Not All Multiparametric Magnetic Resonance Imaging–targeted Biopsies Are Equal: The Impact of the Type of Approach and Operator Expertise on the Detection of Clinically Significant Prostate Cancer

Stabile, Armando; Dell’Oglio, Paolo; Gandaglia, Giorgio; Fossati, Nicola; Brembilla, Giorgio; Cristel, Giulia; Dehò, Federico; Scattoni, Vincenzo; Maga, Tommaso; Losa, A.; Gaboardi, Franco; Cardone, Gianpiero; Esposito, Antonio; Cobelli, Francesco De; Maschio, Alessandro Del; Montorsi, Francesco; Briganti, Alberto

doi:10.1016/j.euo.2018.02.002

Cited by 60 publications

(40 citation statements)

References 28 publications

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“…However, at the time of inclusion of patients, equipment for software-assisted fusion or in-bore biopsy was not available at our facility, which prompted the application of MRI-directed cognitive registration. This method has been reported to yield lower detection rates of PCa compared to the other MRI-targeted techniques (32,33). However, we expect that such biopsies would most likely correlate even better with our uPAR-PET imaging biopsies.…”

Section: Discussionmentioning

confidence: 65%

Urokinase-Type Plasminogen Activator Receptor (uPAR) PET/MRI of Prostate Cancer for Noninvasive Evaluation of Aggressiveness: Comparison with Gleason Score in a Prospective Phase 2 Clinical Trial

et al. 2020

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The aim of this study was to evaluate the correlation between uptake of the positron emission tomography (PET) ligand 68 Ga-NOTA-AE105 targeting the urokinase-type plasminogen activator receptor (uPAR) and Gleason score in patients undergoing prostate biopsy. Materials & methods: Patients with clinical suspicion of prostate cancer (PCa) or previously diagnosed with PCa were prospectively enrolled in this phase II trial. A combined uPAR PET, multiparametric magnetic resonance imaging (mpMRI) was performed and standardized uptake value (SUV) from primary tumor, as delineated by mpMRI, was measured by two independent readers. Correlation between SUV and Gleason score obtained by biopsy was assessed. Results: A total of 27 patients had histologically verified PCa visible on mpMRI and constituted the study population. There was a positive correlation between SUV max and Gleason score (Spearman's rho= 0.55; p=0.003). Receiver operating characteristics analysis showed an area under the curve (AUC) of 0.88 (95%CI: 0.67-1.00) in discriminating Gleason score ≥3+4 from ≤3+3. A cutoff for tumor SUVmax could be established with a sensitivity of 96% (79-99%) and specificity of 75% (30-95%) in detecting Gleason Scores ≥3+4. For discriminating Gleason score ≥ 4+3 vs. ≤ 3+4, a cutoff could be established for detecting Gleason score ≥ 4+3 with a sensitivity of 93% (69-99%) and specificity of 62% (36-82%). Conclusion: SUV measurements from uPAR PET in primary tumors as delineated by mpMRI showed a significant correlation with Gleason score, and tumor SUV max was able to discriminate between low-risk and intermediate risk Gleason score profiles with high diagnostic accuracy. Consequently, uPAR PET/MRI could be a promising method for non-invasive evaluation of PCa, which may in the future potentially reduce the need for repeated biopsies, e.g. in active surveillance.

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Section: Discussionmentioning

confidence: 65%

Urokinase-Type Plasminogen Activator Receptor (uPAR) PET/MRI of Prostate Cancer for Noninvasive Evaluation of Aggressiveness: Comparison with Gleason Score in a Prospective Phase 2 Clinical Trial

et al. 2020

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“…These results further suggest that the yield of mpMRI for detection of higher-grade PCa would not only be contingent upon the experience of the operators performing the targeted biopsy, but also upon the biopsy approach (i.e. transrectal vs transperineal) used for targeting a mpMRI positive lesion [33], this is especially important in African-American men who tend to have a higher prevalence of GG ≥ 2 foci in the anterior transition zone [34].…”

