HR: 9.9, 95% CI: 1.9-38.6, P < 0.001) in this subgroup of patients. CONCLUSIONS After a negative TBx for a positive mpMRI, more than half of Fu-mpMRI were negative. A persistent positive mpMRI was associated with a significant risk of csPCa. The risk of csPCa diagnosis in men with negative mpMRI performed after negative TBx and low PSAd was negligible.
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Affiliation(s)
- Francesco Barletta
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Sorce
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Scuderi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Donato Cannoletta
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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7
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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] [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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8
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Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy? Diagnostics (Basel) 2021; 11:diagnostics11081335. [PMID: 34441270 PMCID: PMC8392157 DOI: 10.3390/diagnostics11081335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Our aim was to assess the value of adding standard biopsy to targeted biopsy in cases of suspicious multiparametric magnetic resonance imaging (mp-MRI) and also to evaluate when a biopsy of a PI-RADS 3 lesion could be avoided. METHODS A retrospective study of patients who underwent targeted biopsy plus standard systematic biopsy between 2016-2019 was performed. All the 1.5 T magnetic resonance images were evaluated according to PI-RADSv.2. An analysis focusing on the clinical scenario, lesion location, and PI-RADS score was performed. RESULTS A total of 483 biopsies were evaluated. The mean age was 65 years, with a PSA density of 0.12 ng/mL/cc. One-hundred and two mp-MRIs were categorized as PI-RADS-3. Standard biopsy was most helpful in detecting clinically significant prostate cancer (csPCa) in patients in the active surveillance (AS) cohort (increasing the detection rate 12.2%), and in peripheral lesions (6.5%). Adding standard biopsy showed no increase in the detection rate for csPCa in patients with PI-RADS-5 lesions. Considering targeted biopsy in patients with PI-RADS 3 lesions, a higher detection rate was shown in biopsy-naïve patients versus AS and in patients with a previous negative biopsy (p = 0.002). Furthermore, in these patients, the highest rate of csPCa detection was in anterior lesions [42.9% (p = 0.067)]. CONCLUSIONS Our results suggest that standard biopsy could be safely omitted in patients with anterior lesions and in those with PI-RADS-5 lesions. Targeted biopsy for PI-RADS-3 lesions would be less effective in peripheral lesions with a previous negative biopsy.
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9
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Checcucci E, Piramide F, Amparore D, De Cillis S, Granato S, Sica M, Verri P, Volpi G, Piana A, Garrou D, Manfredi M, Fiori C, Porpiglia F. Beyond the Learning Curve of Prostate MRI/TRUS Target Fusion Biopsy after More than 1000 Procedures. Urology 2021; 155:39-45. [PMID: 34224778 DOI: 10.1016/j.urology.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the learning curve (LC) of two urology residents in the execution of fusion biopsy (FB) in terms of overall prostate cancer (PCa) and clinically significant (cs) PCa detection rate (DR) and according to different characteristics of the lesions on MRI MATERIAL AND METHODS: We analyzed data from our prospective maintained FB database between January 2015 and December 2019. FB was performed using the BioJet fusion system (D&K Technologies, Barum, Germany) with a transrectal or transperineal approach. An ANOVA test was used to evaluate the homogeneity of our cohort. Multivariable linear and logistic regression analysis were used to evaluate the relationship between operator experience and DR for PCa and csPCa. Then, the postprocedural complication rate trend was evaluated. RESULTS 1005 patients were included. The overall DR of PCa was 61.2% (615/1005) [IC 0.58 - 0.64]; whilst DR for csPCA was 54.6% (549/1005) [IC 0.51 - 0.57]. Operator experience does not seem to influence the DR of overall PCa and csPCa; whilst for lesions <8 mm in diameter, PCa and csPCa DR increased significantly with operator experience (P = 0.048 and P = 0.038, respectively). Postprocedural complications remained stable during the whole study period (P = 0.75). CONCLUSION A standardized FB approach turned out to be feasible, safe, and effective since the beginning of the residents' LC. PCa and csPCa DR remained stable, at 60% and 55% respectively, after more than 1,000 biopsies. However, for lesions smaller than 8 mm, at least 100 FB of experience is needed to correctly sample the area.
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Affiliation(s)
- Enrico Checcucci
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, 10043.
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Stefano Granato
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Gabriele Volpi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Diletta Garrou
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, 10043
| | - Matteo Manfredi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
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10
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Checcucci E, De Cillis S, Amparore D, Garrou D, Aimar R, Piana A, Piramide F, Granato S, Cattaneo G, Manfredi M, Fiori C, Bollito E, Stura I, Migliaretti G, Porpiglia F. Naive patients with suspicious prostate cancer and positive multiparametric magnetic resonance imaging (mp-MRI): is it time for fusion target biopsy alone? JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211023713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To determine if standard biopsy still has a role in the detection of prostate cancer or clinically significant prostate cancer in biopsy-naive patients with positive multiparametric magnetic resonance imaging. Materials and methods: We extracted, from our prospective maintained fusion biopsy database, patients from March 2014 to December 2018. The detection rate of prostate cancer and clinically significant prostate cancer and complication rate were analysed in a cohort of patients who underwent fusion biopsy alone (group A) or fusion biopsy plus standard biopsy (group B). The International Society of Urological Pathology grade group determined on prostate biopsy with the grade group determined on final pathology among patients who underwent radical prostatectomy were compared. Results: Prostate cancer was found in 249/389 (64.01%) and 215/337 (63.8%) patients in groups A and B, respectively ( P=0.98), while the clinically significant prostate cancer detection rate was 57.8% and 55.1% ( P=0.52). No significant differences in complications were found. No differences in the upgrading rate between biopsy and final pathology finding after radical prostatectomy were recorded. Conclusions: In biopsy-naive patients, with suspected prostate cancer and positive multiparametric magnetic resonance imaging the addition of standard biopsy to fusion biopsy did not increase significantly the detection rate of prostate cancer or clinically significant prostate cancer. Moreover, the rate of upgrading of the cancer grade group between biopsy and final pathology was not affected by the addition of standard biopsy. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, Italy
- Department of Pathology, San Luigi Gonzaga Hospital, Italy
| | | | | | - Diletta Garrou
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | - Roberta Aimar
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | | | | | | | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, University of Turin, Italy
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11
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Cata ED, Van Praet C, Andras I, Kadula P, Ognean R, Buzoianu M, Leucuta D, Caraiani C, Tamas-Szora A, Decaestecker K, Coman I, Crisan N. Analyzing the learning curves of a novice and an experienced urologist for transrectal magnetic resonance imaging-ultrasound fusion prostate biopsy. Transl Androl Urol 2021; 10:1956-1965. [PMID: 34159076 PMCID: PMC8185669 DOI: 10.21037/tau-21-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The aim of the current study was to evaluate and compare the learning curves of transrectal magnetic resonance imaging-ultrasound fusion biopsy for two urologists with different backgrounds (Operator 1: experienced, self-trained and Operator 2: novice, trained by a mentor/MRI reading courses). Methods A cohort of 400 patients who underwent fusion prostate biopsy in our department was analyzed. The learning curves were assessed in terms of overall and clinically significant prostate cancer (PCa) detection rates, percentage of positive biopsy cores/targeted and the percentage of PCa tissue on positive targeted cores. Results Increasing trends were observed for both urologists in terms of all biopsy outcomes during the study time. For the novice urologist, a significant increase was observed for overall PCa detection rate, but not for clinically significant disease (25.44%, P=0.04/15%, P=0.145). Operator 1 showed an increasing diagnosis yield of clinically significant disease up to 104 cases. Similar cancer detection rates were observed when comparing the first and last biopsies performed by both operators. Multivariate analysis adjusted for age, PSA, prostate volume, lesion diameter and PIRADS score showed an increase of PCa detection with 51% for every 52 biopsies performed (P=0.022). Conclusions When starting with magnetic resonance imaging-ultrasound fusion prostate biopsy, mentoring and prostate magnetic resonance imaging reading training allow a novice urologist to demonstrate a good initial PCa detection rate. After about 52 cases, he reached a stable PCa and clinically significant PCa detection rate, that was similar to that of an experienced urologist.
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Affiliation(s)
- Emanuel Darius Cata
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | | | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Pierre Kadula
- Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Razvan Ognean
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maximilian Buzoianu
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Cosmin Caraiani
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | | | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
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12
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Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study. Eur Urol Oncol 2021; 5:176-186. [PMID: 33846112 DOI: 10.1016/j.euo.2021.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/21/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa. OBJECTIVE To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC). DESIGN, SETTING, AND PARTICIPANTS Men with MRI-visible prostate lesions underwent combined TBx plus SBx. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score. RESULTS AND LIMITATIONS Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (7.5% vs 8%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%). CONCLUSIONS While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%). PATIENT SUMMARY Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544.
