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Exterkate L, Wegelin O, Barentsz JO, van der Leest MG, Kummer JA, Vreuls W, de Bruin PC, Witjes JA, van Melick HHE, Somford DM. Incidence of significant prostate cancer after negative MRI and systematic biopsy in the FUTURE trial. BJU Int 2023; 131:313-320. [PMID: 35993590 DOI: 10.1111/bju.15876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the proportion of clinically significant (cs) prostate cancer (PCa) found during follow-up in patients with negative systematic biopsy (SB) followed by non-suspicious multiparametric magnetic resonance imaging (mpMRI) and persistent clinical suspicion of PCa compared to the general population. PATIENTS AND METHODS A prospective study in a subgroup of patients from a multicentre randomized controlled trial was conducted between 2014 and 2017, including 665 men with prior negative SB with a persistent elevated prostate-specific antigen and/or suspicious digital rectal examination undergoing mpMRI. All patients with negative SB and Prostate Imaging-Reporting and Data System (PI-RADS) ≤2 on mpMRI entered biochemical follow-up. Follow-up data until December 2021 were collected by reviewing institutional hospital records and the Dutch Pathology Registry (PALGA). The primary outcome was the observed number of csPCa (Gleason ≥3 + 4/International Society of Urological Pathology grade group ≥2) cases during follow-up compared to the expected number in the general population (standardized incidence ratio [SIR]). RESULTS In total, 431 patients had non-suspicious mpMRI and entered biochemical follow-up. After a median (interquartile range) follow-up of 41 (23-57) months, 38 patients were diagnosed with PCa, of whom 13 (3.0%) had csPCa. The SIR for csPCa was 4.3 (95% confidence interval 2.3-7.4; total excess of eight cases). A higher risk of a positive biopsy for (cs)PCa based on the European Randomized Study of Screening for Prostate Cancer risk calculator and a suspicious repeat MRI (PI-RADS ≥3) were significant predictive factors for csPCa. CONCLUSION After negative prior biopsy and non-suspicious mpMRI the risk of csPCa is low. However, compared to the general population, the risk of csPCa is increased despite the high negative predictive value of mpMRI. More research focusing on biochemical and image-guided risk-adapted diagnostic surveillance strategies is warranted.
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Affiliation(s)
- Leonie Exterkate
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Olivier Wegelin
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | | | - J Alain Kummer
- Department of Pathology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Peter C de Bruin
- Department of Pathology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Marra G, Laguna MP, Walz J, Pavlovich CP, Bianco F, Gregg J, Lebastchi AH, Lepor H, Macek P, Rais-Bahrami S, Robertson C, Rukstalis D, Salomon G, Ukimura O, Abreu AL, Barbe Y, Cathelineau X, Gandaglia G, George AK, Gomez Rivas J, Gupta RT, Lawrentschuk N, Kasivisvanathan V, Lomas D, Malavaud B, Margolis D, Matsuoka Y, Mehralivand S, Moschini M, Oderda M, Orabi H, Rastinehad AR, Remzi M, Schulman A, Shin T, Shiraishi T, Sidana A, Shoji S, Stabile A, Valerio M, Tammisetti VS, Phin Tan W, VAN DEN Bos W, Villers A, Willemse PP, DE LA Rosette J, Polascik T, Sanchez-Salas R. Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society. Minerva Urol Nephrol 2022; 74:581-589. [PMID: 33439577 DOI: 10.23736/s2724-6051.20.04160-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Focal therapy (FT) for prostate cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localized PCa. METHODS A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, 1) the current/present role; 2) the potential/future role; 3) the recommended features for future studies. Consensus was defined using a 70% agreement threshold. RESULTS Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (N.=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (N.=3), a consensus on a partial agreement (N.=1), and a consensus on uncertainty (N.=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localized PCa. Research efforts in this field should be considered a priority. CONCLUSIONS The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,D epartment of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maria P Laguna
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Jochen Walz
- Department of Urology, Paoli-Calmettes Institute, Marseille, France
| | | | - Fernando Bianco
- Urological Research Network, Nova University, Miami, FL, USA
| | - Justin Gregg
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir H Lebastchi
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Daniel Rukstalis
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Georg Salomon
- Martini Clinic, Prostate Cancer Center, Hamburg, Germany
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Andre L Abreu
