Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Diagnosis in Biopsy-naive Men with Suspected Prostate Cancer Based on Elevated Prostate-specific Antigen Values: Results from a Randomized Prospective Blinded Controlled Trial

Tonttila, Panu; Lantto, Juha; Pääkkö, Eija; Piippo, U.; Kauppila, Saila; Lammentausta, Eveliina; Ohtonen, Pasi; Vaarala, Markku H.

doi:10.1016/j.eururo.2015.05.024

Cited by 164 publications

(117 citation statements)

References 31 publications

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“…While our sample size is not sufficient to detect small differences in significant CaP detection between the two techniques, the lack of such a difference for first-time biopsy patients is supported in recent randomized control studies comparing MRI-targeted and non-targeted TRUS biopsy. 28,29 Conversely, recent non-randomized prospective studies by Mozer 30 and Peltier 31 did demonstrate a significant increase in significant CaP detection from Fn-Bx for first-time biopsy patients using a low significance thresh- ASAP patients (n=7) 45.7 ± 27.6% 13.9 ± 9.7% <0.01…”

Section: Discussionmentioning

confidence: 99%

Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation

Cool

Romagnoli

Izawa

et al. 2016

CUAJ

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Introduction: This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsy patients with prior atypical small acinar proliferation (ASAP). Materials: 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the prebiopsy MP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches. Results: Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months. Conclusions: MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx.

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Section: Discussionmentioning

confidence: 99%

Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation

Cool

Romagnoli

Izawa

et al. 2016

CUAJ

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“…In 2015 a prospective, randomized controlled trial of over 100 men found no difference in all cancers detected and “clinically relevant” cancers detected in men undergoing initial MRI fusion biopsy versus ultrasound guided biopsy using a 3 Tesla scanner and no endorectal coil (58). Similar findings have been noted in a retrospective series of men without prior biopsy using ultrasound guidance versus cognitive fusion and in-bore MRI guided biopsy (59).…”

Section: Cost Considerations Of Mpmri In the Initial Diagnosis Of Promentioning

confidence: 99%

Cost consideration in utilization of multiparametric magnetic resonance imaging in prostate cancer

Hutchinson

Lotan²

2017

Transl. Androl. Urol.

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The screening, evaluation and management of prostate cancer changed significantly in the last decade. The recommendations regarding prostate cancer screening continue to evolve with new revelations about existing data sets and longer followup of landmark trials. Robotics has gained the vast majority of the marketplace for surgically managed prostate cancer in rapid fashion. The need for intervention in low risk prostate cancer has been closely examined and more men are being expectantly managed than ever before. Amidst all these changes, prostate magnetic resonance imaging (MRI) has emerged as a disruptive technology. Through the use of dynamic contrast-enhanced and diffusion weighted series, prostate tumors that were previously not visible have become identifiable and quantifiable. The ability of MRI to improve staging and identification of clinically significant disease has resulted in increased utilization for different aspects of prostate cancer care. The best studied use is in men with a prior negative transrectal ultrasound guided (TRUS) prostate biopsy and the performance characteristics in this role match well with the clinical question raised. The role for MRI in initial biopsy, in pre-surgical planning before prostatectomy and in men on active surveillance is less well defined. A primary concern in the use of MRI is that of cost. MRI units are expensive, both in initial outlay and ongoing use. The availability of MRI varies widely between countries and even within regions of the same country. Different healthcare models have different approaches for allocating the use of expensive resources, including MRI, in times when they are scarce. Prostate MRI can be used at multiple points in the management algorithm of prostate cancer and each implies different cost concerns. In this review we present an overview of current research in cost and cost efficacy for the use of MRI in the management of prostate cancer. By examining what is known and highlighting areas of ongoing research we hope to provide the reader with a solid foundation for understanding these complex, ever-changing issues.

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“…The randomized trials published by Baco et al 15 , and and Tonttila et al 20 failed to show a superiority of the MR-PB technique compared to standard 10 to 12-cores randomized prostate biopsies. In our study, multivariate logistic regression analysis showed a significantly higher detection rate in the MR-PB group.…”

Section: Discussionmentioning

confidence: 99%

Transrectal ultrasound-guided prostate biopsies vs. magnetic resonance imaging ultrasound fusion targeted biopsies: Who are the best candidates?

Bey¹,

Gaget²,

Descotes³

et al. 2017

CUAJ

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Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Diagnosis in Biopsy-naive Men with Suspected Prostate Cancer Based on Elevated Prostate-specific Antigen Values: Results from a Randomized Prospective Blinded Controlled Trial

Cited by 164 publications

References 31 publications

Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation

Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation

Cost consideration in utilization of multiparametric magnetic resonance imaging in prostate cancer

Transrectal ultrasound-guided prostate biopsies vs. magnetic resonance imaging ultrasound fusion targeted biopsies: Who are the best candidates?

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