Effectiveness of Bi-Parametric MR/US Fusion Biopsy for Detecting Clinically Significant Prostate Cancer in Prostate Biopsy Naïve Men

Kim, Young-Joo; Huh, Jung–Sik; Park, Kyung Kgi

doi:10.3349/ymj.2019.60.4.346

Cited by 11 publications

(9 citation statements)

References 19 publications

(22 reference statements)

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“…These disease burden-dependent suggestions rely heavily on understanding and reporting the population under study, and if studies attempting to answer the primary research question do not address this transparently, they will be severely limited. Another study [ 49 ] that was in the minority of papers that reported their PI-RADS 3 population investigated bpMRI and concluded that PI-RADS 3 lesions are expected to require additional tools to supplement bpMRI based on their results as compared to other PI-RADS lesions. This emphasizes the importance of reporting PI-RADS 3 prevalence in a study to enable more accurate research conclusions.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis

Belue

Yilmaz

Daryanani

et al. 2022

Life

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The role of multiparametric MRI (mpMRI) in the detection of prostate cancer is well-established. Based on the limited role of dynamic contrast enhancement (DCE) in PI-RADS v2.1, the risk of potential side effects, and the increased cost and time, there has been an increase in studies advocating for the omission of DCE from MRI assessments. Per PI-RADS v2.1, DCE is indicated in the assessment of PI-RADS 3 lesions in the peripheral zone, with its most pronounced effect when T2WI and DWI are of insufficient quality. The aim of this study was to evaluate the methodology and reporting in the literature from the past 5 years regarding the use of DCE in prostate MRI, especially with respect to the indications for DCE as stated in PI-RADS v2.1, and to describe the different approaches used across the studies. We searched for studies investigating the use of bpMRI and/or mpMRI in the detection of clinically significant prostate cancer between January 2017 and April 2022 in the PubMed, Web of Science, and Google Scholar databases. Through the search process, a total of 269 studies were gathered and 41 remained after abstract and full-text screening. The following information was extracted from the eligible studies: general clinical and technical characteristics of the studies, the number of PI-RADS 3 lesions, different definitions of clinically significant prostate cancer (csPCa), biopsy thresholds, reference standard methods, and number and experience of readers. Forty-one studies were included in the study. Only 51% (21/41) of studies reported the prevalence of csPCa in their equivocal lesion (PI-RADS category 3 lesions) subgroups. Of the included studies, none (0/41) performed a stratified sub-analysis of the DCE benefit versus MRI quality and 46% (19/41) made explicit statements about removing MRI scans based on a range of factors including motion, noise, and image artifacts. Furthermore, the number of studies investigating the role of DCE using readers with varying experience was relatively low. This review demonstrates that a high proportion of the studies investigating whether bpMRI can replace mpMRI did not transparently report information inherent to their study design concerning the key indications of DCE, such as the number of clinically insignificant/significant PI-RADS 3 lesions, nor did they provide any sub-analyses to test image quality, with some removing bad quality MRI scans altogether, or reader-experience-dependency indications for DCE. For the studies that reported on most of the DCE indications, their conclusions about the utility of DCE were heavily definition-dependent (with varying definitions of csPCa and of the PI-RADS category biopsy significance threshold). Reporting the information inherent to the study design and related to the specific indications for DCE as stated in PI-RADS v2.1 is needed to determine whether DCE is helpful or not. With most of the recent literature being retrospective and not including the data related to DCE indications in particular, the ongoing dispute between bpMRI and mpMRI is likely to linger.

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Section: Discussionmentioning

confidence: 99%

Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis

Belue

Yilmaz

Daryanani

et al. 2022

Life

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“…The technique of targeted MP-MRI/TRUS fusion biopsy is of broad and current interest; it is supported by the joint consensus of the Society of Abdominal Radiology and the American Urological Association (36). The targeted biopsy of suspicious lesions in patients with PSA >4 ng/mL has also been successfully performed by many other clinical applications (37)(38)(39). But a considerable number of patients with PSA in the grey zone have undergone excessive intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Multivariate logistic regression analysis revealed that fPSA/PSA, EQS, and PI-RADS score were independent predictors of PCa in grey zone patients (Table 2); we named this the "+EQS model" (Figure 4). In addition, in order to verify the necessity of EQS for PCa prediction, we created the following two models: the "EQS model" that depended 25 [21] 3 [8] 20 [18] 18 [22] 2 [7] 8 [17] 7 [19] 1 [11] 3 73 [47] 62 [52] 11 [31] 49 [45] 40 [49] 9 [ 31 [26] 14 [39] 33 [30] 24 [29] 9 [33] 12 [26] 7 [19] 5 [56]…”

Section: Modelsmentioning

confidence: 99%

Development and validation of a nomogram for predicting prostate cancer in men with prostate-specific antigen grey zone based on retrospective analysis of clinical and multi-parameter magnetic resonance imaging/transrectal ultrasound fusion-derived data

