Use of TDI during MRI/US fusion-guided biopsy for suspected prostate cancer

2021 ◽  
pp. 1-11
Author(s):  
Andreas Maxeiner ◽  
Thomas Fischer ◽  
Carsten Stephan ◽  
Selda Treskatsch ◽  
Alexander Daniel Jacques Baur ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Gland ◽  
Biological Tissues ◽  
Diagnostic Value ◽  
Tissue Doppler ◽  
Target Lesion ◽  
Doppler Imaging ◽  
Guided Biopsy ◽  
Clinically Significant

BACKGROUND: Tissue Doppler imaging (TDI) uses the Doppler principle to quantify the movement of biological tissues. OBJECTIVE: To investigate the contribution of TDI parameters derived during magnetic resonance imaging and ultrasound (MRI/US) fusion-guided biopsy for prostate cancer (PCa) discrimination. METHODS: From March 2016 to Dec. 2018, 75 men with suspected PCa prospectively underwent fusion-guided prostate biopsy. TDI overlaid on predefined target lesion were compared to the confirmed contralateral tumor-free area of the prostate gland (using Image J). Diagnostic value of TDI parameters was assessed using histopathology as standard of reference. RESULTS: Thirty-seven patients were diagnosed with PCa (49.3%), among them 27 with clinically significant PCa (Gleason score >  3 + 3 = 6 (ISUP 1). The LES/REF ratio was lower in confirmed PCa patients compared to patients without PCa (0.42, IQR, 0.22–0.59 vs. 0.52, IQR, 0.40–0.72, p = 0.017). TDI parameters allowed differentiation of low-risk from high-to-intermediate-risk PCa (ISUP 2 versus ISUP 3) based on lower pixel counts within the target ROI (1340, IQR 596–2430 vs. 2687, IQR 2453–3216, p = 0.004), lower pixel percentage (16.4 IQR 11.4–29.5 vs. 27.3, IQR 22.1–39.5; p = 0.005), and lower LES/REF ratios (0.29, IQR 0.19–0.51 vs. 0.52, IQR 0.47–0.74, p = 0.001). CONCLUSION: TDI of prostate lesions prelocated by MRI discriminates between cancerous and noncancerous lesions and further seems to enable characterization of PCa aggressiveness. This widely available US technique may improve confidence in target lesion localization for tissue sampling.

The contribution of strain patterns in characterization of prostate peripheral zone lesions at transrectal ultrasonography

2012 ◽  
Vol 53 (1) ◽  
pp. 119-126 ◽  
Author(s):  
Yan Zhang ◽  
Jie Tang ◽  
Yan-mi Li ◽  
Xiang Fei ◽  
En-hui He ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Peripheral Zone ◽  
Diagnostic Value ◽  
Ultrasound Elastography ◽  
Transrectal Ultrasonography ◽  
Targeted Biopsy

Background Elasticity is an important characteristic of tissue. During an elastography examination, various strain images of lesions are observed, and a suitable classification of strain patterns (SP) may provide vital diagnostic information about lesions. Numerous studies have shown that ultrasound elastography can improve the detection of prostate cancer, but the diagnostic value of SP classification has not yet been fully evaluated. Purpose To investigate the contribution of SP on the characterization of prostate peripheral zone lesions by transrectal real-time tissue elastography (TRTE) in combination with conventional transrectal ultrasonography (TRUS). Material and Methods One hundred and seventy-one patients with suspected prostate cancer underwent TRUS and TRTE examinations. The SPs of the suspicious lesions were classified into five scores by TRTE according to the degree and distribution of strain. All findings were confirmed by transrectal systematic 12-core biopsies and targeted biopsies for suspicious areas detecting by TRUS and/or TRTE. Results One hundred and forty-eight of 171 patients had high-quality TRTE imaging and were included into the study. When a cut-off point of SP score III was used, the area under the receiver-operating characteristic curve (AUC) was, respectively, 0.75 (95% CI: 0.67–0.83), 0.85 (95% CI: 0.78–0.91) and 0.84 (95% CI: 0.77–0.91) for the diagnosis of prostate cancer by TRUS, TRTE and TRTE + TRUS. A linear tendency of SP and Gleason scores was observed in scores III-V. The detection rate of prostate cancer using TRTE-targeted biopsy (75.8%) was significantly higher than that of systematic 12-core biopsy plus TRUS-targeted biopsy (14.5%) ( P = 0.00). Conclusion This study suggests the significant contribution of SP on characterization of prostate peripheral zone lesions and the improvement of TRTE-targeted biopsy on detection of prostate cancer.