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13
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von Landenberg N, Hanske J, Noldus J, Roghmann F, Tully KH, Wald J, Berg S, Brock M. Probability of Prostate Cancer Diagnosis following Negative Systematic and Targeted MRI: Transrectal Ultrasound Fusion Biopsy: A Real-Life Observational Study. Urol Int 2021; 105:446-452. [PMID: 33498059 DOI: 10.1159/000513075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The risk of occult prostate carcinoma (PCa) after negative multiparametric MRI (mpMRI)-transrectal fusion biopsy (F-Bx) is unknown. To determine the false-negative predictive value, we examined PCa detection after prior negative F-Bx. METHODS Between December 2012 and November 2016, 491 patients with suspected PCa and suspicious mpMRI findings underwent transrectal F-Bx. Patients with benign pathology (n = 191) were eligible for our follow-up (FU) survey. Patient characteristics and clinical parameters were correlated to subsequent findings of newly detected PCa. RESULTS Complete FU with a median of 31 (interquartile range: 17-39) months was available for 176/191 (92.2%) patients. Of those, 54 men had either surgical interventions on the prostate or re-Bxs. Newly detected PCa was evident in 14/176 (7.95%) patients stratified to ISUP ≤2 in 10 and ≥3 in 4 cases. The comparison of patients with newly detected PCa to those without cancerous findings in FU showed significant differences in prostate-specific antigen (PSA) density (0.16 vs. 0.13 ng/mL2) and prostate volume (45 vs. 67 mL, both p < 0.05). Both factors are significant predictors for newly detected cancer after initial negative F-Bx. CONCLUSION Only PSA density (>0.13 ng/mL2) and small prostate volume are significant predictors for newly detected PCa after initial negative F-Bx. Despite negative mpMRI/TRUS F-Bx results, patients should be further monitored due to a risk of developing PCa over time. Notwithstanding the limitation of our study that not all patients underwent another Bx, we assume that the false-negative rate is low but existing. Our data represent a real-world scenario.
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Affiliation(s)
| | - Julian Hanske
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- 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
| | - Sebastian Berg
- 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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14
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Tan G, Jiang L, Li G, Bai K. ESTAT3 Inhibitor AG-490 Inhibits the Growth of Prostate Cancer by miR-503-5p Both In Vivo and In Vitro. Technol Cancer Res Treat 2020; 19:1533033820948062. [PMID: 33063634 PMCID: PMC7580129 DOI: 10.1177/1533033820948062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To explore the effect and the related mechanism of STAT3 inhibitor AG-490 on inhibiting the proliferation of prostate cancer cells. Methods: PC3 cells and DU145 cells were cultured stably and treated with AG-490 to detect the changes in the activity of PC3 cells and DU145 cells. Thirty 6-8 weeks male BALB/c nude mouse were randomly divided into a control group, a DMSO group, and an AG-490 group to detect differences in various indexes . Results: The overexpression of miR-503-5p depends on the activation of STAT3. After treatment with AG-490, The proliferation and invasion of PC3 cells and DU145 cells and the expression of miR-503-5p were all reduced. Luciferase reporter assay demonstrated that the target proteins of miR-503-5p include PDCD4, TIMP-3, and PTEN. After treatment with AG-490, the expression of PDCD4, TIMP-3, and PTEN in cells was significantly up-regulated. IL-6-induced overexpression of miR-503-5p and restored the expression of STAT3, demonstrating the correlation between STAT3 and miR-503-5p. AG-490 can inhibit tumor growth and induce tumor cell apoptosis in the PC3 BALB/c nude mouse xenograft model. Western blotting and immunohistochemical staining showed that the expression levels of STAT3, Ki67, Bcl-2 and MMP-2 in the AG-490 group were significantly reduced, and the expression of PDCD4, TIMP-3 and PTEN increased. Conclusion: AG-490 can inhibit the growth of prostate cancer cells in a miR-503-5p-dependent manner by targeting STAT3. AG-490 is expected to become a new candidate drug for the treatment of prostate cancer.
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Affiliation(s)
- Guangxing Tan
- Wuxi Hospital of Traditional Chinese Medicine, Wuxi, People Republic of China
| | - Lin Jiang
- Wuxi Hospital of Traditional Chinese Medicine, Wuxi, People Republic of China
| | - Gangqin Li
- Wuxi Hospital of Traditional Chinese Medicine, Wuxi, People Republic of China
| | - Kuan Bai
- Wuxi Hospital of Traditional Chinese Medicine, Wuxi, People Republic of China
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15
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Diagnostic performance of PI-RADS version 2.1 compared to version 2.0 for detection of peripheral and transition zone prostate cancer. Sci Rep 2020; 10:15982. [PMID: 32994502 PMCID: PMC7525456 DOI: 10.1038/s41598-020-72544-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/02/2020] [Indexed: 01/20/2023] Open
Abstract
The purpose of this study is to compare diagnostic performance of Prostate Imaging Reporting and Data System (PI-RADS) version (v) 2.1 and 2.0 for detection of Gleason Score (GS) ≥ 7 prostate cancer on MRI. Three experienced radiologists provided PI-RADS v2.0 scores and at least 12 months later v2.1 scores on lesions in 333 prostate MRI examinations acquired between 2012 and 2015. Diagnostic performance was assessed retrospectively by using MRI/transrectal ultrasound fusion biopsy and 10-core systematic biopsy as the reference. From a total of 359 lesions, GS ≥ 7 tumor was present in 135 lesions (37.60%). Area under the ROC curve (AUC) revealed slightly lower values for peripheral zone (PZ) and transition zone (TZ) scoring in v2.1, but these differences did not reach statistical significance. A significant number of score 2 lesions in the TZ were downgraded to score 1 in v2.1 showing 0% GS ≥ 7 tumor (0/11). The newly introduced diffusion-weighted imaging (DWI) upgrading rule in v2.1 was applied in 6 lesions from a total of 143 TZ lesions (4.2%). In summary, PI-RADS v2.1 showed no statistically significant differences in overall diagnostic performance of TZ and PZ scoring compared to v2.0. Downgraded BPH nodules showed favorable cancer frequencies. The new DWI upgrading rule for TZ lesions was applied in only few cases.
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16
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Falagario UG, Lantz A, Jambor I, Martini A, Ratnani P, Wagaskar V, Treacy PJ, Veccia A, Bravi CA, Bashorun HO, Phillip D, Lewis S, Haines K, Cormio L, Carrieri G, Tewari A. Using biomarkers in patients with positive multiparametric magnetic resonance imaging: 4Kscore predicts the presence of cancer outside the index lesion. Int J Urol 2020; 28:47-52. [PMID: 32985040 DOI: 10.1111/iju.14385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/30/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate if the blood biomarker, 4Kscore, in addition to multiparametric magnetic resonance imaging information could identify patients who would benefit from undergoing only a targeted biopsy. METHODS We retrospectively analyzed a population of 256 men with positive multiparametric magnetic resonance imaging who underwent standard + targeted biopsy at Mount Sinai Hospital, New York, NY, USA. 4Kscore (OPKO Health, Miami, FL, USA) was sampled from all patients before biopsy. Uni- and multivariable binary logistic regression analyses were carried out to predict clinically significant prostate cancer, defined as International Society of Urological Pathology grade group ≥2, in standard biopsy cores. The model with the best area under the curve was selected and internal validation was carried out using the leave-one-out cross-validation. RESULTS The developed model showed an area under the curve of 0.86. Carrying out only targeted biopsy in patients with a model-derived probability <12.5% resulted in 39.5% (n = 101) fewer standard biopsies and a 33.9% (n = 20) reduction of detecting grade group 1 disease, while missing grade group ≥2 in 5.2% (n = 4) using standard biopsy only and 1.1% (n = 1) using standard biopsy + targeted biopsy. CONCLUSIONS 4Kscore in combination with multiparametric magnetic resonance imaging can help to reduce unnecessary standard biopsy and decrease detection of clinically insignificant prostate cancer.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, University of Turku, Turku, Finland
| | - Alberto Martini
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alessandro Veccia
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Hafis O Bashorun
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deron Phillip
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Elfatairy KK, Filson CP, Sanda MG, Osunkoya AO, Nour SG. In-Bore MRI-guided Prostate Biopsies in Patients with Prior Positive Transrectal US-guided Biopsy Results: Pathologic Outcomes and Predictors of Missed Cancers. Radiol Imaging Cancer 2020; 2:e190078. [PMID: 33033806 PMCID: PMC7523503 DOI: 10.1148/rycan.2020190078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/25/2020] [Accepted: 05/06/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the role of confirmatory in-bore MRI-guided biopsy in patients with low- or intermediate-risk disease diagnosed at prior transrectal US-guided biopsy and to evaluate the rate and predictors for missed cancers. Materials and Methods A retrospective evaluation of 50 consecutive men who had previously undergone transrectal US-guided biopsy with positive results and who underwent subsequent in-bore MRI-guided biopsy at our university hospital (average time interval, 11 months) between 2012 and 2016 was performed. Ten men were excluded because of a history of treatment after transrectal US-guided biopsy. A total of 40 men (mean age, 63 years; range, 47-84 years) were included in this study. Multiparametric 3-T MRI (T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced) and transrectal in-bore MRI-guided biopsy were performed. Cancer detection, disease-grade changes, and cancers missed at in-bore MRI-guided biopsy were evaluated. Descriptive statistics were used to report different rates. The Fisher exact test was used for categoric variables. The Mann-Whitney U test and independent Student t test were used for nonparametric and parametric data, respectively. The McNemar test was used for paired data. Results The overall cancer detection rate when using in-bore MRI-guided biopsy was 65% (26 of 40). In-bore MRI-guided biopsy detected 14 previously undiscovered cancerous lesions (clinically significant cancers [CSCs], 57.1% [eight of 14]). An overall disease upgrade by in-bore MRI-guided biopsy occurred in 40% (16 of 40) of cases (61.5% [16 of 26] of cases with positive results from in-bore MRI-guided biopsy). One case was downgraded from a Gleason score (GS) of 3 + 4 = 7 to a GS of 3 + 3 = 6. Out of 71 sextant biopsies with positive results detected by transrectal US-guided biopsy (from all 40 patients), 80% (57 of 71) were visible on MR images (in-bore MRI-guided biopsy results were positive in 52.6% [30 of 57]), and 20% (14 of 71) had no image correlates on MR images. In-bore MRI-guided biopsy upgraded 60% (18 of 30) and downgraded 3.3% (one of 30) of detected lesions. The false-negative rate was 35% (14.2% [two of 14] of patients had CSCs; GS ≥ 7), was higher in prostate volumes of greater than 40 mL, and was lower in the anterior gland location (P = .04 and .01, respectively). Conclusion Performing confirmatory in-bore MRI-guided biopsy following positive transrectal US-guided biopsy resulted in a high disease-upgrade incidence with subsequently improved disease-risk stratification, particularly when considering patients for active surveillance or focal therapy. Supplemental material is available for this article. © RSNA, 2020See also the commentary by Weiss and Solomon in this issue.
