scholarly journals MRI-TRUS fusion guided prostate biopsy – initial experience and assessment of the role of contralateral lobe systematic biopsy

2019 ◽  
Vol 21 (1) ◽  
pp. 37
Author(s):  
Iulia Andras ◽  
Dana Crisan ◽  
Emanuel Cata ◽  
Attila Tamas-Szora ◽  
Cosmin Caraiani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Initial Experience ◽  
Positive Biopsy ◽  
Guided Biopsy ◽  
Diagnosis Rate ◽  
The Mean ◽  
Clinically Significant ◽  
Systematic Biopsy

Aims: To present our initial experience and results of MRI-TRUS fusion guided prostate biopsy and assess the role of contralateral lobe systematic biopsy.Material and method: A number of 119 patients with clinical or biochemical suspicion for prostate cancer (PCa) were included. All patients harbored at least one PIRADS score ≥ 3 lesion and underwent MRI-TRUS fusion guided biopsy, as well as a concurrent systematic biopsy. The biopsy was performed by the same operator, using a rigidregistration software system.Results: The mean age of the patients was 62.2 years. The mean pre-biopsy PSA was 9.15 ng/dl. The diagnosis rate of MRI-TRUS fusion guided biopsy was 47% for overall PCa and 29.4% for clinically significant (cs) PCa. A higher PIRADS score was significantly associated with the presence of overall and csPCa. MRI-TRUS fusion guided biopsy had a higher percentage of positive biopsy cores (51% vs 29%), higher likelihood of csPCa (OR 5.36, p=0.008) and upgrading (14.8%) in comparison with systematic biopsy but missed 6.7% csPCa. The contralateral lobe systematic biopsy could have been avoided without losing the PCa diagnosis all patients with PIRADS score 5, both in initial and repeat biopsy setting. Anterior and transitional lesions were more likely to be diagnosed only by targeted cores.Conclusion: MRI-TRUS guided prostate biopsy improves the detection of PCa, but systematic biopsy is still essential. In selected cases (PIRADS 5), contralateral lobe systematic biopsy can safely be avoided. Pre-biopsy mpMRI might reduce the number of biopsy sessions in patients with anterior and transitional lesions.

Clinical outcomes after transperineal template-guided prostate biopsy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 156-156
Author(s):  
Richard A. Hsi ◽  
Randall James Moeller ◽  
Marc Mitchell ◽  
Scott Bildsten ◽  
Paul Kozlowski ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Outcomes ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Entire Group ◽  
Detection Rates ◽  
Positive Biopsy ◽  
Pathologic Features ◽  
The Mean ◽  
Clinically Significant

156 Background: To assess clinical outcomes after transperineal template-guided prostate biopsy (TTPB) including detection rates, pathologic features, clinical relevance and morbidity. Methods: Forty eight men underwent TTPB. All patients had at least one (range 1–4) prior negative transrectal ultrasound-guided (TRUS) prostate biopsy and no prostate cancer diagnosis. The mean pre-biopsy PSA of the entire group was 13.1 ng/ml (range 4.5–46.4). The mean number of cores sampled was 24.7 (range 22–28). Results: The rate of prostate cancer detection was 52% (25/48). Clinically significant prostate cancer, defined as intermediate (n=9) and high (n=11) risk disease using D’Amico criteria, was found in 80% (20/25) of positive biopsy cases. Seventy-two percent of all positive biopsy cores were anatomically located in the anterior or anterolateral positions within the prostate. Urinary retention requiring catheterization after the procedure developed in 6% (3/48) of patients. No patients developed rectal or infectious complications after TTPB. Conclusions: TTPB is a well tolerated procedure resulting in a significant rate of cancer detection. Biopsies were frequently found to be positive in the anterior half of the prostate. Clinically significant disease was found in a high percentage of patients.

