The urologist’s learning curve of “in-bore” magnetic resonance-guided prostate biopsy

Abstract Background The combination of multi-parametric MRI to locate and define suspected lesions together with their being targeted by an MRI-guided prostate biopsy has succeeded in increasing the detection rate of clinically significant disease and lowering the detection rate of non-significant prostate cancer. In this work we investigate the urologist’s learning curve of in-bore MRI-guided prostate biopsy which is considered to be a superior biopsy technique. Materials and methods Following Helsinki approval by The Chaim Sheba Medical Center ethics committee in accordance with The Sheba Medical Center institutional guidelines (5366-28-SMC) we retrospectively reviewed 110 IB-MRGpBs performed from 6/2016 to 1/2019 in a single tertiary center. All patients had a prostate multi-parametric MRI finding of at least 1 target lesion (prostate imaging reporting and data system [PI-RADS] score ≥ 3). We analyzed biopsy duration and clinically significant prostate cancer detection of targeted sampling in 2 groups of 55 patients each, once by a urologist highly trained in IB-MRGpBs and again by a urologist untrained in IB-MRGpBs. These two parameters were compared according to operating urologist and chronologic order. Results The patients’ median age was 68 years (interquartile range 62–72). The mean prostate-specific antigen level and prostate size were 8.6 ± 9.1 ng/d and 53 ± 27 cc, respectively. The mean number of target lesions was 1.47 ± 0.6. Baseline parameters did not differ significantly between the 2 urologists’ cohorts. Overall detection rates of clinically significant prostate cancer were 19%, 55%, and 69% for PI-RADS 3, 4 and 5, respectively. Clinically significant cancer detection rates did not differ significantly along the timeline or between the 2 urologists. The average duration of IB-MRGpB targeted sampling was 28 ± 15.8 min, correlating with the number of target lesions (p < 0.0001), and independent of the urologist’s expertise. Eighteen cases defined the cutoff for the procedure duration learning curve (p < 0.05). Conclusions Our data suggest a very short learning curve for IB-MRGpB-targeted sampling duration, and that clinically significant cancer detection rates are not influenced by the learning curve of this technique.

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Clinical outcomes after transperineal template-guided prostate biopsy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.156 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 156-156

Author(s):

Richard A. Hsi ◽

Randall James Moeller ◽

Marc Mitchell ◽

Scott Bildsten ◽

Paul Kozlowski ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Outcomes ◽

Cancer Detection ◽

Prostate Biopsy ◽

Entire Group ◽

Detection Rates ◽

Positive Biopsy ◽

Pathologic Features ◽

The Mean ◽

Clinically Significant

156 Background: To assess clinical outcomes after transperineal template-guided prostate biopsy (TTPB) including detection rates, pathologic features, clinical relevance and morbidity. Methods: Forty eight men underwent TTPB. All patients had at least one (range 1–4) prior negative transrectal ultrasound-guided (TRUS) prostate biopsy and no prostate cancer diagnosis. The mean pre-biopsy PSA of the entire group was 13.1 ng/ml (range 4.5–46.4). The mean number of cores sampled was 24.7 (range 22–28). Results: The rate of prostate cancer detection was 52% (25/48). Clinically significant prostate cancer, defined as intermediate (n=9) and high (n=11) risk disease using D’Amico criteria, was found in 80% (20/25) of positive biopsy cases. Seventy-two percent of all positive biopsy cores were anatomically located in the anterior or anterolateral positions within the prostate. Urinary retention requiring catheterization after the procedure developed in 6% (3/48) of patients. No patients developed rectal or infectious complications after TTPB. Conclusions: TTPB is a well tolerated procedure resulting in a significant rate of cancer detection. Biopsies were frequently found to be positive in the anterior half of the prostate. Clinically significant disease was found in a high percentage of patients.