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Affiliation(s)
| | - Christopher P. Filson
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Martin G. Sanda
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Adeboye O. Osunkoya
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
| | - Sherif G. Nour
- From the Department of Radiology and Imaging Sciences (K.K.E., S.G.N.), Interventional MRI Program (K.K.E., S.G.N.), Department of Urology (C.P.F., M.G.S., A.O.O.), and Department of Pathology (A.O.O.), School of Medicine, and Winship Cancer Institute (C.P.F., M.G.S., A.O.O., S.G.N.), Emory University, 1364 Clifton Rd NE, Room BG-42, Atlanta, GA 30322; Atlanta Veterans Affairs Medical Center, Decatur, Ga (C.P.F., M.G.S.); Department of Pathology, Veterans Affairs Medical Center, Atlanta, Ga (A.O.O.); and Department of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt (K.K.E.)
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18
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Abstract
PURPOSE OF REVIEW Rapid advances in imaging of the prostate have facilitated the development of focal therapy and provided a non-invasive method of estimating tumour volume. Focal therapy relies on an accurate estimate of tumour volume for patient selection and treatment planning so that the optimal energy dose can be delivered to the target area(s) of the prostate while minimising toxicity to surrounding structures. This review provides an overview of different imaging modalities which may be used to optimise tumour volume assessment and critically evaluates the published evidence for each modality. RECENT FINDINGS Multi-parametric MRI (mp-MRI) has become the standard tool for patient selection and guiding focal therapy treatment. The current evidence suggests that mp-MRI may underestimate tumour volume, although there is a large variability in results. There remain significant methodological challenges associated with pathological processing and accurate co-registration of histopathological data with mp-MRI. Advances in different ultrasound modalities are showing promise but there has been limited research into tumour volume estimation. The role of PSMA PET/CT is still evolving and further investigation is needed to establish if this is a viable technique for prostate tumour volumetric assessment. mp-MRI provides the necessary tumour volume information required for selecting patients and guiding focal therapy treatment. The potential for underestimation of tumour volume should be taken into account and an additional margin applied to ensure adequate treatment coverage. At present, there are no other viable image-based alternatives although advances in new technologies may refine volume estimations in the future.
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19
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Matsuoka Y, Uehara S, Yoshida S, Tanaka H, Tanaka H, Kijima T, Yokoyama M, Ishioka J, Saito K, Fujii Y. Value of extra-target prostate biopsy for the detection of magnetic resonance imaging-missed adverse pathology according to the Prostate Imaging Reporting and Data System scores: Spatial analysis using magnetic resonance-ultrasound fusion images. Int J Urol 2020; 27:760-766. [PMID: 32594578 DOI: 10.1111/iju.14295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To clarify who benefits from extra-target sampling of systematic prostate biopsy to detect magnetic resonance imaging-missed significant cancer and upgrading, when concurrently carried out with magnetic resonance imaging-ultrasound fusion targeted biopsy. METHODS Targeted biopsy and systematic biopsy were carried out in 301 men with Prostate Imaging Reporting and Data System scores ≥3. All score ≥3 regions were designated as targets. According to patients' highest Prostate Imaging Reporting and Data System scores, spatial relations between targets and biopsy-proven cancer were investigated to identify magnetic resonance imaging-missed pathology. RESULTS Overall, targeted biopsy and systematic biopsy detected significant cancer in 56.5% and 46.5%, respectively (P < 0.001). Significant cancer was detected only by systematic biopsy in 7.0%, and only outside targets in 5.0%. Upgrading by systematic biopsy was observed in 16.3%, and occurred outside targets in 11.0%. On multivariate analysis, the highest Prostate Imaging Reporting and Data System 4 was predictive for significant cancer only outside targets (odds ratio 5.81, P = 0.002) and for upgrading derived from outside targets (odds ratio 2.64, P = 0.012). According to the scores of 3, 4 and 5, significant cancer was identified only outside targets in 1.0%, 11.2% and 2.9%, respectively (P = 0.003 for Prostate Imaging Reporting and Data System 3 vs 4; P = 0.019 for Prostate Imaging Reporting and Data System 4 vs 5), and upgrading occurred in 6.1%, 18.4% and 8.6%, respectively (P = 0.009 and 0.040). CONCLUSIONS Men with the highest Prostate Imaging Reporting and Data System score 4 receive the largest benefit from extra-target biopsy for magnetic resonance imaging-missed significant cancer detection and upgrading. In men with a score of 3, less adverse pathology is missed without extra-target biopsy. These findings suggest prostate biopsy strategy could be tailored according to Prostate Imaging Reporting and Data System scores.
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Affiliation(s)
- Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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20
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Rudolph MM, Baur ADJ, Haas M, Cash H, Miller K, Mahjoub S, Hartenstein A, Kaufmann D, Rotzinger R, Lee CH, Asbach P, Hamm B, Penzkofer T. Validation of the PI-RADS language: predictive values of PI-RADS lexicon descriptors for detection of prostate cancer. Eur Radiol 2020; 30:4262-4271. [PMID: 32219507 PMCID: PMC7338829 DOI: 10.1007/s00330-020-06773-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/22/2020] [Accepted: 02/21/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the discriminatory power of lexicon terms used in PI-RADS version 2 to describe MRI features of prostate lesions. METHODS Four hundred fifty-four patients were included in this retrospective, institutional review board-approved study. Patients received multiparametric (mp) MRI and subsequent prostate biopsy including MRI/transrectal ultrasound fusion biopsy and 10-core systematic biopsy. PI-RADS lexicon terms describing lesion characteristics on mpMRI were assigned to lesions by experienced readers. Positive and negative predictive values (PPV, NPV) of each lexicon term were assessed using biopsy results as a reference standard. RESULTS From a total of 501 lesions, clinically significant prostate cancer (csPCa) was present in 175 lesions (34.9%). Terms related to findings of restricted diffusion showed PPVs of up to 52.0%/43.9% and NPV of up to 91.8%/89.7% (peripheral zone or PZ/transition zone or TZ). T2-weighted imaging (T2W)-related terms showed a wide range of predictive values. For PZ lesions, high PPVs were found for "markedly hypointense," "lenticular," "lobulated," and "spiculated" (PPVs between 67.2 and 56.7%). For TZ lesions, high PPVs were found for "water-drop-shaped" and "erased charcoal sign" (78.6% and 61.0%). The terms "encapsulated," "organized chaos," and "linear" showed to be good predictors for benignity with distinctively low PPVs between 5.4 and 6.9%. Most T2WI-related terms showed improved predictive values for TZ lesions when combined with DWI-related findings. CONCLUSIONS Lexicon terms with high discriminatory power were identified (e.g., "markedly hypointense," "water-drop-shaped," "organized chaos"). DWI-related terms can be useful for excluding TZ cancer. Combining T2WI- with DWI findings in TZ lesions markedly improved predictive values. KEY POINTS • Lexicon terms describing morphological and functional features of prostate lesions on MRI show a wide range of predictive values for prostate cancer. • Some T2-related terms have favorable PPVs, e.g., "water-drop-shaped" and "organized chaos" while others show less distinctive predictive values. DWI-related terms have noticeable negative predictive values in TZ lesions making DWI feature a useful tool for exclusion of TZ cancer. • Combining DWI- and T2-related lexicon terms for assessment of TZ lesions markedly improves PPVs. Most T2-related lexicon terms showed a significant decrease in PPV when combined with negative findings for "DW hyperintensity."