The validity of repeat prostate biopsy in prior biopsy negative patients: MRI-TRUS fusion guided biopsy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 95-95
Author(s):  
Jinho Hwang ◽  
Jung Jun Kim ◽  
Jong Jin Oh ◽  
Chang Wook Jeong ◽  
Sangchul Lee ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Statistical Significance ◽  
Transrectal Ultrasound ◽  
Negative Results ◽  
Guided Biopsy ◽  
Clinically Significant ◽  
Magnetic Resonance Imaging Mri ◽  
Target Biopsy

95 Background: To investigate validity of magnetic resonance imaging (MRI)-transrectal ultrasound fusion target biopsy (Fusion-Bx) compared with transrectal ultrasound-guided biopsy (TRUS-Bx) by evaluating detection rate of prostate cancer (PCa). Methods: Medical records of 376 patients with prior negative TRUS-Bx who underwent repeat prostate biopsy between Aug. 2015 and Apr. 2017 were retrospectively reviewed. The cohort was stratified into two groups (TRUS-Bx and Fusion-Bx) and clinical and biopsy characteristics patterns were analyzed. Conventional systemic randomized 12-core biopsy was performed in TRUS-Bx group whereas Fusion-Bx group applied additional 2-croes of target biopsy against suspicious lesions in MRI. Results: There were total 195 and 181 patients in TRUS-Bx and Fusion-Bx group, respectively. The overall cancer detection rate was slightly higher in Fusion-Bx group, but no statistical significance was observed (24.6% vs 28.7%, p = 0.367). Fusion-Bx group showed a significantly greater detection rate in target core analysis (5.0% vs 17.7%, p = 0.044). In confirmed positive biopsy patients, Fusion-Bx group had a higher rate of clinically significant prostate cancer (CsPCa) cases, but failed to achieve statistical significance (85.4% vs 92.3%, p = 0.271). When the patients with highly or very highly suspicious MRI (maximum image grade 4-5) findings in Fusion-Bx group was compared to the whole cohort of TRUS-Bx group, Fusion-Bx group was significantly greater in terms of overall detection rate (24.6% vs 38.0%, p = 0.017) and CsPCa detection rate (85.4% vs 97.0%, p = 0.009). Higher the target image grade, greater biopsy yield was achieved. Conclusions: For the patients who underwent repeat biopsy due to prior negative results, fusion-Bx showed better clinical significance including detection rate. A further study with a larger cohort size and prospective design is still needed to confirm the validity of Fusion-Bx.

scholarly journals Systematic and MRI-Cognitive Targeted Transperineal Prostate Biopsy Accuracy in Detecting Clinically Significant Prostate Cancer after Previous Negative Biopsy and Persisting Suspicion of Malignancy

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 57
Author(s):  
Alvydas Vėželis ◽  
Gediminas Platkevičius ◽  
Marius Kinčius ◽  
Liutauras Gumbys ◽  
Ieva Naruševičiūtė ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Targeted Biopsy ◽  
Negative Biopsy ◽  
Prostate Biopsies ◽  
Clinically Significant ◽  
Systematic Biopsy ◽  
Targeted Biopsies

Background and objectives: Overdiagnosis, overtreatment, and the need for repeated procedures caused by transrectal ultrasound guided prostate biopsies and their related complications places a heavy burden on healthcare systems. This was a prospective cohort validating study to access the clinical accuracy of systematic and MRI-cognitive targeted transperineal prostate biopsies in detecting clinically significant prostate cancer after a previous negative biopsy and persistent suspicion of malignancy. The primary goal was to assess the ability of multiparametric magnetic resonance imaging (mpMRI) to detect clinically significant prostate cancer with an additional goal to assess the diagnostic value of systematic and MRI-cognitive transperineal biopsies. Materials and Methods: In total, 200 patients were enrolled who had rising serum prostate specific antigen (PSA) levels for at least 4 months after a previous negative transrectal ultrasound (TRUS) biopsy. All eligible men underwent 1.5T prostate mpMRI, reported using the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), followed by a 20-region transperineal prostate systematic biopsy and additional targeted biopsies. Results: Systematic 20-core transperineal prostate biopsies (TPBs) were performed for 38 (19%) patients. Systemic 20-core TPB with additional cognitive targeted biopsies were performed for 162 (81%) patients. Clinically significant prostate cancer (csPC) was detected for 31 (15.5%) patients, of which 20 (64.5%) cases of csPC were detected by systematic biopsy, eight (25.8%) cases were detected by targeted biopsy, and three (9.7%) both by systematic and targeted biopsies. Conclusions: Cognitive mpMRI guided transperineal target biopsies increase the detection rate of clinically significant prostate cancer after a previously negative biopsy. However, in a repeat prostate biopsy setting, we recommend applying a cognitive targeted biopsy with the addition of a systematic biopsy.

