Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?

Pepe, Pietro; Garufi, Antonio; Priolo, Giandomenico; Pennisi, Michele

doi:10.1007/s00345-015-1749-3

Cited by 48 publications

(27 citation statements)

References 31 publications

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“…This missing rate of significant PCa is comparable to published missing rates of up to 30% for fusPbx in confirmatory biopsy and therefore, sysPbx should not be completely replaced by exclusive fusPbx [28,30]. Tran et al [31] investigated 207 patients undergoing surveillance biopsy with fusPbx in combination with sysPbx.…”

Section: Discussionsupporting

confidence: 51%

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

Borkowetz¹,

Renner²,

Platzek³

et al. 2018

Urol Int

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Introduction: Targeted biopsy of tumour-suspicious lesions detected in multiparametric magnetic resonance imaging (mpMRI) plays an increasing role in the active surveillance (AS) of patients with low-risk prostate cancer (PCa). The aim of this study was to compare MRI/ultrasound-fusion biopsy (fusPbx) with systematic biopsy (sysPbx) in patients undergoing biopsy for AS. Methods: Patients undergoing mpMRI and transperineal fusPbx combined with transrectal sysPbx (comPbx) as surveillance biopsy were investigated. The detection of Gleason score upgrading and reclassification according to Prostate Cancer Research International Active Surveillance criteria were evaluated. Results: Eighty-three patients were enrolled. PCa upgrading was detected in 39% by fusPbx and in 37% by sysPbx (p = 1.0). The percentage of patients who were reclassified in fusPbx and sysPbx (p = 0.45) were 64 and 59% respectively. ComPbx detected more frequently tumour upgrading than fusPbx (71 vs. 64%, p = 0.016) and sysPbx (71 vs. 59%, p < 0.001) and more patients had to be reclassified after comPbx than after fusPbx or sysPbx alone. Conclusions: The combination of fusPbx and sysPbx outperforms both modalities alone with regard to the detection of upgrading and reclassification in patients under AS. Because a high missing rate of significant PCa still exists in both biopsy modalities, a combination of fusPbx and sysPbx should be recommended in these patients.

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Section: Discussionsupporting

confidence: 51%

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

Borkowetz¹,

Renner²,

Platzek³

et al. 2018

Urol Int

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“…First, a greater number of patients should be prospectively evaluated. Second, although mpMRI is strongly recommended in men candidates to repeat biopsy, still today, standard prostate biopsy (extended or saturation procedure) should be always combined with mMRI/TRUS fusion biopsy because of mpMRI's false-negative rate (15-20% of PCa with low volume and Gleason score ≥7) (19,20). Finally, the reproducibility of ADC values should be evaluated performing multicentric studies and external validation using different mpMRI devices.…”

Section: Discussionmentioning

confidence: 99%

Multiparametric MRI Apparent Diffusion Coefficient (ADC) Accuracy in Diagnosing Clinically Significant Prostate Cancer

Pepe

D’Urso

Garufi

et al. 2017

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The advent of multiparametric magnetic resonance imaging (mpMRI) scanners combined with the international score Prostate Imaging Reporting and Data System (PI-RADS) (1) has improved the diagnosis of clinically significant prostate cancer (PCa). Maps of the apparent diffusion coefficient (ADC), computed from diffusion-weighted imaging (DWI), provide a quantitative parameter to evaluate prostate regions with suspicion of PCa. In neoplastic tissue, ADC values decrease from the one measured in normal prostatic tissue and some studies have demonstrated a possible differentiation in PCa grading, according to Gleason score (GS) classification (2-9). Currently, there are no defined thresholds that have been accepted by the radiological scientific community to discriminate healthy and diseased patients as well as to differentiate PCa grading. Thus, the purpose of our study is to analyze DWI and the corresponding ADC maps in predicting definitive GS in men submitted to radical prostatectomy for PCa. Patients and MethodsFrom January 2016 to December 2016, 44 men with median prostate-specific antigen (PSA) of 7.3 ng/ml (range=4.2-18), clinical stage T1c and median GS equal to 6.8 (range=6-9) underwent radical retropubic prostatectomy (RRP) for biopsy of clinically significant PCa (GS ≥6 and/or more than 2 positive cores and/or a greatest percentage of cancer for each core >50%) (10); 16/44 (36.6%) patients previously enrolled in Active Surveillance (AS) program were upgraded at confirmatory biopsy and 28/44 (63.4%) men underwent repeat saturation biopsy (median=30 cores; range=28-34 cores) for persistent suspicious cancer. Previously, all patients about 10 days before prostate biopsy underwent pelvic mpMRI and two radiologists blinded to pre-imaging clinical parameters evaluated the mpMRI data separately and independently. In the presence of mpMRI lesions suggestive of cancer (PI-RADS score ≥3) (11) mpMRI/transrectal ultrasonography (TRUS) transperineal fusion guided-biopsies (12) were added to transperineal saturation biopsy using a Hitachi 70 Arietta ecograph (Hitachi Medico, Chiba, Japan) (13). All analyzed mpMRI images were acquired using a 3.0 Tesla Achieva Philips MRI scanner (Philips Medical Systems, Eindhoven, the Netherlands); the scanner was characterized by gradients of amplitude of 80 mT/m and a maximum slew rate of 200 mT/m/s. For image acquisition, a pelvic coil was used; model SENSE XL Torso 415