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Affiliation(s)
- Madhuri M Rudolph
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Alexander D J Baur
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 13353, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 13353, Berlin, Germany
| | - Samy Mahjoub
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Urology, Universität zu Köln, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Germany
| | - Alexander Hartenstein
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Kaufmann
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Roman Rotzinger
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Chau Hung Lee
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Patrick Asbach
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
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21
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Hupe MC, Offermann A, Tharun L, Fürschke A, Frydrychowicz A, Garstka N, Shariat SF, Barkhausen J, Merseburger AS, Kramer MW, Perner S. Histomorphological analysis of false positive PI-RADS 4 and 5 lesions. Urol Oncol 2020; 38:636.e7-636.e12. [PMID: 32113858 DOI: 10.1016/j.urolonc.2020.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/21/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI)/ultrasound fusion-guided biopsy, in short "targeted biopsy (TB)", is becoming more attractive as it improves the detection of clinically significant prostate cancer (CaP). The accuracy of fusion-guided biopsies is limited due to false positive radiological findings as well as to histological evidence for cancer in radiologically inconspicuous regions of the prostate. We aimed to analyze histomorphological findings on mpMRI lesions highly suspicious for CaP classified as PI-RADS 4 or PI-RADS 5 (Prostate Imaging - Recording and Data System) but cancer-negative in the biopsy of this region of interest (ROI), and to compare them with findings in radiologically inconspicuous regions. MATERIALS AND METHODS We re-evaluated prostate biopsies from 57 patients who underwent TB in combination with systematic standard biopsy (SB) from June 2017 to July 2018 at the University Hospital Schleswig Holstein Campus Luebeck. Out of 143 ROIs, 34 PI-RADS 4/5 cancer-negative lesions were identified and subjected to comprehensive histomorphological reevaluation. Contralateral cancer-negative SBs were used as control. Chi-square test was used for statistical analysis. RESULTS The frequency of histomorphological alterations including stromal, glandular, vascular, and inflammatory alterations were 97% and 79.2% in prostatic tissues from cancer-negative TBs and SBs, respectively. Stromal, glandular, and inflammatory alterations were present in the majority of biopsies from both TBs and SBs. Statistical analysis revealed no significant difference between TBs and SBs with regard to stromal, glandular, and inflammatory alterations. However, vascular abnormalities were exclusively detected in TBs (18.2%). CONCLUSION The frequency of histomorphological alterations is slightly higher in prostate tissues from TBs compared to SB. Only vascular alterations seem to be distinct for TBs. However, it has to be assumed that additional factors influence the false-negative rate of mpMRI/ultrasound fusion-guided TB.
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Affiliation(s)
| | - Anne Offermann
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany; Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Lars Tharun
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany; Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Alexander Fürschke
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Nathalie Garstka
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Mario W Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany; Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.
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22
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Berg S, Hanske J, von Landenberg N, Noldus J, Brock M. Institutional Adoption and Apprenticeship of Fusion Targeted Prostate Biopsy: Does Experience Affect the Cancer Detection Rate? Urol Int 2020; 104:476-482. [PMID: 32036374 DOI: 10.1159/000505654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/28/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are limited data on the learning curve of magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion targeted prostate biopsies (tBx). OBJECTIVE The aim of this study was to investigate the difference in prostate cancer (PCa) detection rate between an experienced urologist and novice resident performing tBx. METHODS A total of 183 patients underwent tBx from 2012 to 2016 for a total of 518 tBx cores. Biopsies in this study were performed by an experienced urologist (investigator A) or a novice resident (investigator B). The outcome was the detection of PCa on tBx. Using a multivariable logistic regression model, we estimated odds ratios for the detection of PCa. Inverse probability treatment weighting (IPTW) was used to balance patients' baseline characteristics and compare detection rates of PCa. Before performance of tBx, all patients underwent MRI. RESULTS On multivariable logistic regression analysis, investigator experience was associated with a higher odds of detection of PCa (OR = 1.003; 95% confidence interval 1.002-1.006, p = 0.037). After IPTW adjustment, there was no significant difference between the detection rate of investigator A (23%) and investigator B (32%; p = 0.457). CONCLUSIONS Data revealed a positive association between investigator experience and the odds of PCa detection, although there was no difference in the detection rates of the investigators.
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Affiliation(s)
- Sebastian Berg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany, .,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA,
| | - Julian Hanske
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Nicolas von Landenberg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Marko Brock
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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23
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Stabile A, Giganti F, Rosenkrantz AB, Taneja SS, Villeirs G, Gill IS, Allen C, Emberton M, Moore CM, Kasivisvanathan V. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol 2020; 17:41-61. [PMID: 31316185 DOI: 10.1038/s41585-019-0212-4] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/31/2022]
Abstract
The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and consequent overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mpMRI) of the prostate has been identified as a test that could mitigate these diagnostic errors. The performance of mpMRI can vary depending on the population being studied, the execution of the MRI itself, the experience of the radiologist, whether additional biomarkers are considered and whether mpMRI-targeted biopsy is carried out alone or in addition to systematic biopsy. A number of challenges to implementation remain, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. Nevertheless, emerging clinical trial data support the adoption of this technology as part of the standard of care for the diagnosis of prostate cancer.
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Affiliation(s)
- Armando Stabile
- Division of Surgery and Interventional Science, University College London, London, UK.
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Samir S Taneja
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Inderbir S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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24
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Maxeiner A, Nest AM, Stephan C, Cash H, Baur ADJ, Fischer T, Kilic E, Piper SK, Nowak CP, Busch J, Miller K, Mang J. Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies. Urol Int 2019; 104:205-213. [PMID: 31801153 DOI: 10.1159/000504266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/18/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Patients with consistent suspicion for prostate cancer (PCa) and multiple negative prebiopsies prior to multiparametric magnetic resonance imaging (mpMRI) are still frequently evaluated for an image-guided biopsy and are reported with heterogeneous detection rates. The inclusion of a systematic biopsy (SB) is also still recommended with predominant sampling within the posterior/peripheral zone of the prostate. The aim of this study was (I) to evaluate PCa detection rates using a modified 10 core SB template including anterior biopsies in combination with mpMRI/ultrasound fusion-guided targeted biopsy (TB) in patients with 3 or more negative prebiopsies and (II) to compare mpMRI index lesion localization with histologically confirmed locali-zation from associated prostatectomy samples. METHODS Overall 1,337 consecutive patients underwent sensor-based registration TB of the prostate and a subsequent 10-core SB between January 2012 and December 2015 at our institution. For this study, 101 patients with ≥3 negative prebiopsies and prostate imaging - reporting data system lesions ≥3 were pooled prospectively and underwent TB and a modified SB including 2 ventral (anterior) biopsies. Detection rates were estimated for the modified SB, TB, and its combination. A subgroup analysis of 35 patients undergoing prostatectomy was performed by a head-to-head comparison of mpMRI index lesion and histologically confirmed PCa index lesion localization. RESULTS The overall detection rate for PCa was 54.5%. The combination of TB and SB detected 14 (25.4%) more cases missed by TB alone (p < 0.001) and 7 (12.7%) more cases missed by SB alone (p = 0.016), respectively. A postoperative Gleason upgrade was seen in 12/35 (34.3%) cases within the TB group and in 14/35 (40.0%) in the SB group, respectively. The subgroup analysis showed a predominant location of PCa index lesions anteriorly at the level of the midgland. The MRI detection rate of the anteriorly located index lesions was 70.4% (15/21 cases) with a clinically significant Gleason score (≥3 + 4 = 7a [International Society of Urological Pathology grade 2]) in 80.9%. Interestingly a modified SB template detected 90.5% (19/21) of the anteriorly located index lesions. CONCLUSION Our data suggest that in patients with multiple prebiopsies PCa seems to be predominantly located anteriorly. We suggest the general integration of anterior biopsies despite TB in repeat biopsy patients.
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Affiliation(s)
- Andreas Maxeiner
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany,
| | - Alexander M Nest
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Carsten Stephan
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany.,Berlin Institute for Urologic Research, Berlin, Germany
| | - Hannes Cash
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Alexander D J Baur
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Campus Mitte, Berlin, Germany
| | - Thomas Fischer
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Campus Mitte, Berlin, Germany
| | - Ergin Kilic
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pathology, Campus Mitte, Berlin, Germany.,Institute of Pathology, Klinikum Leverkusen, Leverkusen, Germany
| | - Sophie K Piper
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Campus Mitte, Berlin, Germany
| | - Claus-P Nowak
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Campus Mitte, Berlin, Germany
| | - Jonas Busch
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Kurt Miller
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
| | - Josef Mang
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology, Campus Mitte, Berlin, Germany
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25
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Abstract
It is crucial that urologists keep abreast of the latest advances in medical research. This should include an awareness of the role of imaging techniques, collaboration in multidisciplinary teams, adherence to current guidelines, and ongoing documentation of postoperative complications and outcomes. Taken together, these key elements should facilitate optimisation of patient management in routine clinical practice.