Section: Discussionmentioning

confidence: 96%

Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

et al. 2020

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ObjectiveTo assess if the adoption of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) has improved the identification of occult higher-grade prostate cancer (PCa). Patients and MethodsWe retrospectively identified men from the Johns Hopkins AS registry enrolled since 2013 (year of mpMRI adoption) with Grade Group (GG) 1 PCa and who underwent a single mpMRI. Men in this group were dichotomised by the presence (n = 207) or absence (negative mpMRI, n = 225) of one or more lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of ≥ 3. Both groups were compared to a third cohort of men with GG1 PCa enrolled in AS prior to 2013 (pre-mpMRI era, n = 669). The risk of upgrading to GG ≥ 2 PCa on follow-up biopsies (performed with or without MRI targeting) was evaluated among the groups using survival analysis. ResultsMen in both mpMRI groups underwent a median (interquartile range [IQR]) of 2 (2-3) biopsies separated by a median (IQR) interval of 13 (12-16) months, whereas men in the pre-MRI era underwent a median (IQR) of 3 (2-5) biopsies, separated by a median (IQR) interval of 12 (12-14) months. The 2-and 4-year upgrade-free survival rates were 93% and 83%, 74% and 59%; and, 87% and 76% for the negative mpMRI, PI-RADS ≥ 3, and pre-mpMRI-era groups, respectively (P < 0.001). On multivariable analysis, both mpMRI groups had significantly different risk of upgrading compared to pre-mpMRI-era group (negative mpMRI group: hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39-0.95, P = 0.03; PI-RADS ≥ 3 group: HR 1.96, 95% CI 1.36-2.82, P < 0.001). ConclusionsmpMRI improves the risk stratification of men on AS and should be used to aid enrolment and monitoring decisions.

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“…Be the reason as it may, others have also found that TP-fusion have a better detection rate than TR-fusion. Stabile et al [ 22 ] in a multivariable-logistic-regression model predicting csPCa among 157 patients undergoing fusion biopsies found that TP-fusion was four times more likely to detect csPCa even controlling for PSA, prostate volume, and PI-RADS.…”

Section: Discussionmentioning

confidence: 99%

A noninferiority within-person study comparing the accuracy of transperineal to transrectal MRI–US fusion biopsy for prostate-cancer detection

Ber

Segal

Tamir

et al. 2020

Prostate Cancer Prostatic Dis

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Background Magnetic resonance imaging (MRI) and ultrasound (US) fusion prostate-biopsies can be performed in a transrectal (TR-fusion) or transperineal (TP-fusion) approach. Prospective comparative evidence is limited. In this study we compared the detection rate of clinically-significant prostate-cancer (csPCa) within an index lesion between TR and TP-fusion. Patients and methods This was a prospective, noninferiority, and within-person trial. Men scheduled for MRI-US-fusion with a discrete MRI PI-RRAD ≥ 3 lesion were included. A dominant index lesion was determined for each subject and sampled by TR and TP-fusion during the same session. The order of biopsies was randomized and equipment was reset to avoid chronological and incorporation bias. For each subject, the index lesion was sampled 4-6 times in each approach. All biopsies were performed using Navigo fusion software (UC-Care, Yokneam, Israel). csPCa was defined as: Grade Group ≥ 2 or cancer-core length ≥ 6 mm. We used a noninferiority margin of 10% and a one-sided alpha level of 5%. Results Seventy-seven patients completed the protocol. Median age was 68.2 years (IQR:64.2-72.2), median PSA was 8.9 ng/ml (IQR:6.18-12.2). Ten patients (13%) were biopsy naive, others (87%) had a previous biopsy. csPCa was detected in 32 patients (42%). All of these cases were detected by TP-fusion, while only 20 (26%) by TR-fusion. Absolute difference for csPCa diagnosis was 15.6 (CI 90% 27.9-3.2%) in favor of TP-fusion (p = 0.029). TP-fusion was noninferior to TR-fusion. The lower boundary of the 90% confidence-interval between TP-fusion and TR-fusion was greater than zero, therefore TPfusion was also found to be superior. Exploratory subgroup analyses showed TP-fusion was consistently associated with higher detection rates of csPCa compared with TR-fusion in patient and index-lesion derived subgroups (size, location, PI-RADS, PSA, and biopsy history). Conclusions In this study, TP-fusion biopsies were found to be noninferior and superior to TR-fusion biopsies in detecting csPCa within MRI-visible index lesion. Centers experienced in both TP and TR-fusion should consider these results when choosing biopsy method.

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Not All Multiparametric Magnetic Resonance Imaging–targeted Biopsies Are Equal: The Impact of the Type of Approach and Operator Expertise on the Detection of Clinically Significant Prostate Cancer

Cited by 60 publications

References 28 publications

Urokinase-Type Plasminogen Activator Receptor (uPAR) PET/MRI of Prostate Cancer for Noninvasive Evaluation of Aggressiveness: Comparison with Gleason Score in a Prospective Phase 2 Clinical Trial

Urokinase-Type Plasminogen Activator Receptor (uPAR) PET/MRI of Prostate Cancer for Noninvasive Evaluation of Aggressiveness: Comparison with Gleason Score in a Prospective Phase 2 Clinical Trial

Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

A noninferiority within-person study comparing the accuracy of transperineal to transrectal MRI–US fusion biopsy for prostate-cancer detection

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