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Cancer Detection Rates of Systematic and Targeted Prostate Biopsies after Biparametric MRI

Prostate Cancer ◽

10.1155/2020/4626781 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Maudy C. W. Gayet ◽

Anouk A. M. A. van der Aa ◽

Harrie P. Beerlage ◽

Bart Ph Schrier ◽

Maaike Gielens ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rates ◽

Prostate Biopsies ◽

Significant Difference ◽

Significant Pathology ◽

Study Population ◽

Clinically Significant ◽

Control Study

Objective. To compare prostate cancer detection rates (CDRs) and pathology results with targeted prostate biopsy (TB) and systematic prostate biopsy (SB) in biopsy-naive men. Methods. An in-patient control study of 82 men undergoing SB and subsequent TB in case of positive prostate MRI between 2015 and 2017 in the Jeroen Bosch Hospital, the Netherlands. Results. Prostate cancer (PCa) was detected in 54.9% with 70.7% agreement between TB and SB. Significant PCa (Gleason score ≥7) was detected in 24.4%. The CDR with TB and SB was 35.4% and 48.8%, respectively (p=0.052). The CDR of significant prostate cancer with TB and SB was both 20.7%. Clinically significant pathology upgrading occurred in 7.3% by adding TB to SB and 22.0% by adding SB to TB. Conclusions. There is no statistically significant difference between CDRs of SB and TB. Both SB and TB miss significant PCas. Moreover, pathology upgrading occurred more often by adding SB to TB than vice versa. This indicates that the omission of SB in this study population might not be justified.

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3D versus 2D Systematic Transrectal Ultrasound-Guided Prostate Biopsy: Higher Cancer Detection Rate in Clinical Practice

Prostate Cancer ◽

10.1155/2013/783243 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Alexandre Peltier ◽

Fouad Aoun ◽

Fouad El-Khoury ◽

Eric Hawaux ◽

Ksenija Limani ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Transrectal Ultrasound ◽

Daily Practice ◽

Cancer Detection Rate ◽

Prior History ◽

Detection Rates ◽

Significant Difference

Objectives. To compare prostate cancer detection rates of extended 2D versus 3D biopsies and to further assess the clinical impact of this method in day-to-day practice.Methods. We analyzed the data of a cohort of 220 consecutive patients with no prior history of prostate cancer who underwent an initial prostate biopsy in daily practice due to an abnormal PSA and/or DRE using, respectively, the classical 2D and the new 3D systems. All the biopsies were done by a single experienced operator using the same standardized protocol.Results. There was no significant difference in terms of age, total PSA, or prostate volume between the two groups. However, cancer detection rate was significantly higher using the 3D versus the 2D system, 50% versus 34% (P<0.05). There was no statistically significant difference while comparing the 2 groups in term of nonsignificant cancer detection.Conclusion. There is reasonable evidence demonstrating the superiority of the 3D-guided biopsies in detecting prostate cancers that would have been missed using the 2D extended protocol.

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Magnetic resonance/ultrasound fusion targeted biopsy of the prostate can be improved by adding systematic biopsy

Medical Ultrasonography ◽

10.11152/mu-2932 ◽

2021 ◽

Author(s):

Victor Mihail Cauni ◽

Dan Stanescu ◽

Florin Tanase ◽

Bogdan Mihai ◽

Cristian Persu

Keyword(s):

