Diagnostic yield of fusion magnetic resonance-guided prostate biopsy versus cognitive-guided biopsy in biopsy-naive patients: a head-to-head randomized controlled trial

Izadpanahi, Mohammad Hossein; Elahian, Amirreza; Gholipour, Farshad; Khorrami, Mohammad-Hatef; Zargham, Mahtab; Sichani, Mehrdad Mohammadi; Alizadeh, Farshid; Khorrami, Farbod

doi:10.1038/s41391-021-00366-9

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…All targeted biopsies were done with a bk3000 ultrasonography system with bkFusion, powered by MIM Software version 7.2.2.M127-01 (all from BK Medical). Fusion-guided biopsies have been reported to be superior to cognitively guided biopsies . All men with Prostate Imaging Reporting & Data System grade 3 to 5 lesions were recommended to undergo biopsy.…”

Section: Methodsmentioning

confidence: 99%

“…Fusion-guided biopsies have been reported to be superior to cognitively guided biopsies. 11 All men with Prostate Imaging Reporting & Data System 12 grade 3 to 5 lesions were recommended to undergo biopsy. If the PSA level was greater than 0.15 ng/mL (to convert PSA to micrograms per liter, multiply by 1), systematic biopsies were planned regardless of Prostate Imaging Reporting & Data System grade, according to the national guidelines.…”

Section: Methodsmentioning

confidence: 99%

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Frequency of Biopsy and Tumor Grade Before vs After Introduction of Prostate Magnetic Resonance Imaging

Robinson,

Abdulkareem,

Nasrollah

et al. 2023

JAMA Netw Open

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ImportanceIn randomized clinical trials (RCTs), magnetic resonance imaging (MRI) before prostate biopsy has been associated with fewer biopsies, decreased detection of Gleason score 6 cancers, and increased detection of Gleason score 7 or higher cancers.ObjectiveTo study whether MRI of the prostate before the decision to biopsy is associated with biopsy frequency and distribution of Gleason score in clinical practice.Design, Setting, and ParticipantsThis is a retrospective, population-based cohort study of men in Jönköping Region, Sweden. Men with prostate-specific antigen (PSA) level measured between November 2011 and 2020 were monitored until January 31, 2021. Men with known prostate cancer were excluded. Data analysis was performed from July to December 2022.ExposuresData on repeated PSA measures, prostate biopsies, and MRI prostate were extracted from health care records, and cancer characteristics were obtained from The National Prostate Cancer Register.Main Outcomes and MeasuresThe proportions of men who underwent prostate biopsy and risk of Gleason score 6 or Gleason score 7 or higher cancer and negative biopsy before and after introduction of MRI were calculated.ResultsIn this cohort study of 23 802 men (mean [SD] age, 60.8 [13.6] years) who underwent PSA testing, when the use of MRI increased, fewer biopsies were performed (adjusted odds ratio [OR], 0.84; 95% CI, 0.72-0.97) and the odds of detecting Gleason score 6 cancer decreased (OR, 0.47; 95% CI, 0.33-0.64), whereas the odds of detecting Gleason score 7 or higher cancer increased (OR, 1.24; 95% CI, 1.02-1.50).Conclusions and RelevanceIn this study, the introduction of MRI to clinical practice was associated with a decreased proportion of men who underwent a biopsy and decreased detection of Gleason score 6 cancer but increased detection of Gleason score 7 or higher cancer. These clinical data support the use of prostate MRI before biopsy in an effort to avoid unnecessary biopsies.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Frequency of Biopsy and Tumor Grade Before vs After Introduction of Prostate Magnetic Resonance Imaging

Robinson,

Abdulkareem,

Nasrollah

et al. 2023

JAMA Netw Open

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“…Out of the 20 studies included, 4 had a within patients design and were excluded for the evaluation of complications according to MRI-TB method [9,19,20,24]. Eleven studies did not comment on complications [23,[25][26][27][28][29][30][31][32][33][34]. The remaining 5 studies [8,10,21,35,36], including a total of 821 patients, reported 19 (2.3%) Grade 2 adverse events.…”

