Why and Where do We Miss Significant Prostate Cancer with Multi-parametric Magnetic Resonance Imaging followed by Magnetic Resonance-guided and Transrectal Ultrasound-guided Biopsy in Biopsy-naïve Men?

Schouten, Martijn; Leest, Marloes van der; Pokorny, Morgan; Hoogenboom, Martijn; Barentsz, Jelle O.; Thompson, Les; Fütterer, Jurgen J.

doi:10.1016/j.eururo.2016.12.006

Cited by 122 publications

(81 citation statements)

References 27 publications

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“…A recently published study of Schouten et al [31] reports high rates of missed PCa lesions in biopsy-naïve men by SB especially involving segments located anteriorly. The study also concludes to obtain additional samples from the anterior apex and anterior midgland during SB as a consequence of their findings.…”

Section: Discussionmentioning

confidence: 99%

Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies

et al. 2019

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Introduction: Patients with consistent suspicion for prostate cancer (PCa) and multiple negative prebiopsies prior to multiparametric magnetic resonance imaging (mpMRI) are still frequently evaluated for an image-guided biopsy and are reported with heterogeneous detection rates. The inclusion of a systematic biopsy (SB) is also still recommended with predominant sampling within the posterior/peripheral zone of the prostate. The aim of this study was (I) to evaluate PCa detection rates using a modified 10 core SB template includ-ing anterior biopsies in combination with mpMRI/ultrasound fusion-guided targeted biopsy (TB) in patients with 3 or more negative prebiopsies and (II) to compare mpMRI index lesion localization with histologically confirmed localization from associated prostatectomy samples. Methods: Overall 1,337 consecutive patients underwent sensor-based registration TB of the prostate and a subsequent 10-core SB between January 2012 and December 2015 at our institution. For this study, 101 patients with ≥3 negative prebiopsies and prostate imaging -reporting data system lesions ≥3 were pooled prospectively and underwent TB and a modified SB including 2 ventral (anterior) biopsies. Detection rates were estimated for the modified SB, TB, and its combi-A.M. and A.M.N. contributed equally to this work. Maxeiner et al.nation. A subgroup analysis of 35 patients undergoing prostatectomy was performed by a head-to-head comparison of mpMRI index lesion and histologically confirmed PCa index lesion localization. Results: The overall detection rate for PCa was 54.5%. The combination of TB and SB detected 14 (25.4%) more cases missed by TB alone (p < 0.001) and 7 (12.7%) more cases missed by SB alone (p = 0.016), respectively. A postoperative Gleason upgrade was seen in 12/35 (34.3%) cases within the TB group and in 14/35 (40.0%) in the SB group, respectively. The subgroup analysis showed a predominant location of PCa index lesions anteriorly at the level of the midgland. The MRI detection rate of the anteriorly located index lesions was 70.4% (15/21 cases) with a clinically significant Gleason score (≥3 + 4 = 7a [International Society of Urological Pathology grade 2]) in 80.9%. Interestingly a modified SB template detected 90.5% (19/21) of the anteriorly located index lesions. Conclusion: Our data suggest that in patients with multiple prebiopsies PCa seems to be predominantly located anteriorly. We suggest the general integration of anterior biopsies despite TB in repeat biopsy patients.

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Section: Discussionmentioning

confidence: 99%

Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies

et al. 2019

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“…Furthermore, it is challenging to delineate central gland tumors in the presence of benign prostatic hyperplasia because of its associated mixed pattern of tumor echogenicity [14]. Moreover, the nature of transrectal ultrasound means that it is challenging to identify anterior tumors [15]. These issues are further compounded by the multifocal nature of prostate cancer which requires extensive evaluation to accurately characterise the disease state [1617].…”

Section: Facilitating Targeted Biopsymentioning

confidence: 99%

“…A recent analysis of 223 biopsy-naïve men reviewed cases where mpMRI results were discordant with systematic biopsy to potentially identify scenarios in which mpMRI may not be accurate [15]. In this cohort, mpMRI missed 26% of clinically significant cancers.…”

Section: Shortcomings Of Multiparametric Magnetic Resonance Imaging Imentioning

confidence: 99%

The Use of Magnetic Resonance Imaging in the Prostate Cancer Primary Diagnostic Pathway: Is It Ready for Primetime?

Sathianathen

Warlick

2018

World J Mens Health

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Multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized in the prostate cancer diagnostic landscape over the last five years. The majority of the literature has focused on its use in men with a previous negative biopsy. However, over time, clinicians have begun using mpMRI in the work-up of men being considered for primary biopsy and subsequently data characterizing its diagnostic performance in this setting is emerging. This review comprehensively assesses the utility of mpMRI in the primary biopsy setting.