- Department of Urology, Keck School of Medicine, University of South California, Los Angeles, CA, USA
| | - Yann Barbe
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Arvin K George
- Division of Urologic Oncology, Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Rajan T Gupta
- Department of Radiology, Duke University, Durham, NC, USA
| | | | | | - Derek Lomas
- Department of Urology, San Raffaele Hospital, Milan, Italy
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Daniel Margolis
- Department of Radiology, Weill Cornell Imaging, Cornell University, New York, NY, USA
| | - Yoh Matsuoka
- Urology at Tokyo Medical and Dental University, Tokyo, Japan
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marco Moschini
- Department of Urology, San Raffaele Hospital, Milan, Italy.,Department of Urology, Lucerne Kanton Hospital, Lucerne, Switzerland
| | - Marco Oderda
- D epartment of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Hazem Orabi
- Department of Urology, Duke University, Durham, NC, USA.,Department of Urology, University of Assiut, Assiut, Egypt
| | | | - Mesut Remzi
- Department of Urology, Döbling Hospital, Vienna, Austria
| | - Ariel Schulman
- Department of Urology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Abhinav Sidana
- Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sunao Shoji
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | | | - Massimo Valerio
- Department of Urology, Vaudois University Center Hospital, Lausanne, Switzerland
| | - Varaha S Tammisetti
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei Phin Tan
- Department of Urology, Duke University, Durham, NC, USA
| | | | | | | | - Jean DE LA Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
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Bodar Y, Koene B, Meijer D, van Leeuwen PJ, Nadorp S, Donswijk ML, Hendrikse NH, Oprea-Lager DE, Vis AN. Determining the diagnostic value of PSMA-PET/CT imaging in patients with persistent high prostate specific antigen levels and negative prostate biopsies. Urol Oncol 2021; 40:58.e1-58.e7. [PMID: 34404590 DOI: 10.1016/j.urolonc.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To assess the diagnostic performance of prostate specific membranous antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging to localize primary prostate cancer (PCa) in men with persistent elevated prostate-specific antigen (PSA) levels and previous prostate biopsies that were negative for PCa. METHODS In this study, 34 men with persistently elevated PSA-levels, previous negative for PCa biopsies and who subsequently underwent diagnostic PSMA-PET/CT imaging were retrospectively evaluated. Men were divided into 3 groups: 1. 12 men with a previous negative mpMRI scan (PI-RADS 1-2) 2. 17 men with a positive mpMRI scan (PI-RADS 3-5), but negative MRI-targeted biopsies and 3. Four men in whom mpMRI was contraindicated. If PSMA-avid lesions were seen, patients underwent 2-4 cognitive targeted biopsies in combination with systematic biopsies. The detection rate of PSMA-PET/CT for PCa, and the accuracy of (possible) targeted biopsies were calculated. RESULTS Included men had a median PSA-level of 22.8 ng/mL (Interquartile Range 15.6-30.0) at the time of PSMA-PET/CT. Elevated PSMA-ligand uptake in the prostate suspicious for PCa was observed in 22/34 patients (64.7%). In 18/22 patients (54.5%), PSMA-targeted prostate biopsies were performed. In 3/18 patients (16.6%), the targeted biopsies showed International Society of Urological Pathology (ISUP) score 1-2 PCa. The other men had inflammation or benign findings after histopathological examination of the biopsy cores. CONCLUSION In this study, the clinical value of PSMA-PET/CT for patients with an elevated PSA-level, and negative for PCa biopsies was low. Only very few men were diagnosed with PCa, and no clinically significant PCa was found.
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Affiliation(s)
- Yjl Bodar
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland.
| | - Bpf Koene
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - D Meijer
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland
| | - P J van Leeuwen
- The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - S Nadorp
- Amstelland Hospital, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - M L Donswijk
- The Netherlands Cancer Institute, Department of Radiology and Nuclear Medicine, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
| | - N H Hendrikse
- Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland; Amsterdam University Medical Center, VU University, Department of Clinical Pharmacology and Pharmacy, Amsterdam, Netherland
| | - D E Oprea-Lager
- Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherland
| | - A N Vis
- Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, Netherland
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