Predictors for the detection of prostate cancer and clinically significant prostate cancer using TRUS-guided biopsy in patients with negative initial biopsy results

2018 ◽  
Vol 36 (7) ◽  
pp. 1047-1053
Author(s):  
Sangjun Yoo ◽  
Juhyun Park ◽  
Sung Yong Cho ◽  
Min Chul Cho ◽  
Ja Hyeon Ku ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Guided Biopsy ◽  
Initial Biopsy ◽  
Clinically Significant

Prostate epithelial cell differentiation and its relevance to the understanding of prostate cancer therapies

2004 ◽  
Vol 108 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Ronan M. LONG ◽  
Colm MORRISSEY ◽  
John M. FITZPATRICK ◽  
R. William G. WATSON
Keyword(s):  
Prostate Cancer ◽  
Epithelial Cells ◽  
Prostate Gland ◽  
Western World ◽  
Cancer Therapies ◽  
Normal Prostate ◽  
Full Characterization ◽  
Prostate Epithelial Cells ◽  
Common Malignancy

Prostate cancer is the most common malignancy in males in the western world. However, little is known about its origin and development. This review highlights the biology of the normal prostate gland and the differentiation of basal epithelial cells to a secretory phenotype. Alterations in this differentiation process leading to cancer and androgen-independent disease are discussed, as well as a full characterization of prostate epithelial cells. A full understanding of the origin and characteristics of prostate cancer epithelial cells will be important if we are to develop therapeutic strategies to combat the heterogeneous nature of this disease.

Expanded criteria in men on active surveillance monitored by MRI-TRUS fusion biopsy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 115-115
Author(s):  
Thomas P Frye ◽  
Steven F. Abboud ◽  
Richard Ho ◽  
Michele Fascelli ◽  
Raju Chelluri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Progression Free Survival ◽  
Risk Groups ◽  
Low Risk ◽  
Intermediate Risk ◽  
Guided Biopsy ◽  
Risk Prostate Cancer ◽  
Expanded Criteria ◽  
Clinically Significant

115 Background: Active surveillance (AS) is an established option for men with prostate cancer. Studies have shown that multiparametric-MRI along with MRI-TRUS fusion-guided biopsy (FB) may better assess risk in patients eligible for AS, compared to 12-core biopsy, due to improved detection of clinically significant cancers. The objective is to evaluate the performance of expanded criteria eligibility in men on AS being monitored with MRI-TRUS guided biopsy. Methods: Men on AS were included if they had mp-MRI and pathology data for 2 or more FB sessions. FB procedures consisted of targeted biopsies and random 12 core biopsies. Men participated in AS with low and intermediate risk prostate cancer, Gleason score ≤ 3+4=7 with no restriction on percent core involvement or number of cores positive. Progression was defined by patients with initial Gleason 3+3=6 to any Gleason 4, and Gleason 3+4=7 disease progressing to a primary Gleason 4 or higher. Results: 124 men on AS met study criteria. Low risk men had a mean age of 61.3 years versus intermediate risk men with a mean age of 65.5 years (p=0.0062). Mean PSA levels of the low and intermediate risk groups were 5.8 and 5.76 ng/ml (p=0.95), respectively. The mean length of follow-up was 22.56 months (range: 3.6 – 74.4 mo). Rates of pathologic progression in the intermediate and low risk patients were, 38.5% vs. 28.5% (p=0.33). Intermediate risk men had a mean progression-free survival (PFS) of 2.8 years compared to low risk men of 3.9 years (p=0.27). Patients were stratified according to established AS criteria (Epstein, Toronto, PRIAS) and rates of progression are summarized in the Table. 69% of patients met Epstein criteria for AS of which 29.4% (20/68) progressed compared to 28.5% for the low risk cohort overall. Conclusions: Men in our cohort who met strict criteria for AS had the same rate of progression as the entire expaned criteria low risk cohort, 29.4% vs 28.5%, respectively. Our data suggests that with accurate initial Gleason classification other AS criteria such as percent core or number of cores positive have no added benefit in predicting which men may have reclassification or progression of disease. [Table: see text]

