How to Improve TRUS-Guided Target Biopsy following Prostate MRI

Park, Byung Kwan

doi:10.3390/cancers13225647

Cited by 6 publications

(17 citation statements)

References 65 publications

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“…MRI is scanned perpendicularly to the urethra, but TPUS is performed obliquely to it. Like TRUS [3,14,15], as a tumor approaches the anterior capsule on MRI, it is located more inferiorly on TPUS. In contrast, when a tumor is closer to the posterior capsule on MRI, it is located more superiorly on TPUS [3,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Like TRUS [3,14,15], as a tumor approaches the anterior capsule on MRI, it is located more inferiorly on TPUS. In contrast, when a tumor is closer to the posterior capsule on MRI, it is located more superiorly on TPUS [3,14,15]. Moreover, as a tumor becomes significant, peripheral cancer becomes hypoechoic compared to normal peripheral tissue, whereas transition cancer becomes hyperechoic compared to hyperplastic tissue [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

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New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles’ operation

et al. 2023

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Objectives Currently, a prostate biopsy is guided by transrectal ultrasound (US) alone. However, this biopsy cannot be performed in men without an anus. The aim of this study was to show the outcomes of a new transperineal US (TPUS)-guided biopsy technique in patients who underwent Miles’ operation. Methods Between April 2009 and March 2022, TPUS-guided biopsy was consecutively conducted in 9 patients (median, 71 years; range, 61–78 years) with high prostate-specific antigen values (22.60 ng/mL; 6.19–69.7 ng/mL). Their anuses were all removed due to rectal cancer. TPUS-guided biopsy was performed according to information on prostate magnetic resonance imaging. The technical success rate, cancer detection rate, and complication rate were recorded. Tumor sizes were compared between benign and cancer groups using an unpaired t-test with Welch’s correction. Results The new TPUS-guided biopsy was successfully performed in all patients. Cancer was detected in 77.8% (7/9) of the patients. These were all categorized as PI-RADS 5. Among them, the detection rate of significant cancer (Gleason score 7 or higher) was 66.7% (6/9). The median tumor size was 2.4 cm (1.7–3.1 cm). However, two patients were diagnosed with benign tissue with PI-RADS 3 or PI-RADS 4. Their median tumor size was 1.0 cm (0.8–1.2 cm). There was significant difference between the cancer and benign groups (p = 0.037) in terms of tumor size. Neither post-biopsy bleeding nor infections occurred. Conclusions New TPUS-guided biopsy technique may contribute to detecting large PI-RADS 5 prostate cancer in men after Miles’ operation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles’ operation

et al. 2023

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“…Central sampling was followed by peripheral sampling for target biopsies. Accordingly, number 1–3 target cores indicated central sampling, and number 4–6 target cores indicated peripheral sampling ( 24 ). Two radiologists used one of three US scanners including EPIC (Philips Health Care, Bothell, WA, USA), IU22 (Philips Health Care), or Aplio 500 (Toshiba Medical System, Japan).…”

Section: Methodsmentioning

confidence: 99%

TRUS-Guided Target Biopsy for a PI-RADS 3–5 Index Lesion to Reduce Gleason Score Underestimation: A Propensity Score Matching Analysis