Ding¹,

Wu²,

Song³

et al. 2020

Transl Androl Urol

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Background: Urologists face a dilemma when deciding whether prostate biopsy is required for patients with prostate-specific antigen (PSA) levels in the grey zone (4 to 10 ng/mL). Methods:We retrospectively analyzed data from consecutive patients with PSA levels in grey zone, who underwent targeted multiparametric magnetic resonance imaging (MP-MRI)/transrectal ultrasound (TRUS) fusion biopsy with elastography between November 2017 and December 2019 in our hospital. The patientse data including age, PSA, fPSA (free PSA), fPSA/PSA, PSA density (PSAD), prostate volume, elastography Q-analysis score (EQS), and prostate imaging-reporting and data system (PI-RADS) score were collected. The nomogram was built using logistic regression and the final cohort of patients was randomly divided into a training cohort (70%) and a validation cohort (30%) by R software. The models were evaluated by receiver operating characteristic curve (ROC) analysis and calibration curve analysis. The nomogram was constructed from the best model. Results: The final study cohort consisted of 155 patients (training cohort, 109 patients; validation cohort, 46 patients) with PSA in the grey zone, of which 36 patients were pathologically diagnosed with PCa. The EQS model, −EQS model, +EQS model were built. The +EQS model that consisted of fPSA/PSA, EQS, and PI-RADS score had the best PCa diagnostic accuracy (development and validation, 0.783 and 0.781) and probability score (development and validation, 0.939 vs. 0.622). The new nomogram based on this model was constructed, in which fPSA/PSA ratio had the largest impact, followed by PI-RADS and EQS.Conclusions: Elastography and pre-biopsy MP-MRI has clinical significance for patients with PSA in the grey zone. The new nomogram, which is based on pre biopsy data including serological analysis, PI-RADS score, and EQS, can be helpful for clinical decision-making to avoid unnecessary biopsy.

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“…Recent studies elaborated bi-parametric MRI (bpMRI) is a feasible implement with which to distinguish CSPCa. They recommended using supplemental implements to increase PCa detection in patients with Prostate Imaging Reporting and Data System (PI-RADS v2.1) ≥ 3 4 . In addition, bpMRI has been displayed to have a diagnostic accuracy and PCa detection rate that are equivalent to those of mpMRI.…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI

Liang

Cheng

et al. 2021

Sci Rep

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To analyze the clinical characteristics of patients with negative biparametric magnetic resonance imaging (bpMRI) who didn’t need prostate biopsies (PBs). A total of 1,012 male patients who underwent PBs in the First Affiliated Hospital of Nanjing Medical University from March 2018 to November 2019, of 225 had prebiopsy negative bpMRI (defined as Prostate Imaging Reporting and Data System (PI-RADS 2.1) score less than 3). The detection efficiency of clinically significant prostate cancer (CSPCa) was assessed according to age, digital rectal examination (DRE), prostate volume (PV) on bpMRI, prostate-specific antigen (PSA) and PSA density (PSAD). The definition of CSPCa for Gleason score > 6. Univariate and multivariable logistic regression analysis were used to identify predictive factors of absent CSPCa on PBs. Moreover, absent CSPCa contained clinically insignificant prostate cancer (CIPCa) and benign result. The detection rates of present prostate cancer (PCa) and CSPCa were 27.11% and 16.44%, respectively. Patients who were diagnosed as CSPCa had an older age (P < 0.001), suspicious DRE (P < 0.001), a smaller PV (P < 0.001), higher PSA value (P = 0.008) and higher PSAD (P < 0.001) compared to the CIPCa group and benign result group. PSAD < 0.15 ng/ml/cm3 (P = 0.004) and suspicious DRE (P < 0.001) were independent predictors of absent CSPCa on BPs. The negative forecast value of bpMRI for BP detection of CSPCa increased with decreasing PSAD, mainly in patients with naive PB (P < 0.001) but not in prior negative PB patients. 25.33% of the men had the combination of negative bpMRI, PSAD < 0.15 ng/ml/cm3 and PB naive, and none had CSPCa on repeat PBs. The incidence of PB was determined, CSPCa was 1.59%, 0% and 16.67% in patients with negative bpMRI and PSAD < 0.15 ng/ml/cm3, patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and biopsy naive and patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and prior negative PB, separately. We found that a part of patients with negative bpMRI, a younger age, no suspicious DRE and PSAD < 0.15 ng/ml/cm3 may securely avoid PBs. Conversely PB should be considered in patients regardless of negative bpMRI, especially who with a greater age, obviously suspicious DRE, significantly increased PSA value, a significantly small PV on MRI and PSAD > 0.15 ng/ml/cm3.

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Effectiveness of Bi-Parametric MR/US Fusion Biopsy for Detecting Clinically Significant Prostate Cancer in Prostate Biopsy Naïve Men

Cited by 11 publications

References 19 publications

Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis

Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis

Development and validation of a nomogram for predicting prostate cancer in men with prostate-specific antigen grey zone based on retrospective analysis of clinical and multi-parameter magnetic resonance imaging/transrectal ultrasound fusion-derived data

Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI

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