Section: Complicationsmentioning

confidence: 99%

“…Definition of csPCa (ISUP GG ≥ 2). Seven studies did not define csPCa as ISUP GG ≥ 2 [9,21,24,27,30,34,36]. Among these, 4 studies provided data to evaluate ISUP GG ≥ 2 at MRI-TB as outcome [9,21,24,27].…”

Section: Preplanned Sub-analysismentioning

confidence: 99%

Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies

Falagario,

Pellegrino,

Fanelli

et al. 2024

Prostate Cancer Prostatic Dis

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Background Three primary strategies for MRI-targeted biopsies (TB) are available: Cognitive TB (COG-TB), MRI-US Fusion TB (FUS-TB), and In Bore TB (IB-TB). Despite nearly a decade of practice, a consensus on the preferred approach is lacking, with previous studies showing comparable PCa detection rates among the three methods. Methods We conducted a search of PubMed, EMBASE, PubMed, Web of Science, and Scopus databases from 2014 to 2023, to identify studies comparing at least two of the three methods and reporting clinically significant PCa (csPCa) detection rates. The primary and secondary outcomes were to compare the csPCa and insignificant prostate cancer (iPCa, ISUP GG 1) detection rates between TB techniques. The tertiary outcome was to compare the complication rate between TB techniques. Detection rates were pooled using random-effect models. Planned sensitivity analyses included subgroup analysis according to the definition of csPCa and positive MRI, previous biopsy status, biopsy route, prostate volume, and lesion characteristics. Results A total of twenty studies, involving 4928 patients, were included in the quantitative synthesis. The meta-analysis unveiled comparable csPCa detection rates among COG-TB (0.37), FUS-TB (0.39), and IB-TB (0.47). iPCa detection rate was also similar between TB techniques (COG-TB: 0.12, FUS-TB: 0.17, IB-TB: 0.18). All preplanned sensitivity analyses were conducted and did not show any statistically significant difference in the detection of csPCa between TB methods. Complication rates, however, were infrequently reported, and when available, no statistically significant differences were observed among the techniques. Conclusions This unique study, exclusively focusing on comparative research, indicates no significant differences in csPCa and iPCa detection rates between COG-TB, FUS-TB, and IB-TB. Decisions between these techniques may extend beyond diagnostic accuracy, considering factors such as resource availability and operator preferences. Well-designed prospective studies are warranted to refine our understanding of the optimal approach for TB in diverse clinical scenarios.

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“…Targeted prostate biopsy of a visible lesion on mpMRI can be performed using software-based registration of mpMRI images and real-time ultrasound or cognitive registration. Other than in one randomized controlled trial (RCT) 44 where software-based registration demonstrated better cancer detection rate (CDR) compared with cognitive registration (33.3% versus 19.0%; P = .016), both approaches have been shown to have similar CDR in multiple studies (see Guideline for full references), inclusive of an RCT showing no difference in CDR of software-based versus cognitive fusion or in-bore MRI targeted biopsy. 45 Nonetheless, use of software registration facilitates the fusion of multiple MRI and ultrasound images in 2 to 3 planes, allowing for the creation of a composite image that provides a more comprehensive view of the target lesion.…”

Section: Guideline Statementsmentioning

confidence: 99%

Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy

et al. 2023

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Purpose:The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part II of a two-part series focusing on initial and repeat biopsies, and biopsy technique. Please refer to Part I for discussion of initial prostate cancer screening recommendations.Materials and Methods:The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000–November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles.Results:The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsies, and biopsy technique.Conclusions:The evaluation of prostate cancer risk should be focused on the detection of clinically significant prostate cancer (Grade Group 2 or higher [GG2+]). The use of laboratory biomarkers, prostate MRI, and biopsy techniques described herein may improve detection and safety when a prostate biopsy is deemed necessary following prostate cancer screening.

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Diagnostic yield of fusion magnetic resonance-guided prostate biopsy versus cognitive-guided biopsy in biopsy-naive patients: a head-to-head randomized controlled trial

Cited by 7 publications

References 19 publications

Frequency of Biopsy and Tumor Grade Before vs After Introduction of Prostate Magnetic Resonance Imaging

Frequency of Biopsy and Tumor Grade Before vs After Introduction of Prostate Magnetic Resonance Imaging

Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies

Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy

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