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Zalesky M, Stejskal J, Minarik I, Adamcova V, Babjuk M, Zachoval R. Cancer detection rates and inter-examiner variability of MRI/TRUS fusion targeted biopsy and systematic transrectal biopsy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:314-319. [PMID: 31602045 DOI: 10.5507/bp.2019.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Software-based MRI/TRUS fusion biopsy depends on the coordination of several steps, and inter-examiner differences could influence the results. The aim of this bicentric prospective study was to compare the detection rates of MRI/TRUS fusion targeted biopsy (TG) and systematic biopsy (SB), and the detection rates of examiners with different levels of previous experience in prostate biopsy. METHODS A total of 419 patients underwent MRI based on a suspicion of prostate cancer with elevated PSA levels. MRI was positive in 395 patients (221 in the first biopsy group [FB] and 174 in the repeated biopsy group [RB]). A subsequent TG, followed by a SB, was performed on these patients by four different examiners. RESULTS In the detection of clinically significant prostate cancer, a significant difference was found for TG+SB against SB in the RB group (35.1% vs. 25.3%, P=0.047). In the detection of clinically insignificant prostate cancer, the SB had a significantly higher detection rate than TG in both subgroups (FB: 11.9% vs. 4.7%, P=0.008; RB: 13.8% vs. 6.9%, P=0.034). A significant difference was found between the four examiners in the FB for TG (P=0.028), SB (P=0.036), and TG+SB (P=0.017). CONCLUSION MRI/TRUS TG in combination with SB had significantly higher detection rates than SB in the RB group only. Differences in detection rates between examiners were dependent on the level of previous experience with TRUS guided biopsy.
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Affiliation(s)
- Miroslav Zalesky
- Department of Urology, Thomayer Hospital and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, 1
| | - Jiri Stejskal
- Department of Urology, Thomayer Hospital and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vanda Adamcova
- Department of Urology, Thomayer Hospital and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Roman Zachoval
- Department of Urology, Thomayer Hospital and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, 1
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Elwenspoek MMC, Sheppard AL, McInnes MDF, Merriel SWD, Rowe EWJ, Bryant RJ, Donovan JL, Whiting P. Comparison of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy With Systematic Biopsy Alone for the Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e198427. [PMID: 31390032 PMCID: PMC6686781 DOI: 10.1001/jamanetworkopen.2019.8427] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022] Open
Abstract
Importance The current diagnostic pathway for patients with suspected prostate cancer (PCa) includes prostate biopsy. A large proportion of individuals who undergo biopsy have either no PCa or low-risk disease that does not require treatment. Unnecessary biopsies may potentially be avoided with prebiopsy imaging. Objective To compare the performance of systematic transrectal ultrasonography-guided prostate biopsy vs prebiopsy biparametric or multiparametric magnetic resonance imaging (MRI) followed by targeted biopsy with or without systematic biopsy. Data Sources MEDLINE, Embase, Cochrane, Web of Science, clinical trial registries, and reference lists of recent reviews were searched through December 2018 for randomized clinical trials using the terms "prostate cancer" and "MRI." Study Selection Randomized clinical trials comparing diagnostic pathways including prebiopsy MRI vs systematic transrectal ultrasonography-guided biopsy in biopsy-naive men with a clinical suspicion of PCa. Data Extraction and Synthesis Data were pooled using random-effects meta-analysis. Risk of bias was assessed using the revised Cochrane tool. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. All review stages were conducted by 2 reviewers. Main Outcomes and Measures Detection rate of clinically significant and insignificant PCa, number of biopsy procedures, number of biopsy cores taken, and complications. Results Seven high-quality trials (2582 patients) were included. Compared with systematic transrectal ultrasonography-guided biopsy alone, MRI with or without targeted biopsy was associated with a 57% (95% CI, 2%-141%) improvement in the detection of clinically significant PCa, a 33% (95% CI, 23%-45%) potential reduction in the number of biopsy procedures, and a 77% (95% CI, 60%-93%) reduction in the number of cores taken per procedure. One trial showed reduced pain and bleeding adverse effects. Systematic sampling of the prostate in addition to the acquisition of targeted cores did not significantly improve the detection of clinically significant PCa compared with systematic biopsy alone. Conclusions and Relevance In this meta-analysis, prebiopsy MRI combined with targeted biopsy vs systematic transrectal ultrasonography-guided biopsy alone was associated with improved detection of clinically significant PCa, despite substantial heterogeneity among trials. Prebiopsy MRI was associated with a reduced number of individual biopsy cores taken per procedure and with reduced adverse effects, and it potentially prevented unnecessary biopsies in some individuals. This evidence supports implementation of prebiopsy MRI into diagnostic pathways for suspected PCa.
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Affiliation(s)
- Martha M. C. Elwenspoek
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Athena L. Sheppard
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Matthew D. F. McInnes
- Department of Radiology, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Samuel W. D. Merriel
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- College of Medicine & Health, University of Exeter, Exeter, United Kingdom
| | - Edward W. J. Rowe
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Richard J. Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Department of Urology, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Jenny L. Donovan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Penny Whiting
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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28
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Sivasubramanian M, Chuang YC, Chen NT, Lo LW. Seeing Better and Going Deeper in Cancer Nanotheranostics. Int J Mol Sci 2019; 20:E3490. [PMID: 31315232 PMCID: PMC6678689 DOI: 10.3390/ijms20143490] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
Biomedical imaging modalities in clinical practice have revolutionized oncology for several decades. State-of-the-art biomedical techniques allow visualizing both normal physiological and pathological architectures of the human body. The use of nanoparticles (NP) as contrast agents enabled visualization of refined contrast images with superior resolution, which assists clinicians in more accurate diagnoses and in planning appropriate therapy. These desirable features are due to the ability of NPs to carry high payloads (contrast agents or drugs), increased in vivo half-life, and disease-specific accumulation. We review the various NP-based interventions for treatments of deep-seated tumors, involving "seeing better" to precisely visualize early diagnosis and "going deeper" to activate selective therapeutics in situ.
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Affiliation(s)
- Maharajan Sivasubramanian
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan 350, Taiwan
| | - Yao Chen Chuang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan 350, Taiwan
| | - Nai-Tzu Chen
- Department of Cosmeceutics, China Medical University, Taichung 40402, Taiwan.
- Department of Biological Science and Technology, China Medical University, Taichung 40402, Taiwan.
| | - Leu-Wei Lo
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan 350, Taiwan.
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29
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Drost FH, Osses DF, Nieboer D, Steyerberg EW, Bangma CH, Roobol MJ, Schoots IG. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 2019; 4:CD012663. [PMID: 31022301 PMCID: PMC6483565 DOI: 10.1002/14651858.cd012663.pub2] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MRI), with or without MRI-targeted biopsy, is an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of having prostate cancer. At present, evidence on which test to use is insufficient to inform detailed evidence-based decision-making. OBJECTIVES To determine the diagnostic accuracy of the index tests MRI only, MRI-targeted biopsy, the MRI pathway (MRI with or without MRI-targeted biopsy) and systematic biopsy as compared to template-guided biopsy as the reference standard in detecting clinically significant prostate cancer as the target condition, defined as International Society of Urological Pathology (ISUP) grade 2 or higher. Secondary target conditions were the detection of grade 1 and grade 3 or higher-grade prostate cancer, and a potential change in the number of biopsy procedures. SEARCH METHODS We performed a comprehensive systematic literature search up to 31 July 2018. We searched CENTRAL, MEDLINE, Embase, eight other databases and one trials register. SELECTION CRITERIA We considered for inclusion any cross-sectional study if it investigated one or more index tests verified by the reference standard, or if it investigated the agreement between the MRI pathway and systematic biopsy, both performed in the same men. We included only studies on men who were biopsy naïve or who previously had a negative biopsy (or a mix of both). Studies involving MRI had to report on both MRI-positive and MRI-negative men. All studies had to report on the primary target condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the risk of bias using the QUADAS-2 tool. To estimate test accuracy, we calculated sensitivity and specificity using the bivariate model. To estimate agreement between the MRI pathway and systematic biopsy, we synthesised detection ratios by performing random-effects meta-analyses. To estimate the proportions of participants with prostate cancer detected by only one of the index tests, we used random-effects multinomial or binary logistic regression models. For the main comparisions, we assessed the certainty of evidence using GRADE. MAIN RESULTS The test accuracy analyses included 18 studies overall.MRI compared to template-guided biopsy: Based on a pooled sensitivity of 0.91 (95% confidence interval (CI): 0.83 to 0.95; 12 studies; low certainty of evidence) and a pooled specificity of 0.37 (95% CI: 0.29 to 0.46; 12 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI may result in 273 (95% CI: 249 to 285) true positives, 441 false positives (95% CI: 378 to 497), 259 true negatives (95% CI: 203 to 322) and 27 (95% CI: 15 to 51) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.MRI-targeted biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.80 (95% CI: 0.69 to 0.87; 8 studies; low certainty of evidence) and a pooled specificity of 0.94 (95% CI: 0.90 to 0.97; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI-targeted biopsy may result in 240 (95% CI: 207 to 261) true positives, 42 (95% CI: 21 to 70) false positives, 658 (95% CI: 630 to 679) true negatives and 60 (95% CI: 39 to 93) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.The MRI pathway compared to template-guided biopsy: Based on a pooled sensitivity of 0.72 (95% CI: 0.60 to 0.82; 8 studies; low certainty of evidence) and a pooled specificity of 0.96 (95% CI: 0.94 to 0.98; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, the MRI pathway may result in 216 (95% CI: 180 to 246) true positives, 28 (95% CI: 14 to 42) false positives, 672 (95% CI: 658 to 686) true negatives and 84 (95% CI: 54 to 120) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations, inconsistency and imprecision.Systemic biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.63 (95% CI: 0.19 to 0.93; 4 studies; low certainty of evidence) and a pooled specificity of 1.00 (95% CI: 0.91 to 1.00; 4 studies; low certainty of evidence) using a baseline prevalence of 30%, systematic biopsy may result in 189 (95% CI: 57 to 279) true positives, 0 (95% CI: 0 to 63) false positives, 700 (95% CI: 637 to 700) true negatives and 111 (95% CI: 21 to 243) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.Agreement analyses: In a mixed population of both biopsy-naïve and prior-negative biopsy men comparing the MRI pathway to systematic biopsy, we found a pooled detection ratio of 1.12 (95% CI: 1.02 to 1.23; 25 studies). We found pooled detection ratios of 1.44 (95% CI 1.19 to 1.75; 10 studies) in prior-negative biopsy men and 1.05 (95% CI: 0.95 to 1.16; 20 studies) in biopsy-naïve men. AUTHORS' CONCLUSIONS Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed. The certainty in our findings was reduced by study limitations, specifically issues surrounding selection bias, as well as inconsistency. Based on these findings, further improvement of prostate cancer diagnostic pathways should be pursued.