scholarly journals The urologist’s learning curve of “in-bore” magnetic resonance-guided prostate biopsy

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Barak Rosenzweig ◽  
Tomer Drori ◽  
Orit Raz ◽  
Gil Goldinger ◽  
Gadi Shlomai ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Learning Curve ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Medical Center ◽  
Detection Rates ◽  
Targeted Sampling ◽  
The Mean ◽  
Clinically Significant

Abstract Background The combination of multi-parametric MRI to locate and define suspected lesions together with their being targeted by an MRI-guided prostate biopsy has succeeded in increasing the detection rate of clinically significant disease and lowering the detection rate of non-significant prostate cancer. In this work we investigate the urologist’s learning curve of in-bore MRI-guided prostate biopsy which is considered to be a superior biopsy technique. Materials and methods Following Helsinki approval by The Chaim Sheba Medical Center ethics committee in accordance with The Sheba Medical Center institutional guidelines (5366-28-SMC) we retrospectively reviewed 110 IB-MRGpBs performed from 6/2016 to 1/2019 in a single tertiary center. All patients had a prostate multi-parametric MRI finding of at least 1 target lesion (prostate imaging reporting and data system [PI-RADS] score ≥ 3). We analyzed biopsy duration and clinically significant prostate cancer detection of targeted sampling in 2 groups of 55 patients each, once by a urologist highly trained in IB-MRGpBs and again by a urologist untrained in IB-MRGpBs. These two parameters were compared according to operating urologist and chronologic order. Results The patients’ median age was 68 years (interquartile range 62–72). The mean prostate-specific antigen level and prostate size were 8.6 ± 9.1 ng/d and 53 ± 27 cc, respectively. The mean number of target lesions was 1.47 ± 0.6. Baseline parameters did not differ significantly between the 2 urologists’ cohorts. Overall detection rates of clinically significant prostate cancer were 19%, 55%, and 69% for PI-RADS 3, 4 and 5, respectively. Clinically significant cancer detection rates did not differ significantly along the timeline or between the 2 urologists. The average duration of IB-MRGpB targeted sampling was 28 ± 15.8 min, correlating with the number of target lesions (p < 0.0001), and independent of the urologist’s expertise. Eighteen cases defined the cutoff for the procedure duration learning curve (p < 0.05). Conclusions Our data suggest a very short learning curve for IB-MRGpB-targeted sampling duration, and that clinically significant cancer detection rates are not influenced by the learning curve of this technique.

scholarly journals The role of anogenital distance in the incidence risk of prostate cancer in China

2021 ◽  
Author(s):  
jiatong zhou ◽  
ranlu liu
Keyword(s):  
Prostate Cancer ◽  
Benign Prostatic Hyperplasia ◽  
Prostate Biopsy ◽  
Large Scale ◽  
Prostatic Hyperplasia ◽  
Anogenital Distance ◽  
Incidence Risk ◽  
The Mean ◽  
Androgen Levels

Abstract Background: Anogenital distance（AGD） can be used as a biomarker to indirectly indicate androgen levels during the sexual maturation of mammals. In order to gain a deeper understanding of the association between the AGD and the risk of prostate cancer(PCa), we performed this studyMaterials: A total of 107 patients undergoing perineal prostate biopsy from November 2019 to August 2020 were enrolled. All patients diagnosed 57 PCa patients and 50 benign prostatic hyperplasia(BPH) patients through perineal prostate biopsy in our hospital . The anus to the posterior base of the scrotum (AGDAS) and the cephalad insertion of the penis (AGDAP) of all patients were measured before prostate biopsy.Result: The mean age of patients with PCa was 69.46 ± 7.52 and the mean age of patients with BPH was 67.38± 8.26. We did not find a significant association between age and BMI in the risk of PCa(all p＞0.05). Besides, there was no significant association between AGD and the risk of PCa(p＞0.05). we only discovered that PSA could play an important role in the development of PCa.Conclusion: AGD may not play an important role in predicting the incidence risk of PCa. we still need a large-scale prospective study to explore the ture association between AGD and the incidence of PCa.

scholarly journals The Detection of Clinically Significant Prostate Cancer in Chinese Biopsy Naïve Men. The Role of Mpmri and Targeted Biopsy and Risk Stratification Using PSA Density

