Evolution of repeat prostate biopsy strategies incorporating transperineal and MRI–TRUS fusion techniques

Kuru, Timur H.; Saeb‐Parsy, Kasra; Cantiani, Andrea; Frey, Julia; Lombardo, Riccardo; Serrao, Eva M.; Gaziev, Gabriele; Koo, Brendan; Roethke, Matthias; Gnanapragasam, Vincent; Warren, Anne Y.; Doble, Andrew; Hadaschik, Boris; Kastner, Christof

doi:10.1007/s00345-014-1334-1

Cited by 18 publications

(9 citation statements)

References 23 publications

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“…In the present study, we report an overall CDR of 65.0%, with MRI/TRUS fusion-guided prostate biopsy outperforming standard 12-core biopsy in detecting clinically significant prostate cancer (47.9% vs 30.7%; P < 0.001). Findings from our present study also support those of other investigators who reported that MRI-fusion or targeted biopsy increased the detection of high-grade cancer when compared with random prostate biopsies using either the transrectal or transperineal approaches [29,30]. Furthermore, we found that 12-core biopsies tended to miss more clinically significant prostate cancer compared with MRI/TRUS fusion-guided prostate biopsy (20.9% vs 4.4%; P < 0.001).…”

Section: Discussionsupporting

confidence: 91%

In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12‐core biopsy still necessary in addition to a targeted biopsy?

et al. 2015

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ObjectivesTo evaluate the performance of multiparametric magnetic resonance imaging (mpMRI) in predicting prostate cancer on repeat biopsy; and to compare the cancer detection rates (CDRs) of MRI/transrectal ultrasonography (TRUS) fusion-guided biopsy with standard 12-core biopsy in men with at least one previous negative biopsy. Patients and MethodsWe prospectively enrolled men with elevated or rising PSA levels and/or abnormal digital rectal examination into our MRI/TRUS fusion-guided prostate biopsy trial. Participants underwent a 3 T mpMRI with an endorectal coil. Three radiologists graded all suspicious lesions on a 5-point Likert scale. MRI/TRUS fusion-guided biopsies of suspicious prostate lesions and standard TRUS-guided 12-core biopsies were performed. Analysis of 140 eligible men with at least one previous negative biopsy was performed. We calculated CDRs and estimated area under the receiver operating characteristic curves (AUCs) of mpMRI in predicting any cancer and clinically significant prostate cancer. ResultsThe overall CDR was 65.0% (91/140). Higher level of suspicion on mpMRI was significantly associated with prostate cancer detection (P < 0.001) with an AUC of 0.744 compared with 0.653 and 0.680 for PSA level and PSA density, respectively. The CDRs of MRI/TRUS fusion-guided and standard 12-core biopsy were 52.1% (73/140) and 48.6% (68/140), respectively (P = 0.435). However, fusion biopsy was more likely to detect clinically significant prostate cancer when compared with the 12-core biopsy (47.9% vs 30.7%; P < 0.001). Of the cancers missed by 12-core biopsy, 20.9% (19/91) were clinically significant. Most cancers missed by 12-core biopsy (69.6%) were located in the anterior fibromuscular stroma and transition zone. Using a fusion-biopsy-only approach in men with an MRI suspicion score of ≥4 would have missed only 3.5% of clinically significant prostate cancers.

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Section: Discussionsupporting

confidence: 91%

In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12‐core biopsy still necessary in addition to a targeted biopsy?

et al. 2015

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“…We also did not sub-classify within T stages, but we have previously noted the inaccuracies in its standard clinical use [ 34 ]. Our cohort predates the use of magnetic resonance imaging (MRI) for guided biopsies, which is already changing clinical practice [ 35 , 36 ]. The CPG model, however, will retain utility regardless of the biopsy approach, as it is based on standard clinico-pathological variables.…”

Section: Discussionmentioning

confidence: 99%

The Cambridge Prognostic Groups for improved prediction of disease mortality at diagnosis in primary non-metastatic prostate cancer: a validation study