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Affiliation(s)
- Frank‐Jan H Drost
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daniël F Osses
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daan Nieboer
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ewout W Steyerberg
- Erasmus University Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
| | - Chris H Bangma
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Monique J Roobol
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ivo G Schoots
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
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Dell'Oglio P, Stabile A, Soligo M, Brembilla G, Esposito A, Gandaglia G, Fossati N, Bravi CA, Dehò F, De Cobelli F, Montorsi F, Karnes RJ, Briganti A. There Is No Way to Avoid Systematic Prostate Biopsies in Addition to Multiparametric Magnetic Resonance Imaging Targeted Biopsies. Eur Urol Oncol 2019; 3:112-118. [PMID: 31411973 DOI: 10.1016/j.euo.2019.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/15/2019] [Accepted: 03/06/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Whether or not adding systematic biopsies (transrectal ultrasound-guided biopsy [TRUS-Bx]) to targeted cores in patients with a lesion detected at multiparametric magnetic resonance imaging (mpMRI) is still a debated topic. OBJECTIVE To identify patients who can avoid TRUS-Bx at the time of mpMRI targeted biopsy (MRI-TBx) relying on individual patient probability to harbour clinically significant prostate cancer (csPCa) outside the index lesion (IL). DESIGN, SETTING, AND PARTICIPANTS A total of 339 European and 441 North American patients underwent fusion MRI-TBx and concomitant TRUS-Bx at two tertiary care referral centres between 2013 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The study outcome was csPCa, defined as a Gleason score at biopsy of ≥7, outside the IL. Multivariable logistic regression analyses (MVAs) were performed to develop a predictive model for the study outcome. Multivariable-derived coefficients were used to develop a novel risk calculator in each cohort. The models were evaluated using the area under the curve (AUC), calibration plot, and decision-curve analyses. RESULTS AND LIMITATIONS In the European cohort, csPCa detection rate was 55%. The csPCa detection rate for TRUS-Bx was 41%. At MVAs, prostate volume, previous negative biopsy, and Prostate Imaging Reporting and Data System versions 4 and 5 were independent predictors for the presence of csPCa outside the IL. The multivariable model had an AUC of 0.78. Omitting TRUS-Bx in patients with a calculated risk of <15% would have spared 16% of TRUS-Bx at the cost of missing 7% of csPCa. Similar findings were obtained when the same analyses were performed in the North American cohort. No net benefit was observed for low-threshold probabilities (<15%) of the each model relative to the standard of care (performing TRUS-Bx in addition to MRI-TBx to all patients) in both cohorts. The study is limited by its retrospective design. CONCLUSIONS We failed to identify those patients who might safely benefit from MRI-TBx alone. The combination of MRI-TBx and TRUS-Bx should strongly be considered the best available approach. PATIENT SUMMARY In the presence of positive multiparametric magnetic resonance imaging (mpMRI) of the prostate, physicians should always perform systematic sampling of the prostate in addition to mpMRI targeted biopsy.
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Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Soligo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Antonio Esposito
- Department of Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Andrea Bravi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Dehò
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Assessment of PI-RADS v2 categories ≥ 3 for diagnosis of clinically significant prostate cancer. Abdom Radiol (NY) 2019; 44:705-712. [PMID: 30171296 DOI: 10.1007/s00261-018-1751-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the diagnostic accuracy of PI-RADS v2 categories ≥ 3 to detect clinically significant prostate cancer (csPCa) against histopathology of Transperineal Mapping Biopsy (TPMB). MATERIALS AND METHODS IRB-approved retrospective cohort study included 47 men who had 3.0 T multi-parametric MRI (mpMRI) and TPMB of prostate. Two radiologists independently evaluated T2, DWI, ADC map, and DCE images using PI-RADS v2 categories. A third radiologist served as tie-breaker. PI-RADS v2 score (PS) ≥ 3 lesions were correlated with 3D model of TPMB (3DTPMB) results based on prostate sectors. Two groups of csPCa status were separately analyzed for accuracy measures at lesion and person levels: Group 1 with GS (Gleason Score) ≥ 7 and group 2 with tumor volume ≥ 0.5 cc. Inter-rater reliability for PS and MR lexicon was calculated. RESULTS Forty-seven patients with 3DTPMB had at least one lesion with PS ≥ 3 on mpMRI. PS of 5 had high PPV and high specificity of 100% at the lesion and person levels. Sensitivity of a PS ≥ 3 was 68.27% for group 1 and was 48.39% for group 2. Specificity was 93.56% for group 1 and was 95.53% for group 2. At the person level, sensitivity of PS ≥ 3 was 81.25% for group 1 and was 82.35% for group 2. Specificity was 32.26% for group 1 and was 53.85% for group 2. CONCLUSION PI-RADS v2 category of 5 had high PPV and specificity; however, combined PS ≥ 3 had mixed performance in detection of csPCa.
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32
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Marra G, Ploussard G, Futterer J, Valerio M. Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach? World J Urol 2019; 37:277-287. [PMID: 30610359 DOI: 10.1007/s00345-018-02622-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP). METHODS We performed a literature search of peer-reviewed English language articles using PubMed and the words "prostate" AND "biopsy". Web search was implemented by manual search. RESULTS Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx-TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues. CONCLUSION The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy.
| | - Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Jurgen Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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33
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Multidimensional analysis of clinicopathological characteristics of false-negative clinically significant prostate cancers on multiparametric MRI of the prostate in Japanese men. Jpn J Radiol 2019; 37:154-164. [DOI: 10.1007/s11604-018-0801-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/18/2018] [Indexed: 01/16/2023]
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34
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Sathianathen NJ, Warlick CA, Weight CJ, Ordonez MA, Spilseth B, Metzger GJ, Murugan P, Konety BR. A clinical prediction tool to determine the need for concurrent systematic sampling at the time of magnetic resonance imaging-guided biopsy. BJU Int 2018; 123:612-617. [DOI: 10.1111/bju.14617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | - Maria A. Ordonez
- Department of Urology; University of Minnesota; Minneapolis MN USA
| | - Benjamin Spilseth
- Department of Radiology; University of Minnesota; Minneapolis MN, USA
| | | | - Paari Murugan
- Department of Pathology; University of Minnesota; Minneapolis MN USA
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35
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Cornud F, Bomers J, Futterer J, Ghai S, Reijnen J, Tempany C. MR imaging-guided prostate interventional imaging: Ready for a clinical use? Diagn Interv Imaging 2018; 99:743-753. [DOI: 10.1016/j.diii.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/08/2018] [Indexed: 01/22/2023]
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Role of Magnetic Resonance Imaging Targeted Biopsy in Detection of Prostate Cancer Harboring Adverse Pathological Features of Intraductal Carcinoma and Invasive Cribriform Carcinoma. J Urol 2018; 200:104-113. [DOI: 10.1016/j.juro.2018.01.081] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/30/2023]
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Hofbauer SL, Maxeiner A, Kittner B, Heckmann R, Reimann M, Wiemer L, Asbach P, Haas M, Penzkofer T, Stephan C, Friedersdorff F, Fuller F, Miller K, Cash H. Validation of Prostate Imaging Reporting and Data System Version 2 for the Detection of Prostate Cancer. J Urol 2018; 200:767-773. [PMID: 29733838 DOI: 10.1016/j.juro.2018.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The second version of the PI-RADS™ (Prostate Imaging Reporting and Data System) was introduced in 2015 to standardize the interpretation and reporting of prostate multiparametric magnetic resonance imaging. Recently low cancer detection rates were reported for PI-RADS version 2 category 4 lesions. Therefore the aim of the study was to evaluate the cancer detection rate of PI-RADS version 2 in a large prospective cohort. MATERIALS AND METHODS The study included 704 consecutive men with primary or prior negative biopsies who underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy and 10-core systematic prostate biopsy between September 2015 and May 2017. All lesions were rated according to PI-RADS version 2 and lesions with PI-RADS version 2 category 3 or greater were biopsied. An ISUP (International Society of Urological Pathology) score of 2 or greater (ie Gleason 3 + 4 or greater) was defined as clinically significant prostate cancer. RESULTS The overall cancer detection rate of PI-RADS version 2 categories 3, 4 and 5 was 39%, 72% and 91% for all prostate cancer, and 23%, 49% and 77% for all clinically significant prostate cancer, respectively. If only targeted biopsy had been performed, 59 clinically significant tumors (16%) would have been missed. The PI-RADS version 2 score was significantly associated with the presence of prostate cancer (p <0.001), the presence of clinically significant prostate cancer (p <0.001) and the ISUP grade (p <0.001). CONCLUSIONS PI-RADS version 2 is significantly associated with the presence of clinically significant prostate cancer. The cancer detection rate of PI-RADS version 2 category 4 lesions was considerably higher than previously reported. When performing targeted biopsy, the combination with systematic biopsy still provides the highest detection of clinically significant prostate cancer.
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Affiliation(s)
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robin Heckmann
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Laura Wiemer
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Florian Fuller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Maxeiner A, Kittner B, Blobel C, Wiemer L, Hofbauer SL, Fischer T, Asbach P, Haas M, Penzkofer T, Fuller F, Miller K, Cash H. Primary magnetic resonance imaging/ultrasonography fusion-guided biopsy of the prostate. BJU Int 2018; 122:211-218. [PMID: 29569320 DOI: 10.1111/bju.14212] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine the performance of a primary magnetic resonance imaging (MRI)/ultrasonography (US) fusion-guided targeted biopsy (TB), and in combination with an added systematic biopsy (SB). PATIENTS AND METHODS Analysis of 318 consecutive biopsy-naïve men with suspicious multiparametric MRI (mpMRI; Prostate Imaging Reporting and Data System [PI-RADS] score ≥3) undergoing transrectal TB and 10-core SB between January 2012 and December 2016. The indication for performing mpMRI was based on clinical parameters and decided by the treating urologist before admission. TB was performed with a sensor-based MRI/US fusion-guided platform. Clinically significant prostate cancer was defined as Gleason score ≥4 + 3 = 7 (International Society of Urological Pathology Grade [ISUP] grade 3) or maximum cancer core length of ≥6 mm. RESULTS A median (interquartile range) of 14 (13-14) biopsies per case were taken. The overall cancer detection rate (CDR) was 77% (245/318). The TB alone detected 67% of prostate cancers and the SB alone detected 70%. The PI-RADS dependent CDR for the combination of TB/SB were 38% (21/55), 78% (120/154) and 95% (104/109) for PI-RADS scores of 3/4/5, respectively. Clinically significant prostate cancer was diagnosed by the combination of TB and SB in 195 men (61%) and by TB alone in 163 cases (51%). The number of missed or underestimated prostate cancers with a Gleason score ≥8 for TB alone was 31 (10%, P < 0.001) and 21 (7%, P < 0.001) for SB alone in comparison with the results of the combination of TB and SB. The rate of insignificant prostate cancer was comparable for the combination of TB and SB and TB alone (50/318, 16% vs 50/318, 16%). CONCLUSIONS Pre-biopsy mpMRI is of incremental value in increasing the detection of clinically significant prostate cancer in biopsy-naïve patients with suspicion of prostate cancer. Combining TB with SB further improved the diagnostic accuracy without increasing the rate of insignificant prostate cancer.
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Affiliation(s)
- Andreas Maxeiner
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Conrad Blobel
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Laura Wiemer
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Thomas Fischer
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Florian Fuller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
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Berg S, Fletcher SA, Cole AP, Trinh QD. Evaluation of magnetic resonance imaging and targeted biopsy: The difficulty of finding the right reference standard. Cancer 2018; 124:1299-1300. [PMID: 29266175 DOI: 10.1002/cncr.31201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/01/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Sebastian Berg
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Sean A Fletcher
- Division of Urological Surgery and Center for Surgery and Public Health Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts
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Elfatairy KK, Filson CP, Sanda MG, Osunkoya AO, Geller RL, Nour SG. In-bore MRI-guided biopsy: can it optimize the need for periodic biopsies in prostate cancer patients undergoing active surveillance? A pilot test-retest reliability study. Br J Radiol 2018; 91:20170603. [PMID: 29308912 DOI: 10.1259/bjr.20170603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the test-retest reliability of repeated in-bore MRI-guided prostate biopsy (MRGB). METHODS 19 lesions in 7 patients who had consecutive MRGBs were retrospectively analysed. Five patients had 2 consecutive MRGBs and two patients had 3 consecutive MRGBs. Both multiparametric MRI and MRGBs were performed using a 3T MRI scanner. Pathology results were categorized into benign, suspicious and malignant. Consistency between first and subsequent biopsy results were analysed as well as the negative predictive value (NPV) for prostate cancer. RESULTS 15 lesions (≈79%) had matching second biopsy and 4 (21%) had non-matching second biopsy. Lesions with both Prostate Imaging - Reporting and Data System(PIRADS) categories 1 and 4 were all benign and had matching pathology results. Lesions with non-matching results had PIRADS categories 2, 3 and 5. NPV for prostate cancer in first biopsy was 87.5%. Overall agreement was 78.9% and overall disagreement was 21.1%.κ = 0.55 denoting moderate agreement (p = 0.002). 10/19 lesions had a third biopsy session. 9/10 (90%) had matching pathology results across the three biopsy sessions and all matching lesions were benign. CONCLUSION In-bore MRI-guided prostate biopsy may have a better reliability for repeat biopsies compared to TRUS biopsy. Final conclusion awaits a prospective analysis on a larger cohort of patients. Advances in knowledge: This pilot study showed that repeated prostate in-bore MRI-guided prostate biopsy may have better reliability compared to TRUS biopsy with a suggested high NPV.
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Affiliation(s)
- Kareem K Elfatairy
- 1 Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,2 Interventional MRI Program,Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,3 Department of Radiology, Faculty of Medicine, Suez Canal University , Ismailia , Egypt
| | - Christopher P Filson
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,5 Department of Urology, Veterans Affairs Medical Center , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
| | - Martin G Sanda
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,5 Department of Urology, Veterans Affairs Medical Center , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
| | - Adeboye O Osunkoya
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States.,7 Department of Pathology, Emory University School of Medicine , Atlanta, GA United States.,8 Department of Pathology, Veterans Affairs Medical Center , Atlanta, GA , United States
| | - Rachel L Geller
- 7 Department of Pathology, Emory University School of Medicine , Atlanta, GA United States
| | - Sherif G Nour
- 1 Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,2 Interventional MRI Program,Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
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Fletcher SA, Berg S, Trinh QD. The new frontier of prostate biopsy: determining the role of image-guidance in moving the needle. BJU Int 2018; 121:4-5. [PMID: 29314538 DOI: 10.1111/bju.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sean A Fletcher
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sebastian Berg
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Schütz V, Kesch C, Dieffenbacher S, Bonekamp D, Hadaschik BA, Hohenfellner M, Radtke JP. Multiparametric MRI and MRI/TRUS Fusion Guided Biopsy for the Diagnosis of Prostate Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:87-98. [DOI: 10.1007/978-3-319-99286-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Truong M, Weinberg E, Hollenberg G, Borch M, Park JH, Gantz J, Feng C, Frye T, Ghazi A, Wu G, Joseph J, Rashid H, Messing E. Institutional Learning Curve Associated with Implementation of a Magnetic Resonance/Transrectal Ultrasound Fusion Biopsy Program Using PI-RADS™ Version 2: Factors that Influence Success. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Truong
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eric Weinberg
- Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Gary Hollenberg
- Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marianne Borch
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ji Hae Park
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jacob Gantz
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Thomas Frye
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ahmed Ghazi
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Guan Wu
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jean Joseph
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Hani Rashid
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Edward Messing
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Pathology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Truong M, Feng C, Hollenberg G, Weinberg E, Messing EM, Miyamoto H, Frye TP. A Comprehensive Analysis of Cribriform Morphology on Magnetic Resonance Imaging/Ultrasound Fusion Biopsy Correlated with Radical Prostatectomy Specimens. J Urol 2018; 199:106-113. [DOI: 10.1016/j.juro.2017.07.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Truong
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Gary Hollenberg
- Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eric Weinberg
- Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Edward M. Messing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Thomas P. Frye
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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Xie Y, Tokas T, Grabski B, Loch T. Internal Fusion: exact correlation of transrectal ultrasound images of the prostate by detailed landmarks over time for targeted biopsies or follow-up. World J Urol 2017; 36:693-698. [PMID: 29282497 DOI: 10.1007/s00345-017-2161-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/20/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Innovative imaging modalities are applied for diagnosing and follow-up of prostate cancer (PCa). To perform authentic targeted biopsies and evaluate prostate changes, it is essential to reliably identify and hit targets in their true anatomical location over time. A newly described image correlation method (Internal Fusion) allows precise correlation of serial transrectal ultrasound (TRUS) images in vitro and vivo. Identifiable morphologic structures such as prostatic calcifications define internal anchor points (Internal Landmarks) to facilitate exact correlation. METHODS After verification of Internal Fusion in vitro, 83 patients were included from January to August 2017 with at least one prior series of 5-mm spaced TRUS images stored as computed tomographic (US-CT) online data set. Two experienced operators collected new images in correlation with each cross-section of the previous examinations based on Internal Landmarks. RESULTS Of the 83 patients, fifty (60%) had prior negative biopsies. Fourteen (17%) wished US-CT targeted biopsies and PCa were detected in 7/14 patients (50%). Overall, accurate imaging correlations were attained in 369/397 slices (93%). In initial and repeat biopsy, 31/31 and 35/35 images could be correlated detecting PCa in 5/8 (63%) and 2/6 patients (33%). The longest observation of prostate changes over time (Trend Monitoring) with accurate image correlation was 8 years and 6 months. CONCLUSIONS Internal Fusion by Internal Landmarks ensures exact correlation in long-term follow-up. It is possible to precisely monitor trends in prostate tissue changes. In case of PCa suspicion, biopsies could be targeted with high accuracy by Internal Fusion, even over time.