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“…Additionally, TRUS‐guided biopsies of central gland lesions with malignant potential can produce false‐negative findings . A reliable and noninvasive imaging technique could increase the sensitivity and specificity for identification of central gland lesions missed by PI‐RADS V2 or biopsies . MR spectroscopic imaging ( 1 H MRSI) provides metabolic information in the form of spectra, which are associated with the presence and aggressiveness of primary and recurrent PCa .…”

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confidence: 99%

“…7 A reliable and noninvasive imaging technique could increase the sensitivity and specificity for identification of central gland lesions missed by PI-RADS V2 or biopsies. 8 MR spectroscopic imaging ( 1 H MRSI) provides metabolic information in the form of spectra, which are associated with the presence and aggressiveness of primary and recurrent PCa. [9][10][11] The predominant prostate metabolites detected by 1 H MRSI are citrate (Cit), choline (Cho), creatine (Cr), and polyamines, mostly spermine (Spm).…”

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confidence: 99%

Supervised risk predictor of central gland lesions in prostate cancer using ¹H MR spectroscopic imaging with gradient offset‐independent adiabaticity pulses

Gholizadeh

Greer

Simpson

et al. 2019

Magnetic Resonance Imaging

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Background Due to the histological heterogeneity of the central gland, accurate detection of central gland prostate cancer remains a challenge. Purpose To evaluate the efficacy of in vivo 3D 1H MR spectroscopic imaging (3D 1H MRSI) with a semi‐localized adiabatic selective refocusing (sLASER) sequence and gradient‐modulated offset‐independent adiabatic (GOIA) pulses for detection of central gland prostate cancer. Additionally four risk models were developed to differentiate 1) normal vs. cancer, 2) low‐ vs. high‐risk cancer, 3) low‐ vs. intermediate‐risk cancer, and 4) intermediate‐ vs. high‐risk cancer voxels. Study Type Prospective. Subjects Thirty‐six patients with biopsy‐proven central gland prostate cancer. Field Strength/Sequence 3T MRI / 3D 1H MRSI using GOIA‐sLASER. Assessment Cancer and normal regions of interest (ROIs) were selected by an experienced radiologist and 1H MRSI voxels were placed within the ROIs to calculate seven metabolite signal ratios. Voxels were split into two subsets, 80% for model training and 20% for testing. Statistical Tests Four support vector machine (SVM) models were built using the training dataset. The accuracy, sensitivity, and specificity for each model were calculated for the testing dataset. Results High‐quality MR spectra were obtained for the whole central gland of the prostate. The normal vs. cancer diagnostic model achieved the highest predictive performance with an accuracy, sensitivity, and specificity of 96.2%, 95.8%, and 93.1%, respectively. The accuracy, sensitivity, and specificity of the low‐ vs. high‐risk cancer and low‐ vs. intermediate‐risk cancer models were 82.5%, 89.2%, 70.2%, and 73.0%, 84.7%, 60.8%, respectively. The intermediate‐ vs. high‐risk cancer model yielded an accuracy, sensitivity, and specificity lower than 55%. Data Conclusion The GOIA‐sLASER sequence with an external phased‐array coil allows for fast assessment of central gland prostate cancer. The classification offers a promising diagnostic tool for discriminating normal vs. cancer, low‐ vs. high‐risk cancer, and low‐ vs. intermediate‐risk cancer. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1926–1936.

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Why and Where do We Miss Significant Prostate Cancer with Multi-parametric Magnetic Resonance Imaging followed by Magnetic Resonance-guided and Transrectal Ultrasound-guided Biopsy in Biopsy-naïve Men?

Cited by 122 publications

References 27 publications

Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies

Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies

The Use of Magnetic Resonance Imaging in the Prostate Cancer Primary Diagnostic Pathway: Is It Ready for Primetime?

Supervised risk predictor of central gland lesions in prostate cancer using ¹H MR spectroscopic imaging with gradient offset‐independent adiabaticity pulses

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Why and Where do We Miss Significant Prostate Cancer with Multi-parametric Magnetic Resonance Imaging followed by Magnetic Resonance-guided and Transrectal Ultrasound-guided Biopsy in Biopsy-naïve Men?

Cited by 122 publications

References 27 publications

Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies

Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies

The Use of Magnetic Resonance Imaging in the Prostate Cancer Primary Diagnostic Pathway: Is It Ready for Primetime?

Supervised risk predictor of central gland lesions in prostate cancer using 1H MR spectroscopic imaging with gradient offset‐independent adiabaticity pulses

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Supervised risk predictor of central gland lesions in prostate cancer using ¹H MR spectroscopic imaging with gradient offset‐independent adiabaticity pulses