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Eismann L, Ledderose ST, Enzinger B, Berg E, Westhofen T, Rodler S, Schulz GB, Toms J, Holzgreve A, Gildehaus FJ, Brendel M, Cyran CC, Unterrainer M, Stief CG, Bartenstein P, Schlenker B, Unterrainer LM. [ 68Ga]Ga-FAPI-46 PET/CT for penile cancer - a feasibility study. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06763-1. [PMID: 38761187 DOI: 10.1007/s00259-024-06763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Penile cancer is a rare entity and has a good prognosis in localized stage. Delayed surgical treatment of lymphatic disease is associated with poor overall survival but conventional imaging cannot detect occult lymph node metastasis sufficiently. Imaging cancer related fibroblasts has shown promising results as non-invasive staging tool in various tumor entities but has not yet been evaluated in penile cancer. METHODS In this single-center pilot study, patients planned for surgical treatment for penile cancer underwent preoperatively [68Ga]Ga-FAPI-46 PET/CT. Post-operative histopathology was compared to [68Ga]Ga-FAPI-46 PET/CT results. RESULTS From January 2022 to June 2022, a total number 11 patients with histopathologically proven penile cancer underwent surgery and received [68Ga]Ga-FAPI-46 PET/CT prior therapy. 8 primary tumor sites and 4 lymph node regions were analyzed. FAPI uptake was increased on primary tumor site (SUVmax 16.2 (9.1 - 25.8)). Histopathological proven lymph node regions showed highly increased FAPI uptakes (SUVmax 17.9 (16.4 - 23.5) on [68Ga]Ga-FAPI-46 PET/CT. CONCLUSION In this first pilot cohort, there were no false-positive FAPI uptake which might allow the detection of occult lymph node metastasis by [68Ga]Ga-FAPI-46 PET/CT and might consequently lead to omitting lymph node regions during surgery that had no increased FAPI uptake pre-operatively.
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Affiliation(s)
- Lennert Eismann
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Stephan T Ledderose
- Institute of Pathology, LMU Munich, Munich, Germany Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Benazir Enzinger
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Elena Berg
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Severin Rodler
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Gerald B Schulz
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Johannes Toms
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Franz J Gildehaus
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
- Die Radiologie, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Lena M Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
- Department of Nuclear Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Bayerisches Zentrum Für Krebsforschung (BZKF), Partner Site LMU Munich, Munich, Germany
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Chaloupka M, Pyrgidis N, Ebner B, Volz Y, Pfitzinger PL, Berg E, Enzinger B, Atzler M, Ivanova T, Clevert DA, Buchner A, Stief CG, Apfelbeck M. Added value of randomised biopsy to multiparametric magnetic resonance imaging-targeted biopsy of the prostate in a contemporary cohort. BJU Int 2024; 133:548-554. [PMID: 38060339 DOI: 10.1111/bju.16248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To assess the added value of concurrent systematic randomised ultrasonography-guided biopsy (SBx) to multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy and the additional rate of overdiagnosis of clinically insignificant prostate cancer (ciPCa) by SBx in a large contemporary, real-world cohort. PATIENTS AND METHODS A total of 1552 patients with positive mpMRI and consecutive mpMRI-targeted biopsy and SBx were enrolled. Added value and the rate of overdiagnosis by SBx was evaluated. PRIMARY OUTCOME added value of SBx, defined as detection rate of clinically significant PCa (csPCa; International Society of Urological Pathology [ISUP] Grade ≥2) by SBx, while mpMRI-targeted biopsy was negative or showed ciPCa (ISUP Grade 1). SECONDARY OUTCOME rate of overdiagnosis by SBx, defined as detection of ciPCa in patients with negative mpMRI-targeted biopsy and PSA level of <10 ng/mL. RESULTS Detection rate of csPCa by mpMRI-targeted biopsy and/or SBx was 753/1552 (49%). Added value of SBx was 145/944 (15%). Rate of overdiagnosis by SBx was 146/656 (22%). Added value of SBx did not change when comparing patients with previous prostate biopsy and biopsy naïve patients. In multivariable analysis, a Prostate Imaging-Reporting and Data System (PI-RADS) 4 index lesion (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.66-6.78; P = 0.001), a PI-RADS 5 index lesion (OR 2.89, 95% CI 1.39-6.46; P = 0.006) and age (OR 1.05, 95% CI 1.03-1.08; P < 0.001) were independently associated with added value of SBx. CONCLUSIONS In our real-world analysis, we saw a significant impact on added value and added rate of overdiagnosis by SBx. Subgroup analysis showed no significant decrease of added value in any evaluated risk group. Therefore, we do not endorse omitting concurrent SBx to mpMRI-guided biopsy of the prostate.
