Efficiency of Prostate Cancer Diagnosis by MR/Ultrasound Fusion-Guided Biopsy vs Standard Extended-Sextant Biopsy for MR-Visible Lesions

Siddiqui, Mohummad Minhaj; George, Arvin; Rubin, Rachel; Rais‐Bahrami, Soroush; Parnes, Howard L.; Merino, María J.; Simon, Richard; Türkbey, Barış; Choyke, Peter L.; Wood, Bradford J.; Pinto, Peter A.

doi:10.1093/jnci/djw039

Cited by 70 publications

(43 citation statements)

References 16 publications

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“…Only initial biopsy sessions were included for analysis in patients with multiple biopsies during the study period. This cohort has been reported on previously; however, the current objective and analysis have not been published 9, 12 .…”

Section: Methodsmentioning

confidence: 99%

Missing the Mark: Prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy

et al. 2017

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Purpose Multiparametric MRI (mpMRI) and fusion biopsy (FBx) detect more high-risk prostate cancer (PCa) and less low-risk PCa than systematic biopsy (SBx). However, there remains a small subset of patients where SBx captures higher grade disease than FBx. We aim to identify potential mechanisms for failure of FBx biopsy in detection of clinically significant (CS) PCa. Methods We reviewed a prospectively maintained database of patients undergoing mpMRI followed by FBx and SBx from 2007-2014. In patients disease upgraded to CS disease (Gleason ≥ 7) by SBx over FBx, independent re-review of MR imaging, archived biopsy imaging, and whole mount pathology, as well as needle coordinate mapping were conducted. Multivariate logistic regression analysis was performed to determine predictors for upgrading by SBx. Results Disease upgrading based on SBx over FBx occurred in 135/1003 (13.5%) patients, of which only 62 (6.2%) were to intermediate (Gleason=7) [N=51, 5.1%] or high risk PCa (Gleason≥8) [N=11, 1.1%]. On multivariate analysis, lower PSA (p <0.001), higher MRI prostate volume (p <0.001), and lower number of target cores (p=0.001) were predictors of upgrading by SBx. Main mechanisms for under-grading by FBx included mpMRI reader oversight, presence of MR invisible cancer, FBx technique error, and intra-lesion Gleason heterogeneity. Conclusions MRI and FBx rarely misses CS PCa, as only 62/1003 (6.2%) cases were upgraded to CS disease by SBx. Imaging and biopsy techniques are continually refined and further studies will help to clarify mechanisms of FBx failure and patient populations which benefit from SBx in addition to FBx.

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Section: Methodsmentioning

confidence: 99%

Missing the Mark: Prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy

et al. 2017

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“…However, recent advances in multiparametric MRI (mpMRI) for prostate imaging coupled with the evolution of MR targeted biopsy have resulted in a paradigm shift in prostate cancer evaluation. MR targeted biopsy, performed either ‘in-bore’ or through cognitive or MRI-ultrasound fusion, allows for more precise sampling within the prostate, and, relative to systematic 12-core biopsy, has been repeatedly shown to identify more high-risk prostate cancer cases while avoiding detection of low-risk disease (5–8). This, in turn, has led to improved efforts in defining tumor burden and staging PCa prior to definitive treatment (9, 10).…”

Section: Introductionmentioning

confidence: 99%

Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance–targeted biopsy

Muthigi

Sidana

George

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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Introduction and Objective Multiparametric MRI (mpMRI) and MR targeted biopsy have a growing role in the screening and evaluation of prostate cancer. We aim to evaluate the current knowledge, attitude, and practice patterns of urologists regarding this new technique. Methods An anonymous online questionnaire was designed to collect information on urologists’ beliefs and use of prostate mpMRI and MR targeted biopsy. The survey was sent to members of the Society of Urologic Oncology (SUO), the Endourological Society (ES), and European Association of Urology (EAU). Multivariate logistic regression analysis was performed to determine predictors for use of prostate MRI and MR targeted biopsy. Results A total of 302 responses were received [ES: 175, EAU: 23, SUO: 104]. The majority of respondents (83.6%) believe MR targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer. 85.7% of responders utilize prostate MR imaging in their practice, and 63.0% utilize MR targeted biopsy. The two most common settings for utilization of MR targeted biopsy include patients with history of prior negative biopsy (96.3%) and monitoring patients on active surveillance (72.5%). In those who do not utilize MR targeted biopsy, the principal reasons were lack of necessary infrastructure (64.1%) and prohibitive costs (48.1%). On multivariate logistic regression analysis, practice in an academic setting (1.86 [1.02–3.40], p = 0.043), and performing > 25 radical prostatectomies per year (2.32 [1.18–4.56], p = 0.015) remained independent predictors for utilizing MR targeted biopsy. Conclusions A majority of respondents to our survey look favorably upon use of prostate MRI and MR targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology.

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“…In a prospective study of 62 patients using PI-RADS version 2, 0% of patients with a PI-RADS score of 3 had clinically significant cancer found. 27 However, because many men will continue to have no PCa found after FB, our nomogram has the potential to spare these men the morbidity of unnecessary biopsies and to reduce health care costs. Because clinically significant PCa is detected at a higher rate in lesions with PI-RADS scores of 4 and 5 versus 3, performing biopsy for all patients with PI-RADS scores of 4 or 5 may be a reasonable approach.…”

Section: Discussionmentioning

confidence: 99%

Multi‐institutional nomogram predicting benign prostate pathology on magnetic resonance/ultrasound fusion biopsy in men with a prior negative 12‐core systematic biopsy

Truong

Wang

Gordetsky

et al. 2017

Cancer

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False-positive mpMRI examinations may occur in up to 46.3% of patients with a prior negative biopsy. Thus, a multi-institutional nomogram has been developed and validated for predicting benign pathology after FB in patients with a prior negative biopsy, and this may help to reduce the number of unnecessary biopsies in the setting of abnormal mpMRI findings. Cancer 2018;124:278-85. © 2017 American Cancer Society.

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Efficiency of Prostate Cancer Diagnosis by MR/Ultrasound Fusion-Guided Biopsy vs Standard Extended-Sextant Biopsy for MR-Visible Lesions

Abstract: In men with MR-visible prostate lesions, targeted biopsy is more efficient than standard biopsy, diagnosing a similar number of cancer cases and more high-grade cases while sampling 56.1% fewer biopsy cores.

Cited by 70 publications

References 16 publications

Missing the Mark: Prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy

Missing the Mark: Prostate Cancer Upgrading by Systematic Biopsy over Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Biopsy

Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance–targeted biopsy

Multi‐institutional nomogram predicting benign prostate pathology on magnetic resonance/ultrasound fusion biopsy in men with a prior negative 12‐core systematic biopsy

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