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Affiliation(s)
- Yanqi Xie
- Urologische Klinik des Ev. Luth. Diakonissenkrankenhauses, Akademisches Lehrkrankenhaus der Christian-Albrechts-Universität zu Kiel, Knuthstraße 1, 24939, Flensburg, Germany.
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria
| | - Björn Grabski
- Urologische Klinik des Ev. Luth. Diakonissenkrankenhauses, Akademisches Lehrkrankenhaus der Christian-Albrechts-Universität zu Kiel, Knuthstraße 1, 24939, Flensburg, Germany
| | - Tillmann Loch
- Urologische Klinik des Ev. Luth. Diakonissenkrankenhauses, Akademisches Lehrkrankenhaus der Christian-Albrechts-Universität zu Kiel, Knuthstraße 1, 24939, Flensburg, Germany
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Hakozaki Y, Matsushima H, Kumagai J, Murata T, Masuda T, Hirai Y, Oda M, Kawauchi N, Yokoyama M, Homma Y. A prospective study of magnetic resonance imaging and ultrasonography (MRI/US)-fusion targeted biopsy and concurrent systematic transperineal biopsy with the average of 18-cores to detect clinically significant prostate cancer. BMC Urol 2017; 17:117. [PMID: 29233150 PMCID: PMC5727964 DOI: 10.1186/s12894-017-0310-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study compared the detection rates for clinically significant prostate cancer (CSPC) between magnetic resonance imaging and ultrasonography (MRI/US)-fusion-targeted biopsy (TB), systematic biopsy (SB) and combination of TB and SB. Methods This prospective study evaluated simultaneous TB and SB for consecutive patients with suspicious lesions that were detected using pre-biopsy multiparametric MRI. A commercially available real-time virtual sonography system was used to perform the MRI/US-fusion TB with the transperineal technique. The prostate imaging reporting and data system version 2 (PI-RADS v2) was assigned to categorize the suspicious lesions. Results A total of 177 patients were included in this study. The detection rate for CSPC was higher using SB, compared to TB (57.1% vs 48.0%, p = 0.0886). The detection rate for CSPC was higher using the combination of TB and SB, compared to only SB (63.3% vs 57.1%, p = 0.2324). Multivariate analysis revealed that PIRADS v2 category 4 and an age of <65 years were independent predictors for TB upgrading (vs. the SB result). Conclusions PI-RADS v2 category 4 and an age of <65 years were predictive factors of upgrading the Gleason score by MRI/US-fusion TB. Thus, MRI/US-fusion TB may be appropriate for patients with those characteristics. Trial registration This study was retrospectively registered at the University Hospital Medical Information Network (UMINID000025911) in Jan 30, 2017.
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Affiliation(s)
- Yuji Hakozaki
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan.
| | - Hisashi Matsushima
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Jimpei Kumagai
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Taro Murata
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Tomoko Masuda
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Yoko Hirai
- Department of Urology, Tokyo Metropolitan Police Hospital, #4-22-1 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Mai Oda
- Department of Radiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Nobuo Kawauchi
- Department of Radiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Munehiro Yokoyama
- Department of Pathology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Boesen L, Nørgaard N, Løgager V, Balslev I, Thomsen HS. Where Do Transrectal Ultrasound- and Magnetic Resonance Imaging-guided Biopsies Miss Significant Prostate Cancer? Urology 2017; 110:154-160. [DOI: 10.1016/j.urology.2017.08.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 11/30/2022]
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Nguyentat M, Ushinsky A, Miranda-Aguirre A, Uchio E, Lall C, Shirkhoda L, Lee T, Green C, Houshyar R. Validation of Prostate Imaging-Reporting and Data System Version 2: A Retrospective Analysis. Curr Probl Diagn Radiol 2017; 47:404-409. [PMID: 29126575 DOI: 10.1067/j.cpradiol.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Use of magnetic resonance imaging (MRI)/transrectal ultrasound fusion biopsies to determine the accuracy of multiparametric MRI (mpMRI), using Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2), for detecting clinically significant prostate cancer in the overall gland and specifically the peripheral zone (PZ) and transitional zone (TZ). METHODS A retrospective analysis of patients who underwent fusion biopsy identified 137 men with 231 prostate lesions was approved by the Institutional Review Board. Subjects initially classified under PI-RADSv1 criteria were regraded using PI-RADSv2 by a radiologist blinded to PI-RADSv1 score and biopsy results. Spearman correlation, chi-squared, and logistic regression analysis were performed. RESULTS There was positive correlation between PI-RADSv2 and Gleason scores (P < 0.001). In the PZ, mpMRI demonstrated 100% sensitivity, 100% negative predictive value, and 35.9% positive predictive value, compared to 100%, 100%, and 27.1%, respectively, for TZ lesions. When predicting clinically significant prostate cancer, the PI-RADSv2 area under the curve for TZ lesions was 0.844 (95% CI: 0.753-0.935, P < 0.001) and 0.769 (95% CI: 0.684-0.854, P < 0.001) for PZ lesions. Combining PI-RADSv2 with additional risk factors (body mass index, prostate-specific antigen density, digital rectal examination) improved the area under curve. CONCLUSIONS PI-RADSv2 achieves excellent sensitivity and negative predictive value for both PZ and TZ lesions.
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Affiliation(s)
- Michael Nguyentat
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Alexander Ushinsky
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA.
| | | | - Edward Uchio
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Chandana Lall
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Layla Shirkhoda
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Thomas Lee
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Christopher Green
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA
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The Influence of Serum Prostate-Specific Antigen on the Accuracy of Magnetic Resonance Imaging Targeted Biopsy versus Saturation Biopsy in Patients with Previous Negative Biopsy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7617148. [PMID: 29159180 PMCID: PMC5660748 DOI: 10.1155/2017/7617148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/17/2017] [Accepted: 09/10/2017] [Indexed: 12/16/2022]
Abstract
Objective We compared the prostate cancer (PCa) detection rates of targeted biopsy (TB) and saturation biopsy (SB) in patients with previous negative biopsy and the accuracy of TB and SB stratified by different serum prostate-specific antigen (PSA) levels. Materials and Methods Overall 185 patients were enrolled. In the magnetic resonance imaging (MRI) group, 65 men underwent TB and SB. In the control group, 120 men underwent SB alone. The primary outcome was the difference in PCa detection rate between the MRI group and control group. The secondary outcome was the difference in accuracy between TB and SB in detecting clinically significant PCa by stratifying the patients in the MRI group into those with PSA < 10 ng/ml and PSA ≥ 10 ng/ml. Results The detection rates for overall and clinically significant PCa were higher in the MRI group than in the control group (46.2% versus 20.9% and 43.1% versus 16.7%, both p < 0.001). In the MRI group, the accuracy of TB was higher than SB (94.7% versus 84.2%, p = 0.001) for the patients with PSA ≥ 10 ng/mL. Conclusions Combining TB and SB achieved the best cancer detection rate. The accuracy of TB was better than SB in the patients with serum PSA ≥ 10 ng/mL.
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