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Affiliation(s)
| | | | | | - Yannic Volz
- Department of Urology, LMU Klinikum, Munich, Germany
| | | | - Elena Berg
- Department of Urology, LMU Klinikum, Munich, Germany
| | | | | | - Troya Ivanova
- Department of Urology, LMU Klinikum, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, Interdisciplinary Ultrasound Center, LMU Klinikum, Munich, Germany
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Pyrgidis N, Volz Y, Ebner B, Kazmierczak PM, Enzinger B, Hermans J, Buchner A, Stief C, Schulz GB. The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data. World J Urol 2024; 42:19. [PMID: 38197902 PMCID: PMC10781819 DOI: 10.1007/s00345-023-04742-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/21/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVES To determine a data-based optimal annual radical cystectomy (RC) hospital volume threshold and evaluate its clinical significance regarding perioperative mortality, complications, length of hospital stay, and hospital revenues. MATERIAL AND METHODS We used the German Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005-2020). 95,841 patients undergoing RC were included. Based on ROC analyses, the optimal RC threshold to reduce mortality, ileus, sepsis, transfusion, hospital stay, and costs is 54, 50, 44, 44, 71 and 76 cases/year, respectively. Therefore, we defined an optimal annual hospital threshold of 50 RCs/year, and we also used the threshold of 20 RCs/year proposed by the EAU guidelines to perform multiple patient-level analyses. RESULTS 28,291 (29.5%) patients were operated in low- (< 20 RC/year), 49,616 (51.8%) in intermediate- (20-49 RC/year), and 17,934 (18.7%) in high-volume (≥ 50 RC/year) centers. After adjusting for major risk factors, high-volume centers were associated with lower inpatient mortality (OR 0.72, 95% CI 0.64-0.8, p < 0.001), shorter length of hospital stay (2.7 days, 95% CI 2.4-2.9, p < 0.001) and lower costs (457 Euros, 95% CI 207-707, p < 0.001) compared to low-volume centers. Patients operated in low-volume centers developed more perioperative complications such as transfusion, sepsis, and ileus. CONCLUSIONS Centralization of RC not only improves inpatient morbidity and mortality but also reduces hospital stay and costs. We propose a threshold of 50 RCs/year for optimal outcomes.
