The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance

Ayres, B.; Montgomery, Βruce; Barber, Neil; Pereira, N.; Langley, Stephen; Denham, Philippa; Bott, Simon

doi:10.1111/j.1464-410x.2011.10480.x

Cited by 69 publications

(72 citation statements)

References 43 publications

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“…About half of the patients' tumors were localized in the anterior lob. [17,18] MR image assisted transperineal biopsy is not superior to ultrasound assisted biopsy in patients whose tumors are low grade and volume similar to AS patients. [19] But MR image assisted and 3D mapping method has shown that 25% of AS patients have GS ≥7 tumor and 61% of them are bilateral.…”

Section: Discussionmentioning

confidence: 99%

The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey

Bayar

Horasanlı

Acinikli

et al. 2016

Turkish Journal of Urology

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Objective: To evaluate long-term outcomes of active surveillance (AS) applied in low-risk prostate cancer patients, and the impact of re-biopsy results on the prediction of progression. Material and methods:In our clinic, patients who had undergone AS for low-risk localized prostate cancer between the years 2005-2013 were included in the study. Our AS criteria are Gleason score ≤6, prostate-specific antigen (PSA) level <10 ng/mL, number of positive cores <3, maximum cancer involvement ratio <50% each core. Immediate re-biopsy (within 3 months) was performed to 65 patients who accepted AS. Finally, 43 patients who met re-biopsy criteria were included in the study. Prostate biopsy specimens were harvested from 12 cores under the guidance of transrectal ultrasound (TRUS). Re-biopsy was performed within 3 months (1-12 weeks). In rebiopsy, a total of 20 core biopsies were performed including the far lateral (6 cores) and transition zone (2 cores) in addition to standard 12 core biopsy. Our follow-up protocol is PSA measurement and digital rectal examination (DRE) every 3 months within the first 2 years, than every 6 months. Control biopsies was performed one year later and once upon every 3 years to patients whose PSA levels and DREs were normal at follow-up visits. More than 2 tumor invaded cores or 50% tumor in one core, and Gleason score exceeding 6 points were accepted as indications for definitive treatment. Patients were divided into two groups by re-biopsy results and compared according to the time to progression. We have done multivariate regression analysis to predict prognosis by using data on age, PSA level, and detection of tumor in re-biopsy specimens.Results: Patients' median age was 61 years and PSA level was 5 (2.7-9) ng/mL. Tumor was detected in 22 (34%) patients at re-biopsy and they underwent definitive treatment. Additionally tumor was detected in 9 patients, but active surveillance was maintained because their pathologic results met active surveillance criteria. Median follow time was 42 (24-117) months. Definitive treatment was performed in 9 (21%) patients. PSA recurrence was not detected in none of 9 patients during 38 months of follow up. Only the presence of tumor in re-biopsy specimens was found predictor of disease progression in multivariate analysis. Conclusion:We think that AS is safe method for low-risk localized prostate cancer patients, if it is performed in compliance with certain criteria and regular follow up, and early re-biopsy can be useful either during early period or long term follow-up.

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Section: Discussionmentioning

confidence: 99%

The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey

Bayar

Horasanlı

Acinikli

et al. 2016

Turkish Journal of Urology

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“…TPSB is reported to more accurately detect and characterise the extent and grade of PCa [16,19]. We, therefore, decided to offer this as an option to those considering AS after conventional TRUS biopsy.…”

Section: Discussionmentioning

confidence: 99%

Active Surveillance Following Modified Transperineal Template Guided Saturation Biopsy Demonstrates a Low Rate of Progression and Conversion to Radical Treatment, with Age and PSA Associated with Upgrading, Upstaging and Treatment

Sarkar¹,

Ekwueme²,

Parr³

2017

Adv Cancer Prev

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Objectives: To evaluate outcomes in patients embarking upon active surveillance for Prostate cancer (Pca) following tumour characterisation by modified transperineal template guided saturation biopsy. Materials and Methods:Of 500 patients with initial negative conventional transrectal ultrasound guided prostate biopsy underwent transperineal template guided saturation biopsy, detected cancer in 276 (55%). Of these, 30 (11%) elected for active surveillance. Another 158 patients considering active surveillance after initial positive transrectal ultrasound guided biopsy underwent confirmatory transperineal template guided saturation biopsy, with 43 (27%) subsequently electing for active surveillance. A total of 73 patients from these two groups (median age 63 years) were, thus, enrolled for active surveillance. Follow up consisted of 3 monthly PSA and DRE, offering repeat Multi-parametric MRI and repeat transperineal template Guided Saturation Biopsy, at 24 months, or on suspicion of progression.Results: At a median follow up of 58 months, 59 patients have undergone repeat Multi-parametric MRI. Radiological progression was identified in 6 (8%), Gleason upgrading on repeat transperineal template guided saturation biopsy, in 14 (19%). Six (8%) have undergone radical treatments. Age >60 yrs and PSA >5 ng/mL were associated with upgrading and upstaging (p<0.05). Conclusion:A large proportion of patients initially considering active surveillance dropped out following confirmatory transperineal template Guided saturation biopsy, however, in those electing for active surveillance after transperineal template guided saturation biopsy, progression rates are low and related to age and presenting PSA.

