Can biopsy be a reliable predictor of spatial distribution of prostate cancer? Comparison of a novel biopsy regimen with radical prostatectomy findings

Introini, Carlo; Naselli, Angelo; Vigliercio, G.; Spina, Bruno; Truini, Mauro; Puppó, P.

doi:10.1016/j.urology.2006.08.1065

Cited by 5 publications

(5 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increasing the number of cores from 6 to 10 in our study improved the accuracy of TRUS-guided biopsy in locating tumours, especially apical tumours, thus confirming published findings [20] . However, 16-core biopsies were found to be no more accurate than 10-core biopsies maybe because of the reduced statistical power of our subgroup analysis, because we systematically included TZ biopsies (2 cores), and because the 10-core biopsies systematically biopsied the anterior region of the prostate.…”

Section: Discussionsupporting

confidence: 91%

Localising Prostate Cancer: Comparison of Endorectal Magnetic Resonance (MR) Imaging and 3D-MR Spectroscopic Imaging with Transrectal Ultrasound-Guided Biopsy

Gbenou¹,

Peltier²,

Addla

et al. 2011

Urol Int

View full text Add to dashboard Cite

Background: Magnetic resonance imaging (MRI) and MR spectroscopic imaging (MRSI) have been gaining acceptance as tools in the evaluation of prostate cancer. We compared the accuracy of transrectal ultrasound (TRUS)-guided biopsy and dynamic contrast-enhanced MRI combined with three-dimensional (3D) MRSI in locating prostate tumours and determined the influence of prostate weight on MRI accuracy. Patients and Methods: Between March 1999 and October 2006, 507 patients with localised prostate cancer underwent radical prostatectomy (RP) at the Jules Bordet Institute. Of these, 220 had undergone endorectal MRI (1.5 T Siemens Quantum Symphony) and 3D-MRSI prior to RP. We retrospectively reviewed data on tumour location and compared the results obtained by MRI and by TRUS-guided biopsy with those obtained on histopathology of the RP specimen. Results: Patient data were as follows: median age 62.4 years (45–74); median PSA 6.36 ng/ml (0.5–22.6); 73.6% of patients had non-palpable disease (T1c); median biopsy Gleason score 6 (3–9); median RP specimen weight 50 g (12–172); median pathological Gleason score 7 (4–10); 68.64% of patients had organ-confined (pT2) disease. Tumour localisation was correlated with RP data in a significantly higher percentage of patients when using MRI rather than TRUS-guided biopsy (47.4 vs. 36.6%, p < 0.0001). MRI was marginally superior to TRUS-guided biopsy in detecting malignancy at the prostate apex (48.3 vs. 41.9%, p = 0.0687) and somewhat better at the prostate base (46 vs. 39.1%, p = 0.0413). It was highly significantly better at mid-gland (52 vs. 41.1%, p = 0.0015) and in the transition zone (40.1 vs. 24.3%, p < 0.0001). MRI had higher sensitivity in larger (≧50 g) than smaller (<50 g) prostates (50.3 vs. 42.2%, p = 0.0017). Conclusions: MRI was superior to TRUS-guided biopsy in locating prostate tumours except at the gland apex. MRI was more accurate in larger (≧50 g) than smaller prostates.

show abstract

Section: Discussionsupporting

confidence: 91%

Localising Prostate Cancer: Comparison of Endorectal Magnetic Resonance (MR) Imaging and 3D-MR Spectroscopic Imaging with Transrectal Ultrasound-Guided Biopsy

Gbenou¹,

Peltier²,

Addla

et al. 2011

Urol Int

View full text Add to dashboard Cite

show abstract

“…However, prostatectomy is not performed in all patients. Extensive biopsy for histological correlation might improve sampling errors 18 . Another limitation is that we did not evaluate interobserver variability in the MR imaging findings.…”

Section: Discussionmentioning

confidence: 98%

“…Extensive biopsy for histological correlation might improve sampling errors. 18 Another limitation is that we did not evaluate interobserver variability in the MR imaging findings. Two independent observers interpreted the MR images prospectively.…”

Section: Discussionmentioning

confidence: 99%

The potential role of prebiopsy magnetic resonance imaging combined with prostate‐specific antigen density in the detection of prostate cancer