Prostate Cancer ◽

Magnetic Resonance ◽

Cancer Detection ◽

Detection Rate ◽

Specific Antigen ◽

Cancer Detection Rate ◽

Targeted Biopsy ◽

Detection Rates ◽

Clinically Significant ◽

Systematic Biopsy

Aim: Magnetic resonance/ ultrasound fusion targeted biopsy (Tbs) is widely used for diagnosing prostate cancer (PCa). The aim of our study was to compare the cancer detection rate (CDR) and the clinically significant prostate cancer detection rate (csPCa) of the magnetic resonance/ultrasound fusion targeted biopsy with those of the standard systematic biopsy (Sbs) and of the combination of both techniques.Material and methods: A total of 182 patients underwent magnetic resonance/ultrasound fusion Tbs on the prostate for PCa suspicion based on multiparametric magnetic resonance imaging (mMRI) detection of lesions with PI-RADSv2 score ≥3. A total of 78 patients had prior negative biopsies. Tb was performed by taking 2-4 cores from each suspected lesion, followed by Sb with 12 cores. We evaluated the overall detection rate of PCa and clinically significant prostate cancer, defined as any PCa with Gleason score ≥3+4.Results: Median prostate specific antigen (PSA) level pre-biopsy was 7.4 ng/ml and median free-PSA/PSA ratio was 10.2%. Patient median age was 62 years old. PIRADSv2 score was 3 in 54 cases, 4 in 96 cases and 5 in 32 cases. PI-RADS-dependent detection rate of Tbs for scores 3, 4 and 5 was 25.9%, 65.6% and 84.4%, respectively, with csPCa detection rates of 24.1%, 54.2%, and 71.9%. Overall detection rate was 57.1% for Tbs, which increased to 60.4% by adding Sbs results. Detection rate for clinically significant prostate cancer (csPCa) was 48.4% and increased to 51.1% by adding Sbs. Overall detection rate for repeated biopsy was 50% and 68.3% for biopsy in naïve patients. Sbs detection rate was 55.5%, 8 patients having a negative biopsy on Tbs.Conclusions: When Tbs is considered due to a PI-RADS ≥3 lesion on mMRI, combined Tbs + Sbs increases the overall CDR and csPCa detection rates.

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Transrectal versus transperineal 14-core prostate biopsy in detection of prostate cancer: A comparative evaluation at the same Institution

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.4.284 ◽

2014 ◽

Vol 86 (4) ◽

pp. 284 ◽

Cited By ~ 6

Author(s):

Maria Angela Cerruto ◽

Fabio Vianello ◽

Carolina D’Elia ◽

Walter Artibani ◽

Giovanni Novella

Keyword(s):

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Cancer Detection Rate ◽

Controlled Study ◽

Pain Level ◽

Prostatic Biopsy ◽

Detection Rates ◽

The Mean ◽

Prospective Controlled Study

Background: The ideal bioptic strategy for CaP detection is still to be completely defined. The aim of our study is to compare transperineal (TP) and transrectal (TR) approaches, in a 14-core initial prostate biopsy for CaP detection. Material and methods: A prospective controlled study was conducted enrolling 108 consecutive patients with a PSA level greater than 4 ng/mL and/or an abnormal DRE. TR versus TP 14-core initial prostatic biopsies were performed on 54 and 54 patients, respectively, with a randomisation ratio of 1:1. Results: The cancer detection rates were 46.29 (25 out of 54 patients), and 44.44% (24 out of 54 patients), respectively, using the TR or the TP approach (p = 0.846). The overall cancer core rate was significantly higher when the TP approach was used: 21.43% (162 out of 756 cores) and 16.79% (127 out of 756 cores), with the TP and the TR approach, respectively (p = 0.022). The cores were significantly longer performing TP approach: at the site “1” (14.92 versus 12.97 mm, p = 0.02); at “5” (15.53 versus 13.69 mm, p = 0.037); at “7” (15.06 versus 12.86 mm, p = 0.001); at “9” (14.92 versus 13.38 mm, p = 0.038); at “11” (16.32 versus 12.31 mm, p = 0.0001); at “12” (15.14 versus 12.19 mm, p = 0.0001); at “13” (17.49 versus 13.98 mm, p = 0.0001); at “14” (16.77 versus 13.36 mm, p = 0.0001). As to the biopsy related pain, the mean pain level perceived by patients during the TR approach was 1.56 ± 1.73 versus 1.42 ± 1.37 registered during TP approach (p = 0.591). Conclusions: No significant differences were found in cancer detection rate, cancer core rate between TP and TR approaches for prostatic biopsy. Even in terms of complication rate or pain level, it cannot be concluded that one procedure is superior to the other one. Apparently, strictly following our protocol, TP approach seems to offer a better sampling at the level of the apex and the TZ, however without adding any significant advantage in terms of overall cancer detection rate.