et al. 2022

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BackgroundMagnetic resonance imaging (MRI) and transrectal ultrasound (TRUS)-guided cognitive or image fusion biopsy is performed to target a prostate imaging reporting and data system (PI-RADS) 3–5 lesion. Biopsy Gleason score (GS) is frequently underestimated compared to prostatectomy GS. However, it is still unclear about how many cores on target are necessary to reduce undergrading and if additional cores around the target may improve grade prediction on surgical specimen.PurposeTo determine the number of target cores and targeting strategy to reduce GS underestimation.Materials and MethodsBetween May 2017 and April 2020, a total of 385 patients undergoing target cognitive or image fusion biopsy of PI-RADS 3–5 index lesions and radical prostatectomies (RP) were 2:1 matched with propensity score using multiple variables and divided into the 1–4 core (n = 242) and 5–6 core (n = 143) groups, which were obtained with multiple logistic regression with restricted cubic spline curve. Target cores of 1–3 and 4–6 were sampled from central and peripheral areas, respectively. Pathologic outcomes and target cores were retrospectively assessed to analyze the GS difference or changes between biopsy and RP with Wilcoxon signed-rank test.ResultsThe median of target cores was 3 and 6 in the 1–4 core and 5–6 core groups, respectively (p < 0.001). Restricted cubic spline curve showed that GS upgrade was significantly reduced from the 5th core and there was no difference between 5th and 6th cores. Among the matched patients, 35.4% (136/385; 95% confidence interval, 0.305–0.403) had a GS upgrade after RP. The GS upgrades in the 1–4 core and 5–6 core groups were observed in 40.6% (98/242, 0.343–0.470) and 26.6% (38/143, 0.195–0.346), respectively (p = 0.023). Although there was no statistical difference between the matched groups in terms of RP GS (p = 0.092), the 5–6 core group had significantly higher biopsy GS (p = 0.006) and lower GS change from biopsy to RP (p = 0.027).ConclusionFive or more target cores sampling from both periphery and center of an index tumor contribute to reduce GS upgrade.

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“…However, the imprecise localization of cancer focus by systematic biopsy has caused the overdiagnosis of clinically unimportant diseases and the underdiagnosis of clinically significant cancer [2]. Although invasive multiparametric magnetic resonance imaging-ultrasound (mpMRI-US) fusion biopsy has been demonstrated to improve the detection of clinically significant PCa (csPCa) and is more frequently used in clinical practice [3], the biopsy is associated with numerous complications, including bleeding, infection, and lower urinary tract symptoms [4]. Therefore, the reduction of prostate biopsy is crucial in males with low-grade or no PCa.…”

Section: Introductionmentioning

confidence: 99%

Developing a predictive model for clinically significant prostate cancer by combining age, PSA density, and mpMRI

Ma¹,

Wang

Zhang

et al. 2023

World J Surg Onc

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Purpose The study aimed to construct a predictive model for clinically significant prostate cancer (csPCa) and investigate its clinical efficacy to reduce unnecessary prostate biopsies. Methods A total of 847 patients from institute 1 were included in cohort 1 for model development. Cohort 2 included a total of 208 patients from institute 2 for external validation of the model. The data obtained were used for retrospective analysis. The results of magnetic resonance imaging were obtained using Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1). Univariate and multivariate analyses were performed to determine significant predictors of csPCa. The diagnostic performances were compared using the receiver operating characteristic (ROC) curve and decision curve analyses. Results Age, prostate-specific antigen density (PSAD), and PI-RADS v2.1 scores were used as predictors of the model. In the development cohort, the areas under the ROC curve (AUC) for csPCa about age, PSAD, PI-RADS v2.1 scores, and the model were 0.675, 0.823, 0.875, and 0.938, respectively. In the external validation cohort, the AUC values predicted by the four were 0.619, 0.811, 0.863, and 0.914, respectively. Decision curve analysis revealed that the clear net benefit of the model was higher than PI-RADS v2.1 scores and PSAD. The model significantly reduced unnecessary prostate biopsies within the risk threshold of > 10%. Conclusions In both internal and external validation, the model constructed by combining age, PSAD, and PI-RADS v2.1 scores exhibited excellent clinical efficacy and can be utilized to reduce unnecessary prostate biopsies.

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How to Improve TRUS-Guided Target Biopsy following Prostate MRI

Cited by 6 publications

References 65 publications

New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles’ operation

New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles’ operation

TRUS-Guided Target Biopsy for a PI-RADS 3–5 Index Lesion to Reduce Gleason Score Underestimation: A Propensity Score Matching Analysis

Developing a predictive model for clinically significant prostate cancer by combining age, PSA density, and mpMRI

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