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“…Furthermore, there is increasing interest in MRI/TRUS fusion biopsy in this setting. Pepe et al in a small study investigated whether MRI/TRUS fusion targeted biopsy can replace confirmatory TPSB before AS [22]. Although mpMRI had a high diagnostic accuracy for PCa (about 95%), MRI/TRUS fusion biopsy missed 30% significant PCa characterized by the presence of a single positive core of Gleason score >7 or greatest proportion cancer within a core of >50%.…”

Section: Discussionmentioning

confidence: 99%

Active Surveillance Following Modified Transperineal Template Guided Saturation Biopsy Demonstrates a Low Rate of Progression and Conversion to Radical Treatment, with Age and PSA Associated with Upgrading, Upstaging and Treatment

Sarkar¹,

Ekwueme²,

Parr³

2017

Adv Cancer Prev

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Objectives: To evaluate outcomes in patients embarking upon active surveillance for Prostate cancer (Pca) following tumour characterisation by modified transperineal template guided saturation biopsy. Materials and Methods:Of 500 patients with initial negative conventional transrectal ultrasound guided prostate biopsy underwent transperineal template guided saturation biopsy, detected cancer in 276 (55%). Of these, 30 (11%) elected for active surveillance. Another 158 patients considering active surveillance after initial positive transrectal ultrasound guided biopsy underwent confirmatory transperineal template guided saturation biopsy, with 43 (27%) subsequently electing for active surveillance. A total of 73 patients from these two groups (median age 63 years) were, thus, enrolled for active surveillance. Follow up consisted of 3 monthly PSA and DRE, offering repeat Multi-parametric MRI and repeat transperineal template Guided Saturation Biopsy, at 24 months, or on suspicion of progression.Results: At a median follow up of 58 months, 59 patients have undergone repeat Multi-parametric MRI. Radiological progression was identified in 6 (8%), Gleason upgrading on repeat transperineal template guided saturation biopsy, in 14 (19%). Six (8%) have undergone radical treatments. Age >60 yrs and PSA >5 ng/mL were associated with upgrading and upstaging (p<0.05). Conclusion:A large proportion of patients initially considering active surveillance dropped out following confirmatory transperineal template Guided saturation biopsy, however, in those electing for active surveillance after transperineal template guided saturation biopsy, progression rates are low and related to age and presenting PSA.

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Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?

Abstract: Although mpMRI provided high diagnostic accuracy (about 95 %) in diagnosing clinically significant PCa, mpMRI/TRUS fusion targeted biopsy cannot replace SPBx at confirmatory biopsy of men enrolled in AS protocols.

Cited by 48 publications

References 31 publications

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

Multiparametric MRI Apparent Diffusion Coefficient (ADC) Accuracy in Diagnosing Clinically Significant Prostate Cancer

Active Surveillance Following Modified Transperineal Template Guided Saturation Biopsy Demonstrates a Low Rate of Progression and Conversion to Radical Treatment, with Age and PSA Associated with Upgrading, Upstaging and Treatment

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