A Comparison of Prostate Cancer Detection between Visual Estimation (Cognitive Registration) and Image Fusion (Software Registration) Targeted Transperineal Prostate Biopsy

Khoo, Christopher C.; Eldred‐Evans, David; Peters, Max; Son, Marieke van; Rossum, Peter S.N. van; Connor, Martin J.; Hosking‐Jervis, Feargus; Tanaka, Mariana Bertoncelli; Reddy, Deepika; Bass, Edward; Powell, L.; Ahmad, Shahzad; Pegers, E.; Joshi, Suchita; Sri, Denosshan; Wong, Kathie; Tam, Henry; Hrouda, David; Qazi, Hasan; Gordon, S.; McCracken, Stuart; Winkler, Mathias; Ahmed, Hashim U.

doi:10.1097/ju.0000000000001476

Cited by 27 publications

(17 citation statements)

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“…Guided biopsies obtained 2 to 3 cores from each PI-RADS v.2.0 ≥3 lesion through the TRUS-MRI cognitive-fusion technique [ 17 ]. A 12-core systematic biopsy was also performed in all men.…”

Section: Methodsmentioning

confidence: 99%

The Efficacy of Proclarix to Select Appropriate Candidates for Magnetic Resonance Imaging and Derived Prostate Biopsies in Men with Suspected Prostate Cancer

Morote

Campistol

Celma

et al. 2022

World J Mens Health

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Purpose To analyze how Proclarix is valuable to appropriately select candidates for multiparametric magnetic resonance imaging (mpMRI) and derived biopsies, among men with suspected prostate cancer (PCa). Proclarix is a new marker computing the clinically significant PCa (csPCa) risk, based on serum thosmbospondin-1, cathepsin D, prostate-specific antigen (PSA) and percent free PSA, in addition to age, that has been developed in men with serum PSA 2 to 10 ng/mL, prostate volume ≥35 mL, and normal digital rectal examination (DRE). Materials and Methods Proclarix score (0%–100%) is analyzed in a prospective frozen serum collection of 517 correlative men scheduled for guided and/or systematic biopsies after mpMRI. Outcome variables were csPCa detection (grade group ≥2), insignificant PCa (iPCa) overdetection and avoided mpMRIs. Results The area under the curve of Proclarix was 0.701 (95% CI 0.637–0.765) among 281 men with serum PSA 2 to 10 ng/mL, prostate volume ≥35 mL, and -normal DRE, and 0.754 (95% CI 0.701–0.807) in the others, p=0.038. Net benefit of Proclarix existed in all men. After selecting 10% threshold, Proclarix was integrated in an algorithm which also used the serum PSA level and DRE. A reduction of 25.4% of mpMRIs request was observed and 17.7% of prostate biopsies. Overdetection of iPCa was reduced in 18.2% and 2.6% of csPCa were misdiagnosed. Conclusions Proclarix is valuable in all men with suspected PCa. An algorithm integrating Proclarix score, serum PSA, and DRE can avoid mpMRI requests, unnecessary prostate biopsies and iPCa overdetection, with minimal loss of csPCa detection.

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Section: Methodsmentioning

confidence: 99%

The Efficacy of Proclarix to Select Appropriate Candidates for Magnetic Resonance Imaging and Derived Prostate Biopsies in Men with Suspected Prostate Cancer

Morote

Campistol

Celma

et al. 2022

World J Mens Health

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“…Software‐assisted registration was available using the Biopsee mpMRI Fusion Biopsy System (MedCom GmbH, Darmstadt, Germany) in combination with a Hitachi Preirus biplanar ultrasound probe, attached to a Civco transperineal biopsy stepper holding a 5‐mm spaced grid. Visual estimation targeting was also carried out if required and we have previously reported outcomes comparing these two approaches [18]. The biopsy protocol included sampling of both MRI‐targeted and non‐targeted sampling of ipsilateral and contralateral non‐suspicious peripheral zone (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Visual estimation targeting was also carried out if required and we have previously reported outcomes comparing these two approaches [18]. The biopsy protocol included sampling of both MRI-targeted and non-targeted sampling of ipsilateral and contralateral non-suspicious peripheral zone (Fig.…”

