A Multicentre Analysis of the Detection of Clinically Significant Prostate Cancer Following Transperineal Image-fusion Targeted and Nontargeted Systematic Prostate Biopsy in Men at Risk

Miah, Saiful; Hosking‐Jervis, Feargus; Connor, Martin J.; Eldred‐Evans, David; Shah, Taimur T.; Arya, Manit; Barber, Neil; Bhardwa, Jeetesh; Bott, Simon; Burke, Daniel; Doherty, Alan; Foster, Christopher S.; Freeman, Alex; Hindley, Richard G.; Jameson, Charles; Karim, O.; Laniado, Marc; Montgomery, Βruce; Nigam, Raj; Punwani, Shonit; Sinclair, Andrew; Winkler, Mathias; Allen, Clare; Ahmed, Hashim U.

doi:10.1016/j.euo.2019.03.005

Cited by 31 publications

(32 citation statements)

References 28 publications

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“…The perfect test for diagnosing prostate cancer would be a minimally invasive procedure, performed without general anaesthesia in the day-case or office outpatient setting; it would have insignificant side effects, and it would identify a high proportion of men who would benefit from treatment whilst also not overdiagnosing patients who would not benefit [11]. Performing targeted transperineal biopsies only has been suggested as such an investigation: a multicentre analysis of 640 patients undergoing transperineal image-fusion targeted biopsy, with 357 patients undergoing both targeted and systematic biopsy, stated that targeting the MRI lesion alone detected high rates of clinically significant prostate cancer whilst reducing the detection of clinically insignificant cancer [13]. This analysis initially seems promising: reducing the number of biopsy cores taken will hopefully by nature reduce the risk of complications, as performing a high number of systematic biopsies has been linked with detrimental impacts on genitourinary functional outcomes, including sexual function and flow rates [14].…”

Section: Discussionmentioning

confidence: 99%

Targeted and systematic cognitive freehand‐guided transperineal biopsy: is there still a role for systematic biopsy?

et al. 2020

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To assess whether targeted cognitive freehand-assisted transperineal biopsies using a Precisionpoint TM device still require additional systematic biopsies to avoid missing clinically significant prostate cancer, and to investigate the benefit of a quadrant-only biopsy approach to analyse whether a quadrant or extended target of the quadrant containing the target only would have been equivalent to systematic biopsy. Patients and MethodsPatients underwent combined systematic mapping and targeted transperineal prostate biopsies at a single institution. Biopsies were performed using the Precisionpoint device (Perineologic, Cumberland, MD, USA) under either local anaesthetic (58%, 163/282), i.v. sedation (12%, 34/282) or general anaesthetic (30%, 85/282). A mean (range) of 24 (5-42) systematic and 4.2 (1-11) target cores were obtained. Magnetic resonance imaging (MRI) scans were reported using the Likert scale. Clinically significant cancer was defined as Gleason 7 or above. Histopathological results were correlated with the presence of an MRI abnormality within a spatial quadrant and the other adjoining or non-adjoining (opposite) quadrants. Histological concordance with radical prostatectomy specimens was analysed. ResultsA total of 282 patients were included in this study. Their mean (range) age was 66.8 (36-80) years, median (range) prostate-specific antigen level 7.4 (0.91-116) ng/mL and mean prostate volume 45.8 (13-150) mL. In this cohort, 82% of cases (230/282) were primary biopsies and 18% (52/282) were patients on surveillance. In all, 69% of biopsies (195/282) were identified to have clinically significant disease (Gleason ≥3 + 4). Any cancer (Gleason ≥3 + 3) was found in 84% (237/ 282) of patients. Of patients with clinically significant disease, the target biopsies alone picked up 88% (171/195), with systematic biopsy picking up the additional 12% (24/195) that the target biopsies missed. This altered with Likert score; 73% of Likert score 3 disease was detected by target biopsy, 92% of Likert score 4 and 100% of Likert score 5. Target biopsies with additional same-quadrant-only systematic cores picked up 75% (18/24) of significant cancer that was missed on target only, found in the same quadrant as the target. ConclusionSystematic biopsy is still an important tool when evaluating all patients referred for prostate biopsy, but the need is decreased with increasing suspicion on MRI. Patients with very high suspicion of prostate cancer (Likert score 5) may not require systematic cores, unless representative surrounding biopsies are required for other specific treatments (e.g. focal therapy, or operative planning). More prospective studies are needed to evaluate this in full.