Gnanapragasam

Bratt

Muir

et al. 2018

BMC Med

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BackgroundThe purpose of this study is to validate a new five-tiered prognostic classification system to better discriminate cancer-specific mortality in men diagnosed with primary non-metastatic prostate cancer.MethodsWe applied a recently described five-strata model, the Cambridge Prognostic Groups (CPGs 1-5), in two international cohorts and tested prognostic performance against the current standard three-strata classification of low-, intermediate- or high-risk disease. Diagnostic clinico-pathological data for men obtained from the Prostate Cancer data Base Sweden (PCBaSe) and the Singapore Health Study were used. The main outcome measure was prostate cancer mortality (PCM) stratified by age group and treatment modality.ResultsThe PCBaSe cohort included 72,337 men, of whom 7162 died of prostate cancer. The CPG model successfully classified men with different risks of PCM with competing risk regression confirming significant intergroup distinction (p < 0.0001). The CPGs were significantly better at stratified prediction of PCM compared to the current three-tiered system (concordance index (C-index) 0.81 vs. 0.77, p < 0.0001). This superiority was maintained for every age group division (p < 0.0001). Also in the ethnically different Singapore cohort of 2550 men with 142 prostate cancer deaths, the CPG model outperformed the three strata categories (C-index 0.79 vs. 0.76, p < 0.0001). The model also retained superior prognostic discrimination in the treatment sub-groups: radical prostatectomy (n = 20,586), C-index 0.77 vs. 074; radiotherapy (n = 11,872), C-index 0.73 vs. 0.69; and conservative management (n = 14,950), C-index 0.74 vs. 0.73. The CPG groups that sub-divided the old intermediate-risk (CPG2 vs. CPG3) and high-risk categories (CPG4 vs. CPG5) significantly discriminated PCM outcomes after radical therapy or conservative management (p < 0.0001).ConclusionsThis validation study of nearly 75,000 men confirms that the CPG five-tiered prognostic model has superior discrimination compared to the three-tiered model in predicting prostate cancer death across different age and treatment groups. Crucially, it identifies distinct sub-groups of men within the old intermediate-risk and high-risk criteria who have very different prognostic outcomes. We therefore propose adoption of the CPG model as a simple-to-use but more accurate prognostic stratification tool to help guide management for men with newly diagnosed prostate cancer.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1019-5) contains supplementary material, which is available to authorized users.

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“…While it has been proposed that transperineal template biopsy may be an option for men with previous negative biopsies due to improved access to the anterior prostate, current evidence suggests that MRI-targeted biopsy has a comparable detection rate of clinically significant cancers while reducing over-detection of clinically insignificant disease as compared to transperineal template biopsy 18–20 .…”

Section: Discussionmentioning

confidence: 99%

Prebiopsy MRI and MRI-ultrasound Fusion–targeted Prostate Biopsy in Men With Previous Negative Biopsies: Impact on Repeat Biopsy Strategies

Mendhiratta

Meng

Rosenkrantz

et al. 2015

Urology

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OBJECTIVE To report outcomes of MRI-ultrasound fusion (MRF-TB) and 12-core systematic biopsy (SB) over a 26-month period in men with prior negative prostate biopsy. METHODS Between 6/12 and 8/14, 210 men presenting to our institution for prostate biopsy with ≥1 prior negative biopsy underwent multiparametric MRI followed by MRF-TB and SB and were entered into a prospective database. Clinical characteristics, MRI suspicion scores (mSS), and biopsy results were queried from the database and the detection rates of Gleason ≥7 prostate cancer (PCa) and overall PCa were compared between biopsy techniques using McNemar’s test. RESULTS Fifty-three (31%) of 172 men meeting inclusion criteria (mean age 65±8 years; mean PSA 8.9±8.9) were found to have PCa. MRF-TB and SB had overall cancer detection rates (CDR) of 23.8% and 18.0% (p=0.12), respectively, and CDR for Gleason score (GS)≥7 disease of 16.3% and 9.3% (p=0.01), respectively. Of 31 men with GS≥7 disease, MRF-TB detected 28 (90.3%) while SB detected 16 (51.6%) (p<0.001). Using UCSF-CAPRA criteria, only one man was re-stratified from low-risk to higher risk based on SB results compared to MRF-TB alone. Among men with mSS<4, 80% of detected cancers were low-risk by UCSF-CAPRA criteria. CONCLUSIONS In men with previous negative biopsies and persistent suspicion for PCa, SB contributes little to the detection of GS≥7 disease by MRF-TB, and avoidance of SB bears consideration. Based on the low likelihood of detecting GS≥7 cancer and overall low-risk features of PCa in men with mSS<4, limiting biopsy to men with mSS≥4 warrants further investigation.

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Evolution of repeat prostate biopsy strategies incorporating transperineal and MRI–TRUS fusion techniques

Cited by 18 publications

References 23 publications

In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12‐core biopsy still necessary in addition to a targeted biopsy?

In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging, is a 12‐core biopsy still necessary in addition to a targeted biopsy?

The Cambridge Prognostic Groups for improved prediction of disease mortality at diagnosis in primary non-metastatic prostate cancer: a validation study

Prebiopsy MRI and MRI-ultrasound Fusion–targeted Prostate Biopsy in Men With Previous Negative Biopsies: Impact on Repeat Biopsy Strategies

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