Section: The Interventionmentioning

confidence: 99%

The rapid assessment for prostate imaging and diagnosis (RAPID) prostate cancer diagnostic pathway

et al. 2022

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Objective To report outcomes within the Rapid Assessment for Prostate Imaging and Diagnosis (RAPID) diagnostic pathway, introduced to reduce patient and healthcare burdens and standardize delivery of pre‐biopsy multiparametric magnetic resonance imaging (MRI) and transperineal biopsy. Patients and Methods A total of 2130 patients from three centres who completed the RAPID pathway (3 April 2017 to 31 March 2020) were consecutively entered as a prospective registry. These patients were also compared to a pre‐RAPID cohort of 2435 patients. Patients on the RAPID pathway with an MRI score 4 or 5 and those with PSA density ≥0.12 and an MRI score 3 were advised to undergo a biopsy. Primary outcomes were rates of biopsy and cancer detection. Secondary outcomes included comparison of transperineal biopsy techniques, patient acceptability and changes in time to diagnosis before and after the introduction of RAPID. Results The median patient age and PSA level were 66 years and 6.6 ng/mL, respectively. Biopsy could be omitted in 43% of patients (920/2130). A further 7.9% of patients (168/2130) declined a recommendation for biopsy. The percentage of biopsies avoided among sites varied (45% vs 36% vs 51%; P < 0.001). In all, 30% (221/742) had a local anaesthetic (grid and stepper) transperineal biopsy. Clinically significant cancer detection (any Gleason score ≥3 + 4) was 26% (560/2130) and detection of Gleason score 3 + 3 alone constituted 5.8% (124/2130); detection of Gleason score 3 + 3 did not significantly vary among sites (P = 0.7). Among participants who received a transperineal targeted biopsy, there was no difference in cancer detection rates among local anaesthetic, sedation and general anaesthetic groups. In the 2435 patients from the pre‐RAPID cohor, time to diagnosis was 32.1 days (95% confidence interval [CI] 29.3–34.9) compared to 15.9 days (95% CI 12.9–34.9) in the RAPID group. A total of 141 consecutive patient satisfaction surveys indicated a high satisfaction rate with the pathway; 50% indicated a preference for having all tests on a single day. Conclusions The RAPID prostate cancer diagnostic pathway allows 43% of men to avoid a biopsy while preserving good detection of clinically significant cancers and low detection of insignificant cancers, although there were some centre‐level variations.

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“…However, on multivariate analysis, operator expertise was independently associated with increased cancer detection, regardless of the fusion method used. Khoo et al then reported on 1841 patients undergoing TP biopsy [31]. The overall csPCa detection rate was similar between COG-TB and FUS-TB, but with senior operators, there was a higher csPCa detection rate with FUS-TB.…”

Section: Cognitive Fusion Versus Software-guided Fusion-targeted Biopsymentioning

confidence: 97%

Comparative Effectiveness of Techniques in Targeted Prostate Biopsy

Sugano

Kaneko

Yip

et al. 2021

Cancers

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In this review, we evaluated literature regarding different modalities for multiparametric magnetic resonance imaging (mpMRI) and mpMRI-targeted biopsy (TB) for the detection of prostate cancer (PCa). We identified studies evaluating systematic biopsy (SB) and TB in the same patient, thereby allowing each patient to serve as their own control. Although the evidence supports the accuracy of TB, there is still a proportion of clinically significant PCa (csPCa) that is detected only in SB, indicating the importance of maintaining SB in the diagnostic pathway, albeit with additional cost and morbidity. There is a growing subset of data which supports the role of TB alone, which may allow for increased efficiency and decreased complications. We also compared the literature on transrectal (TR) vs. transperineal (TP) TB. Although further high-level evidence is necessary, current evidence supports similar csPCa detection rate for both approaches. We also evaluated various TB techniques such as cognitive fusion biopsy (COG-TB) and in-bore biopsy (IB-TB). COG-TB has comparable detection rates to software fusion, but is operator-dependent and may have reduced accuracy for smaller lesions. IB-TB may allow for greater precision as lesions are directly targeted; however, this is costly and time-consuming, and does not account for MRI-invisible lesions.

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A Comparison of Prostate Cancer Detection between Visual Estimation (Cognitive Registration) and Image Fusion (Software Registration) Targeted Transperineal Prostate Biopsy

Cited by 27 publications

References 0 publications

The Efficacy of Proclarix to Select Appropriate Candidates for Magnetic Resonance Imaging and Derived Prostate Biopsies in Men with Suspected Prostate Cancer

The Efficacy of Proclarix to Select Appropriate Candidates for Magnetic Resonance Imaging and Derived Prostate Biopsies in Men with Suspected Prostate Cancer

The rapid assessment for prostate imaging and diagnosis (RAPID) prostate cancer diagnostic pathway

Comparative Effectiveness of Techniques in Targeted Prostate Biopsy

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