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.

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 Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions

Life ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1432
Author(s):  
Caleb Natale ◽  
Christopher R. Koller ◽  
Jacob W. Greenberg ◽  
Joshua Pincus ◽  
Louis S. Krane
Keyword(s):  
Prostate Cancer ◽  
African American Men ◽  
Gleason Grade ◽  
Fusion Biopsy ◽  
Prostate Imaging ◽  
Clinically Significant ◽  
Associated Risk Factors ◽  
Work Up ◽  
Significant Disease

The use of multi-parametric magnetic resonance imaging (mpMRI) in conjunction with the Prostate Imaging Reporting and Data System (PI-RADS) is standard practice in the diagnosis, surveillance, and staging of prostate cancer. The risk associated with lesions graded at a PI-RADS score of 3 is ambiguous. Further characterization of the risk associated with PI-RADS 3 lesions would be useful in guiding further work-up and intervention. This study aims to better characterize the utility of PI-RADS 3 and associated risk factors in detecting clinically significant prostate cancer. From a prospectively maintained IRB-approved dataset of all veterans undergoing mpMRI fusion biopsy at the Southeastern Louisiana Veterans Healthcare System, we identified a cohort of 230 PI-RADS 3 lesions from a dataset of 283 consecutive UroNav-guided biopsies in 263 patients from October 2017 to July 2020. Clinically significant prostate cancer (Gleason Grade ≥ 2) was detected in 18 of the biopsied PI-RADS 3 lesions, representing 7.8% of the overall sample. Based on binomial analysis, PSA densities of 0.15 or greater were predictive of clinically significant disease, as was PSA. The location of the lesion within the prostate was not shown to be a statistically significant predictor of prostate cancer overall (p = 0.87), or of clinically significant disease (p = 0.16). The majority of PI-RADS 3 lesions do not represent clinically significant disease; therefore, it is possible to reduce morbidity through biopsy. PSA density is a potential adjunctive factor in deciding which patients with PI-RADS 3 lesions require biopsy. Furthermore, while the risk of prostate cancer for African-American men has been debated in the literature, our findings indicate that race is not predictive of identifying prostate cancer, with comparable Gleason grade distributions on histology between races.

Is perfect the enemy of good? Weighing the evidence for biparametric MRI in prostate cancer

2021 ◽  
Author(s):  
Alexander P Cole ◽  
Bjoern J. Langbein ◽  
Francesco Giganti ◽  
Fiona M. Fennessy ◽  
Clare M. Tempany ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Multiparametric Mri ◽  
Benefit Analysis ◽  
Advantages And Disadvantages ◽  
Contrast Enhanced ◽  
Clinically Significant

The role of multiparametric MRI in diagnosis, staging and treatment planning for prostate cancer is well established. However there remain several challenges to widespread adoption. One such challenge is the duration and cost the examination. Abbreviated exams omitting contrast enhanced sequences may help address this challenge. In this review, we will discuss the rationale for biparametric MRI (bpMRI) for detection and characterization of clinically significant prostate cancer prior to biopsy and synthesize the published literature. We will weigh up the advantages and disadvantages to this approach and lay out a conceptual cost/benefit analysis regarding adoption of bpMRI.

Sign in / Sign up

Export Citation Format

Share Document