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Section: Discussionmentioning

confidence: 99%

Targeted and systematic cognitive freehand‐guided transperineal biopsy: is there still a role for systematic biopsy?

et al. 2020

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“…Alternatively, while transperineal TBx failed to detect cancer in 11.2% of participants (18/161), only four of these cases (2.5%) were clinically significant (GS ≥7). A recent large multicentre study examining detection of clinically significant PCa in 640 men undergoing image‐fusion transperineal biopsy found that the addition of non‐targeted systematic transperineal biopsies only detected an additional 0.8–1.1% of clinically significant PCa when combined with image‐fusion TBx . Comparing transperineal template saturation biopsy to transperineal TBx (BiopSee ® system), Radtke et al showed that 7% of GS ≥7 cancers were missed by transperineal TBx alone.…”

Section: Discussionmentioning

confidence: 99%

A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection

et al. 2019

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Objective To evaluate the ability to detect clinically significant prostate cancer (PCa) using a novel electromagnetically (EM) tracked transperineal magnetic resonance imaging (MRI)/ultrasonography (US) fusion‐guided targeted biopsy (transperineal TBx) platform and the impact of inter‐reader variability on cancer detection. Materials and Methods A total of 176 patients with suspicious lesions detected on multiparametric MRI (mpMRI) underwent a systematic modified Barzel template biopsy (12‐core) transperineal biopsy (transperineal SBx) and transperineal TBx with EM tracking (UroNav; Philips Healthcare, Best, the Netherlands) in the same setting. Cancer detection rates (CDRs) were stratified by Prostate Imaging Reporting and Data System (PI‐RADS) v2 scores and compared with Fisher’s exact test. Area under the curve (AUC) was calculated for prostate‐specific antigen (PSA), PSA density (PSAD), PI‐RADS score, and subgroup analysis of individual readers' PI‐RADS scores with respect to overall CDR and clinically significant CDR. Results The overall CDR was 76.7% (135/176), of which 76.3% (103/135) was clinically significant PCa. Among the 135 patients with PCa, transperineal TBx detected 90.4% of cases (122/135), either alone or in combination with transperineal SBx. The remaining 9.6% of cases (13/135) missed by transperineal TBx were diagnosed by transperineal SBx alone, of which three were clinically significant. Conversely, transperineal SBx missed 14% of cases (19/135), 14 of which were clinically significant PCa. Sensitivities for transperineal TBx and transperineal SBx were 90.4% and 85.9%, respectively. On a per‐lesion basis, PI‐RADS score (AUC 0.74) outperformed both PSA (AUC 0.59) and PSAD (AUC 0.63) in discriminating clinically significant from non‐clinically significant PCa on transperineal TBx. Although not formally statistically tested, AUCs amongst different mpMRI readers appeared to display considerable variability. There were no adverse events, including sepsis. Conclusions Electromagnetically tracked transperineal TBx of MRI‐visible lesions enhanced the ability of transperineal SBx to detect PCa, with greater sensitivity for clinically significant disease. These findings suggest transperineal TBx is a safe, alternative fusion platform for patients with a suspicious lesion on prostate MRI. The assessment of inter‐reader variability, in conjunction with prediction of clinically significant PCa and CDR, is an important first step for quality control in implementing an MRI‐based screening programme.

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“…Non-targeted systematic prostate biopsy cores had only a 9% csPCa yield with a 26.1% prevalence of clinically insignificant prostate cancer. This calls into question the role of systematic biopsy especially in the context of PIRADS >/=3 lesions 21 . Other studies have shown a 1-2 in 20 rate of significant prostate cancer in non-suspicious MP-MRI cases is in-keeping with findings from the PROMIS cohort while showing the rise in insignificant disease detected in using additional non-targeted systematic TRUS-biopsy 19 .…”

Section: A C C E P T E D U N E D I T E D M a N U S C R I P Tmentioning

confidence: 99%

Comparison of Transrectal Ultrasound Biopsy to Transperineal Template Mapping Biopsies Stratified by Multiparametric Magnetic Resonance Imaging Score in the PROMIS Trial

et al. 2020

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In 41 months, 740 men at 11 centres were recruited; 576 underwent all three tests. Of 150 with MRI score 1-2, 8 (5.1%) had any Gleason >/=3+4 disease on TRUS-biopsy. In 75 where TRUS-biopsy showed Gleason 3+3 of any MCCL, 61/75 (81%) had Gleason 3+4, 8/75 (11%) Gleason 4+3 and 0/75 (0%) Gleason >/=4+5. For definition1 csPCa, TRUS-biopsy sensitivity remained stable and low across MP-MRI Likert scores (35%-52%). For definition2 csPCa and any cancer, sensitivity increased with higher MP-MRI score. Negative predictive value varied due to varying disease prevalence but for all cancer thresholds declined with increasing MP-MRI score. ConclusionsTRUS-biopsy in the setting of MP-MRI Likert scores 1-2 finds Gleason 3+4 disease in only 1 in 20 men. Further, for any csPCa definition, TRUS-biopsy had poor sensitivity and variable but low NPV across MP-MRI scores. Men undergoing TRUS-biopsy without targeting in the setting of MP-MRI score 3 to 5 should be advised to undergo a repeat (targeted) biopsy.

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A Multicentre Analysis of the Detection of Clinically Significant Prostate Cancer Following Transperineal Image-fusion Targeted and Nontargeted Systematic Prostate Biopsy in Men at Risk

Cited by 31 publications

References 28 publications

Targeted and systematic cognitive freehand‐guided transperineal biopsy: is there still a role for systematic biopsy?

Targeted and systematic cognitive freehand‐guided transperineal biopsy: is there still a role for systematic biopsy?

A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection

Comparison of Transrectal Ultrasound Biopsy to Transperineal Template Mapping Biopsies Stratified by Multiparametric Magnetic Resonance Imaging Score in the PROMIS Trial

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