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Kai Zhang ◽  
Zijian Song ◽  
S. Remmers ◽  
Rui Chen ◽  
Gang Zhu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Stratification ◽  
Prostate Biopsy ◽  
Digital Rectal Examination ◽  
Psa Density ◽  
Medical Centers ◽  
Chinese Cohort ◽  
Detection Ratio ◽  
Clinically Significant

Objective To evaluate the performance of the systematic (SBx) and targeted prostate biopsy (TBx) in detecting prostate cancer (PCa) and significant prostate cancer (csPCa) and including upfront risk stratification with PSA Density (PSAD) in a biopsy naïve cohort of Chinese men. Methods A total of 348 men from two medical centers were available for analyses. All men underwent a mpMRI scan based on an elevated PSA and/or abnormal digital rectal examination (DRE). A total of 150 men received both SBx and TBx prostate biopsy (PIRADS >= 3). In these men the detection ratio was calculated as the PCa and csPCa prevalence of the TBx strategy divided by the prevalence of PCa and csPCa of the SBx + TBx strategy. For PSAD analyses the percentage missed csPCa were plotted against the clinically relevant thresholds of PSAD (range 0.01 – 0.20). Results In the men with PIRADS >= 3, a total of 89 PCa cases (59 being csPCa) were detected. The TBx alone strategy detected 74 of all PCa, leading to a detection ratio of 0.83 (95% CI 0.74-0.90). For csPCa these numbers were 48 of the total 59 csPCa cases, i.e a detection ratio of 0.81 (95% CI 0.69-0.90).With the focus on avoiding missing csPCa diagnoses a cut-off of PSA D 0.10 seemed optimal in this cohort, leading to a reduction of 15% of all referrals, missing 6% of all PCa and 2% of csPCa. A similar cut-off of PSAD holds if also men with PIRADS >= 2 were included. Conclusion In this Chinese cohort of biopsy naïve men a TBx approach can aid in improved detection of csPCa. Omitting SBx would results in missing csPCa cases. An upfront risk stratification step with the use of PSAD is advised although the optimal PSAD cut-off in Asian men most likely differs from the generally advised cut-off of 0.15 ng/ml/ml.

scholarly journals 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 ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1335
Author(s):  
Enrique Gomez-Gomez ◽  
Sara Moreno Sorribas ◽  
Jose Valero-Rosa ◽  
Ana Blanca ◽  
Juan Mesa ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Detection Rate ◽  
Magnetic Resonance Images ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Negative Biopsy ◽  
The Mean ◽  
Clinically Significant ◽  
Systematic Biopsy

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.

scholarly journals Evaluation of the Ginsburg Scheme: Where Is Significant Prostate Cancer Missed?

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2502
Author(s):  
August Sigle ◽  
Cordula A. Jilg ◽  
Timur H. Kuru ◽  
Nadine Binder ◽  
Jakob Michaelis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Detection ◽  
Logistic Regression Analysis ◽  
Anterior Region ◽  
Targeted Biopsy ◽  
Detection Rates ◽  
Clinically Significant ◽  
Systematic Biopsy

Background: Systematic biopsy (SB) according to the Ginsburg scheme (GBS) is widely used to complement MRI-targeted biopsy (MR-TB) for optimizing the diagnosis of clinically significant prostate cancer (sPCa). Knowledge of the GBS’s blind sectors where sPCa is missed is crucial to improve biopsy strategies. Methods: We analyzed cancer detection rates in 1084 patients that underwent MR-TB and SB. Cancerous lesions that were missed or underestimated by GBS were re-localized onto a prostate map encompassing Ginsburg sectors and blind-sectors (anterior, central, basodorsal and basoventral). Logistic regression analysis (LRA) and prostatic configuration analysis were applied to identify predictors for missing sPCa with the GBS. Results: GBS missed sPCa in 39 patients (39/1084, 3.6%). In 27 cases (27/39, 69.2%), sPCa was missed within a blind sector, with 17/39 lesions localized in the anterior region (43.6%). Neither LRA nor prostatic configuration analysis identified predictors for missing sPCa with the GBS. Conclusions: This is the first study to analyze the distribution of sPCa missed by the GBS. GBS misses sPCa in few men only, with the majority localized in the anterior region. Adding blind sectors to GBS defined a new sector map of the prostate suited for reporting histopathological biopsy results.

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