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Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | | | - Benazir Enzinger
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julian Hermans
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Gerald Bastian Schulz
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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Ebner B, Fleckenstein F, Volz Y, Eismann L, Hermans J, Buchner A, Enzinger B, Weinhold P, Wichmann C, Stief CG, Humpe A, Pyrgidis N, Schulz GB. Oncological impact of perioperative blood transfusion in bladder cancer patients undergoing radical cystectomy: Do we need to consider storage time of blood units, donor age, or gender matching? Transfusion 2024; 64:29-38. [PMID: 38053445 DOI: 10.1111/trf.17618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The oncological impact of perioperative blood transfusions (PBTs) of patients undergoing radical cystectomy (RC) because of bladder cancer (BCa) has been a controversial topic discussed in recent years. The main cause for the contradictory findings of existing studies might be the missing consideration of the storage time of red blood cell units (BUs), donor age, and gender matching. STUDY DESIGN AND METHODS We retrospectively analyzed BCa patients who underwent RC in our department between 2004 and 2021. We excluded patients receiving BUs before RC, >10 BUs, or RC in a palliative setting. We assessed the effect of blood donor characteristics and storage time on overall survival (OS) and cancer-specific survival (CSS) through univariate and multivariable Cox regression analysis. We also performed a propensity score matching with patients who received BUs and patients who did not on a 1:1 ratio. RESULTS We screened 1692 patients and included 676 patients for the propensity score matching. In the multivariable analysis, PBT was independently associated with worse OS and CSS (p < .001). Postoperative transfusions were associated with better OS (p = .004) and CSS (p = .008) compared to intraoperative or mixed transfusions. However, there was no influence of blood donor age, storage time, or gender matching on prognosis. DISCUSSION In our study of BCa patients undergoing RC, we demonstrate that PBT, especially if administered intraoperatively, is an independent risk factor for a worse prognosis. However, storage time, donor age, or gender matching did not negatively affect oncological outcomes. Therefore, the specific selection of blood products does not promise any benefits.
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Affiliation(s)
- Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | - Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Lennert Eismann
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Hermans
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benazir Enzinger
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Wichmann
- Division of Transfusion Medicine, Cell Therapeutics and Haemostaseology, University Hospital, LMU Munich, Munich, Germany
| | | | - Andreas Humpe
- Division of Transfusion Medicine, Cell Therapeutics and Haemostaseology, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Chaloupka M, Pyrgidis N, Ebner B, Pfitzinger PL, Volz Y, Berg E, Enzinger B, Atzler M, Ivanova T, Pfitzinger PL, Stief CG, Apfelbeck M, Clevert DA. mpMRI-targeted biopsy of the prostate in men ≥ 75 years. 7-year report from a high-volume referral center. Clin Hemorheol Microcirc 2024; 86:63-70. [PMID: 37718788 DOI: 10.3233/ch-238101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Multiparametric magnetic resonance imaging (mpMRI) -Ultrasound- fusion guided biopsy of the prostate (FBx) is the new gold standard for the detection of prostate cancer. Hallmark studies showing superior detection rates of FBx over randomized biopsies routinely excluded patients≥75 years and information on outcome of FBx on this patient cohort is sparse. As a large referral center, we have performed FBx on a substantial number of patients this age. By evaluating outcome of FBx of patients over the age of 75 years we wanted to close the gap of knowledge on this patient cohort. MATERIALS AND METHODS Between 2015 -2022, 1577 patients underwent FBx at our department and were considered for analysis. Clinical and histopathological parameters were recorded. Clinical data comprised age at FBx, serum level of Prostate-specific antigen (PSA), prostate volume, PSA-density, history of previous biopsies of the prostate, result of the digital rectal examination (DRE) and assessment of the indexlesion of mpMRI according to the Prostate Imaging and Reporting Data System (PI-RADS). Univariate analysis and multivariable logistic regression was used to identify age barrier of 75 years as a potential risk factor of detection of clinically significant prostate cancer by FBx. RESULTS 379/1577 patients (24%) were≥75 years and 1198/1577 (76%) patients were < 75 years, respectively. Preoperative PSA was significantly higher in patients≥75 years compared to patients < 75 years (9.54 vs. 7.8, p < 0.001). Patients≥75 years presented significantly more often with mpMRI target lesions classified as PI-RADS 5 compared to patients < 75 years (45% vs. 29%, p < 0.001). Detection rate of clinically significant prostate cancer was significantly higher in patients≥75 years compared to patients < 75 years (63% vs. 43%, p < 0.001). Aggressive prostate cancer grade ISUP 5 was significantly more often detected in patients≥75 years compared to patients < 75 years (13% vs. 8%, p = 0.03). On multivariable logistic regression model adjusted for PSA and PI-RADS score, age barrier of 75 years was identified as a significant risk factor for the detection of clinically significant prostate cancer by FBx (OR: 1.77, 95% CI: 1.36 -2.31, p < 0.001). CONCLUSION After evaluation of a large patient cohort, we show that age≥75 years represents a significant risk factor for the detection of clinically significant prostate cancer. Further studies on mid- and long term outcome are necessary to draw conclusions for clinical decision making in this patient cohort.