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“…yaptıkları çalışmada 301 hastanın biyopsi ve RP sonuçlarını karşılaştırmış ve GS artış oranı 18 ve üzeri kor biyopsi alınan olgularda %23.5, 10-12 kor biyopsi alınanlarda ise %47.9 olarak rapor edilmiştir (39). Transrektal yöntem ile Aİ'e dahil edilme kriterlerine uygun bulunan 101 olgunun, transperineal yolla yapılan tekrar evrelendirilmesinde olguların %34'de anlam Pca olduğu, diğer bir ifade ile transrektal yolun bazı hastalarda düşük evrelemeye eden olduğu gösterilmiştir (40).…”

Section: Biyopsisi Gs=6 Olan Bir Olgunun Rp Gs'u Benign Idi (Toplam;unclassified

Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması

Şahinkanat¹,

Küçükdurmaz²,

Efe³

et al. 2017

Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi

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Amaç: Prostat biyopsisi ile elde edilen Gleason skoru (GS), lokalize prostat kanseri olgularının tedavi kararında önem taşıdığı için radikal prostatektominin (RP) GS ile uyumu oldukça önemlidir. Ancak literatürde bu uyum % 24-50 arasında bildirilmektedir. Çalışmamızda kliniğimizde yapılan prostat biyopsileri ile RP sonrası elde edilen patolojik bulguların uyumu değerlendirilmiştir.Gereç ve Yöntemler: KSÜ Tıp Fakültesi Üroloji Kliniği'nde standart 12 kor transrektal biyopsi ile prostat kanseri tanısı konan ve sonraki sekiz haftada RP yapılan 24 hastanın patoloji sonuçları retrospektif olarak değerlendirildi. Biyopsilerde GS, kanserli kor sayısı, kanserli korlardaki kanser yüzdesi değerlendirildi. Ayrıca yaş, prostat hacmi, PSA değerlerinin biyopsi ve RP GS'ları arasındaki uyuma etkisi araştırıldı. GS artışı ya da azalışı bir prognostik gruptan diğerine geçiş olarak tanımlandı. Prognostik gruplar GS 6; 7 ve 8≤ olarak kategorize edildi.Bulgular: Hastaların ortanca yaşı 68 (58-79) yıl, ortanca PSA değeri 9,65 ng/ml (4.2-149) ve prostat hacmi 46.5 ml (27-70) idi. Tüm hastalar değerlendirildiğinde yalnızca bir olguda (%4.2) GS düşüşü saptandı. Biyopsisinde GS=6 olan olguların % 43.5' inde (n:7/16) RP GS'unda artış saptanırken, GS=7 olan 7 hastanın ise sadece birinde GS artışı izlendi. GS=8 olan bir hastanın RP GS, biyopsi GS'u ile aynıy-dı. Prostat biyopsi ve patolojik GS arasındaki genel uyum % 62,5 ve kappa değeri 0,31 (p:0,025) idi. GS artışı ile ileri yaş arasında k: 0.47 (p=0.01), PSA> 9 olan 14 vaka için k: 0.50 (p=0.021) ve prostat hacmi ≥30 cc olan olgularda k: 0.42 (p=0.014) olarak bulundu.Sonuç: Çalışmamızda iğne biyopsi GS ile RP GS arasındaki uyum oranı literatürle uyumlu bulunmakla birlikte, verilerimiz biyopsi ile daha doğru derecelendirme için yeni teknik yaklaşımlara yönelmemiz gerektiğini düşündürtmektedir.Anahtar Kelimeler: Biyopsi, prostat kanseri, Gleason skoru, radikal prostatektomi AbstractObjective: Prostate biopsy Gleason score is important for treatment planning in patients with localized prostate cancer. Therefore, concordance between biopsy and radical prostatectomy (RP) pathologies is critically important. However, discordance rates between those two was reported as 24-50% in the literature. Aim of present study is to evaluate concordance rates between biopsy and RP results.Material and Methods: A retrospective review of 24 patients, who underwent prostate biopsy (standart 12 cores) due to elevated PSA or abnormal digital rectal examination and diagnosed with localised prostate cancer was performed. All patients underwent radical prostatectomy within 8 weeks after biopsy. Associations between preoperative clinical factors and Gleason score upgrading were analyzed. Those factors include Gleason scores, percentage of positive cores, age, prostate volume and PSA value. Gleason upgrading or downgrading was defined as an increase or decrease from one prognostic group to another. Prognostic groups were categorised as GS 6; 7 and 8≤.Results: Median age of patients was68 (58-79) years and median PS...

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The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance

Cited by 69 publications

References 43 publications

The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey

The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey

Active Surveillance Following Modified Transperineal Template Guided Saturation Biopsy Demonstrates a Low Rate of Progression and Conversion to Radical Treatment, with Age and PSA Associated with Upgrading, Upstaging and Treatment

Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması

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