Kubota

Kamei²,

Nakano³

et al. 2008

Int J of Urology

View full text Add to dashboard Cite

Aim: Two-thirds of patients with a gray-zone prostate-specific antigen (PSA) level undergo unnecessary biopsy. Sensitivity is not yet sufficient to permit the use of modified PSA parameters or magnetic resonance (MR) imaging alone for prostate cancer screening. Thus, we evaluated the combination of MR imaging and PSA density (PSAD) for specificity and sensitivity. Methods: During the period April 2004 through March 2006, 185 patients with a PSA level of 4.0-10.0 ng/mL underwent MR imaging and transrectal ultrasonography-guided 8-core biopsy (systemic sextant biopsy of the peripheral zone plus two cores of transition zone). All MR images were interpreted prospectively by two radiologists. An image was considered positive for prostate cancer if any feature indicated a cancerous lesion. Receiver operating characteristic (ROC) curves were used to compare the usefulness of the PSA level, PSAD and PSA transitional zone density (PSATZ) for the detection of prostate cancer. Results: Of the 185 patients, 62 had prostate cancer. Sensitivity and specificity of the axial T2-weighted MR imaging findings for cancer detection were 79.0% and 59.4%, respectively. The area under the ROC curve was 0.590 for the PSA level, 0.718 for PSAD and 0.695 for PSATZ. MR imaging findings and PSAD were shown by multivariate analysis to be statistically significant independent predictors of prostate cancer (P < 0.001). With a PSAD cut-off value of 0.111, sensitivity was 96.8%, but specificity was 19.5%. Combining MR imaging findings with PSAD increased the specificity to 40% and retained 95% sensitivity. Conclusion: MR imaging findings combined with PSAD provide high sensitivity and improve the specificity for the early detection of prostate cancer.

show abstract

“…Interestingly, we were unable to identify any diagnostic, clinical or pathological factors that were significantly associated with better DG identification. Various biopsy schemes have been evaluated, all with consistently low levels of accuracy that did not exceed those found in our study [3,8,11,12,20,21,25,26]. A previous study reported that increasing the number of cores taken per biopsy increases the detection rate of prostate cancer [25].…”

Section: Discussionmentioning

confidence: 41%

“…Several studies have compared pathological findings from diagnostic biopsies with radical prostatectomy (RP) specimens, with varying reports of concordance [6,12]. Two recent reports have suggested that TRUS‐guided prostate biopsy may either underestimate [13,14] or overestimate [15,16] tumour grade in as many as 35% of cases.…”

Section: Introductionmentioning

confidence: 99%

Transrectal ultrasonography‐guided biopsy does not reliably identify dominant cancer location in men with low‐risk prostate cancer

Washington¹,

Bonham

Whitson³

et al. 2011

BJU International

View full text Add to dashboard Cite

What ' s known on the subject? and What does the study add?The widespread use of serum PSA testing followed by TRUS-guided biopsy have resulted in profound prostate cancer stage migration with many patients presenting with focal rather than multifocal disease. There is increasing interest in the use of focal rather than whole-gland treatment. However, current biopsy schemes may still miss cancer or, even when cancer is identifi ed, its extent or grade might not be accurately characterized. In order for focal therapy to be effective, the area of highest tumour volume and/or grade needs to localized accurately. The aim of this study was to assess how well biopsy, as currently performed, locates the focus of highest prostate cancer volume and/or grade. OBJECTIVE• To evaluate the ability of transrectal ultrasonography (TRUS)-guided extended core biopsy to identify the dominant tumour accurately in men with early stage prostate cancer. PATIENTS AND METHODS• Patients with early stage, low-risk prostate cancer who subsequently underwent radical prostatectomy (RP) and had complete surgical specimens were identifi ed.• Re-review was performed by a single uropathologist using ImageJ software to identify tumour location, dominant grade (DG) and dominant volume (DV).• Pathology fi ndings were then compared with biopsy results. RESULTS• A total of 51 men with early stage, low-risk prostate cancer, who had undergone RP, had complete specimens for review and a median of 15 biopsy cores taken for diagnosis and grading.• Sixteen men had a single diagnostic biopsy, 21 had one repeat biopsy, and 14 had two or more repeat biopsies.• Compared with surgical fi ndings, biopsy correctly identifi ed the sextant with the largest tumour volume in 55% (95% CI 0.5 -0.6) of specimens and the highest grade in 37% (95 CI 0.3 -0.5).• No demographic or clinical factors were signifi cantly associated with identifi cation of DG. Interval between last biopsy and RP, total tissue length taken and total length of tumour identifi ed were signifi cantly associated with correct identifi cation of DV. CONCLUSIONS• Our fi ndings show that TRUS-guided biopsy detects and localizes DV better than it does DG.• Even with an extended scheme, TRUS-guided biopsy does not reliably identify dominant cancer location in this low-risk cohort of men with early stage prostate cancer.• TRUS-guided biopsy may perform better in similar men with low stage, but higher volume disease. KEYWORDShumans , male , prostatic neoplasms/ pathology , prostatic neoplasms/surgery Study Type -Diagnostic (exploratory cohort) Level of Evidence 2b

show abstract

Can biopsy be a reliable predictor of spatial distribution of prostate cancer? Comparison of a novel biopsy regimen with radical prostatectomy findings

Cited by 5 publications

References 22 publications

Localising Prostate Cancer: Comparison of Endorectal Magnetic Resonance (MR) Imaging and 3D-MR Spectroscopic Imaging with Transrectal Ultrasound-Guided Biopsy

Localising Prostate Cancer: Comparison of Endorectal Magnetic Resonance (MR) Imaging and 3D-MR Spectroscopic Imaging with Transrectal Ultrasound-Guided Biopsy

The potential role of prebiopsy magnetic resonance imaging combined with prostate‐specific antigen density in the detection of prostate cancer

Transrectal ultrasonography‐guided biopsy does not reliably identify dominant cancer location in men with low‐risk prostate cancer

Contact Info

Product

Resources

About