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Affiliation(s)
- Michael Chaloupka
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Nikolaos Pyrgidis
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Paulo L Pfitzinger
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Yannic Volz
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Elena Berg
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Benazir Enzinger
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Troya Ivanova
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Paulo L Pfitzinger
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Maria Apfelbeck
- Department of Urology, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center, LMU Klinikum, Ludwigs-Maximilians University Munich, Munich, Germany
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Volz Y, Trappmann R, Ebner B, Eismann L, Enzinger B, Hermans J, Pyrgidis N, Stief C, Schulz GB. Upstaging after Transurethral Resection of the Bladder for Non-Muscle-Invasive Cancer of the Bladder: Who Is at Highest Risk? Urol Int 2023; 108:42-48. [PMID: 37944501 DOI: 10.1159/000535024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Transurethral resection of the bladder (TUR-BT) is the standard initial treatment and diagnosis of bladder cancer (BC). Of note, upstaging into muscle-invasive disease (MIBC) during re-resection occurs in a significant proportion of patients. This study aimed to define risk factors at initial TUR-BT for upstaging. METHODS TUR-BT between 2009 and 2021 were retrospectively screened (n = 3,237). We included patients with visible tumors that received their primary and re-TUR-BT at our institution. Upstaging was defined as pathological tumor stage progression into MIBC at re-TUR-BT. Clinicopathological variables were analyzed for the impact on upstaging. RESULTS Two hundred and sixty-six patients/532 TUR-BTs were included in the final analysis. Upstaging occurred in 7.9% (21/266) patients. Patients with upstaging presented with stroma-invasive and papillary non-muscle-invasive BC at primary resection in 85.7% (18/21) and 14.3% (3/21), respectively. Detrusor muscle at primary TUR-BT was significantly less present in patients with upstaging (4.1 vs. 95.9%; p < 0.001). After multivariate analysis, solid tumor configuration (HR: 4.17; 95% CI: 1.23-14.15; p = 0.022) and missing detrusor muscle at initial TUR-BT (HR: 3.58; 95% CI: 1.05-12.24; p = 0.043) were significant risk factors for upstaging into MIBC. CONCLUSIONS The current study defined two major risk factors for upstaging: missing detrusor muscle and solid tumor configuration. We propose that a second resection should be performed earlier if these risk factors apply.
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Affiliation(s)
- Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Rabea Trappmann
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Lennert Eismann
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benazir Enzinger
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Hermans
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Gerald B Schulz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Volz Y, Apfelbeck M, Pyrgidis N, Pfitzinger PL, Berg E, Ebner B, Enzinger B, Ivanova T, Atzler M, Kazmierczak PM, Clevert DA, Stief C, Chaloupka M. The Impact of Prostate Volume on the Prostate Imaging and Reporting Data System (PI-RADS) in a Real-World Setting. Diagnostics (Basel) 2023; 13:2677. [PMID: 37627939 PMCID: PMC10453915 DOI: 10.3390/diagnostics13162677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Multiparametric magnetic resonance imaging (mpMRI) has emerged as a new cornerstone in the diagnostic pathway of prostate cancer. However, mpMRI is not devoid of factors influencing its detection rate of clinically significant prostate cancer (csPCa). Amongst others, prostate volume has been demonstrated to influence the detection rates of csPCa. Particularly, increasing volume has been linked to a reduced cancer detection rate. However, information about the linkage between PI-RADS, prostate volume and detection rate is relatively sparse. Therefore, the current study aims to assess the association between prostate volume, PI-RADS score and detection rate of csP-Ca, representing daily practice and contemporary mpMRI expertise. Thus, 1039 consecutive patients with 1151 PI-RADS targets, who underwent mpMRI-guided prostate biopsy at our tertiary referral center, were included. Prior mpMRI had been assessed by a plethora of 111 radiology offices, including academic centers and private practices. mpMRI was not secondarily reviewed in house before biopsy. mpMRI-targeted biopsy was performed by a small group