218 Association of level of suspicion of prostate cancer on multi-parametric MRI with detection rate of prostate cancer

Kasivisvanathan, Veeru; Dufour, Robert; Moore, C.; Ahmed, Hashim U.; Abd-Alazeez, Mohamed; Charman, S.; Freeman, Alex; Kirkham, Alex; Allen, Christine; Meulen, Jan van der; Emberton, Mark

doi:10.1016/s1569-9056(13)60705-8

Cited by 1 publication

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“…An alternative way of increasing sampling density of larger prostates is to carry out transperineal template prostate biopsies (TTPB) using a brachytherapy grid (64). This approach allows for a more systematic sampling of the prostate, with improved access to anterior and midline areas.…”

Section: Biopsy Strategies In Men With Large Prostatesmentioning

confidence: 99%

“…This approach allows for a more systematic sampling of the prostate, with improved access to anterior and midline areas. Notwithstanding, it is resource intensive, requiring general or spinal anaesthetic (64), and, due to the increasing sampling, it is more prone to causing unwanted side effects (63). Additionally, this strategy does not negate the problem of overdiagnosing insignificant cancer, but may maximise the identification of clinically significant cancer (65), which can be of value when clinical doubt exists.…”

Section: Biopsy Strategies In Men With Large Prostatesmentioning

confidence: 99%

“…Similarly, a prospective study in men who had targeted biopsy cores in addition to 12 core TRUS biopsies indicated that prostate cancer may be more likely to be diagnosed using targeted cores than systematic 12 core sampling in prostates with a volume from 40 up to 160cc (69). Compared to TTPB, mpMRI-targeted biopsies may have similar clinically significant cancer detection rates and lower clinically insignificant cancer detection rates (64). They are also associated with fewer side effects (63).…”

Section: Biopsy Strategies In Men With Large Prostatesmentioning

confidence: 99%

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Management of an Elevated PSA and Biopsy Strategies in the Large Prostate

2017

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An abnormally high serum PSA is still the most frequent trigger for men to enter a suspected prostate cancer diagnostic pathway. Large prostates, especially the ones with a volume over 100cc, are usually associated with elevated PSA levels. Similarly, in men with benign prostatic hyperplasia (BPH), PSA tends to increase over time, something that also occurs in men with untreated progressive prostate cancer. These two factors lead to frequent and unnecessary referrals of men with large prostates to suspected prostate cancer pathways. Many PSA derivatives and risk stratification tools have been developed in an attempt to overcome the limitations of total serum PSA and more accurately predict which men should have prostate biopsies, but translation into clinical practice has been hindered. Thus, many men with large prostates are referred for prostate biopsy. However, biopsy strategies may need to be adapted in the setting of a 100cc prostate. Higher sampling density schemes have been advocated for these men to ensure the diagnosis of clinically significant cancer but this can be accompanied by increased side effects. mpMRI is increasingly done prior to biopsy and can aid in the selection of men who can safely avoid biopsies. Likewise, they can help target biopsies to suspicious areas, which may represent an avenue to balance adequate sampling of large prostates and adverse events.

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Section: Biopsy Strategies In Men With Large Prostatesmentioning

confidence: 99%