of a total of ten urologists, who had performed at least 100 previous biopsies. Using ROC analysis, we defined cut-off values of prostate volume for each PI-RADS score, where the detection rate drops significantly. For PI-RADS 4 lesions, we found a volume > 61.5 ccm significantly reduced the cancer detection rate (OR 0.24; 95% CI 0.16-0.38; p < 0.001). For PI-RADS 5 lesions, we found a volume > 51.5 ccm to significantly reduce the cancer detection rate (OR 0.39; 95% CI 0.25-0.62; p < 0.001). For PI-RADS 3 lesions, none of the evaluated clinical parameters had a significant impact on the detection rate of csPCa. In conclusion, we show that enlarged prostate volume represents a major limitation in the daily practice of mpMRI-targeted biopsy. This study is the first to define exact cut-off values of prostate volume to significantly impair the validity of PI-RADS assessed in a real-world setting. Therefore, the results of mpMRI-targeted biopsy should be interpreted carefully, especially in patients with prostate volumes above our defined thresholds.
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Affiliation(s)
- Yannic Volz
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Maria Apfelbeck
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Nikolaos Pyrgidis
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Paulo L. Pfitzinger
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Elena Berg
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Benedikt Ebner
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Benazir Enzinger
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Troya Ivanova
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Michael Atzler
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Philipp M. Kazmierczak
- Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (D.-A.C.)
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (D.-A.C.)
| | - Christian Stief
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
| | - Michael Chaloupka
- Department of Urology, LMU Klinikum, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany; (M.A.); (N.P.); (P.L.P.); (E.B.); (B.E.); (B.E.); (T.I.); (M.A.); (C.S.); (M.C.)
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Enzinger B, Pfitzinger PL, Ebner B, Ivanova T, Volz Y, Apfelbeck M, Kazmierczak P, Stief C, Chaloupka M. [Common errors, pitfalls, and management of complications of prostate biopsy : The most common diagnostic and procedural challenges of transrectal fusion prostate biopsy in the initial diagnosis of clinically significant prostate cancer]. Urologie 2023; 62:479-486. [PMID: 37052650 DOI: 10.1007/s00120-023-02063-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Transrectal (TR) prostate biopsy is the gold standard in diagnosis of prostate cancer (PC). It requires a precise and safe technique for sample acquisition. OBJECTIVE Several approaches will be discussed to avoid overdiagnosis, false-negative results, and complications of the procedure. MATERIALS AND METHODS We analyzed national and European guidelines, systematic reviews, meta-analyses, as well as prospective and retrospective studies to describe current trends in indication and performance of biopsies. RESULTS Incorporation of risk calculators and magnetic resonance imaging (MRI) into daily routine reduces biopsy rates and results in a more precise diagnosis of clinically significant prostate cancer (csPC). Combination of random- and MRI-fusion guided biopsy-but also extending the radius of sampling by 10 mm beyond the MRI lesion and a transperineal (TP) sampling approach - lead to a higher tumor-detection rate. Bleeding is the most common complication after prostate biopsy and is usually self-limiting. Postbiopsy infection rates can be reduced through TP biopsy. CONCLUSION TR MRI-fusion guided biopsy is a widely acknowledged tool in primary diagnostics of csPC. Higher detection rates and safety can be achieved through a TP sampling approach.
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Affiliation(s)
- Benazir Enzinger
- Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | | | - Benedikt Ebner
- Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Troya Ivanova
- Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Yannic Volz
- Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Maria Apfelbeck
- Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Philipp Kazmierczak
- Klinik und Poliklinik für Radiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Christian Stief
- Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Michael Chaloupka
- Urologische Klinik und Poliklinik, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
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