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Clinically Significant Prostate Cancer Detection with Various Prostate Sampling Schemes Based on Different csPCa Definitions

10.21203/rs.3.rs-911714/v1 ◽

2021 ◽

Author(s):

Fei Wang ◽

Tong Chen ◽

Meng Wang ◽

Hanbing Chen ◽

Caishan Wang ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Detection Rate ◽

First Line ◽

Detection Rates ◽

Sampling Schemes ◽

Number Of Patients ◽

Clinically Significant ◽

Magnetic Resonance Imaging Mri ◽

Biopsy Method

Abstract Background Combining targeted biopsy (TB) with systematic biopsy (SB) is currently recommended as the first-line biopsy method by the European Association of Urology (EAU) guidelines in patients diagnosed with prostate cancer (PCa) with an abnormal magnetic resonance imaging (MRI). The combined SB and TB indeed detected an additional number of patients with clinically significant prostate cancer (csPCa); however, it did so at the expense of a concomitant increase in biopsy cores. Our study aimed to evaluate if ipsilateral SB (ipsi-SB) + TB or contralateral SB (contra-SB) + TB could achieve almost equal csPCa detection rates as SB + TB using fewer cores based on a different csPCa definition.Methods Patients with at least one positive prostate lesion were prospectively diagnosed by MRI. The combination of TB and SB was conducted in all patients. We compared the csPCa detection rates of the following four hypothetical biopsy sampling schemes with those of SB + TB: SB, TB, ipsi-SB + TB, and contra-SB + TB. Results The study enrolled 279 men. The median core of SB, TB, ipsi-SB + TB, and contra-SB + TB was 10, 2, 7 and 7, respectively; they all differed significantly from SB + TB (P < 0.001). ipsi-SB + TB detected significantly more patients with csPCa than contra-SB + TB based on the EAU guidelines (P = 0.042). ipsi-SB + TB and contra-SB + TB detected almost equal number of csPCa on the basis of the Epstein criteria (P = 1.000). Compared with SB + TB, each remaining method detected significantly fewer patients with csPCa regardless of the definition (P < 0.001) except ipsi-SB + TB, which achieved an almost equivalent csPCa detection rate to that of SB + TB on the grounds of D1 (P = 0.066).Conclusions ipsi-SB + TB could detect significantly more patients with csPCa than contra-SB + TB and acquire an almost equivalent csPCa detection rate to that of SB + TB using significantly fewer cores when csPCa was defined as International Society for Urological Pathology (ISUP) 2 or higher.

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Magnetic Resonance Imaging in Hematospermia: Does It Increase Unnecessary Prostate Biopsy?

Current Urology ◽

10.1159/000447151 ◽

2016 ◽

Vol 10 (1) ◽

pp. 50-54

Author(s):

Luke A. McGuinness ◽

Samer Obeidat ◽

Christopher Powell

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Digital Rectal Examination ◽

Cancer Detection Rate ◽

Detection Rates ◽

Uncommon Presentation ◽

Imaging Results ◽

Second Year

Introduction: Hematospermia is an uncommon presentation of prostate cancer. Following the introduction of MRI for patients with hematospermia we evaluated its use and effect on prostate biopsy and cancer detection rates. Materials and Methods: Analysis of patients attending our outpatient department over 2 years was undertaken. Diagnostic workup included digital rectal examination and PSA. Those with abnormal findings or persisting symptoms were offered prostate biopsy. In the second year MRI became available for patients with hematospermia. Abnormal MRI or persisting symptoms were offered biopsy. We compared the frequency of prostate biopsy and cancer detection in patients undergoing MRI and those not having imaging. Results: Forty-seven patients were referred with hematospermia. Nineteen patients did not undergo MRI; four received prostate biopsy with one adenocarcinoma found. Twenty-four patients had an MRI with 17 biopsies undertaken. Three biopsies revealed adenocarcinoma. In the MRI group 71% of patients underwent prostate biopsy but only 21% from the non-MRI group (p < 0.05). Prostate cancer detection rate in the MRI group was 18% whilst in the non-MRI group was 25% (p = 0.7). Conclusions: Our findings indicate that caution should be used with MRI as it can lead to an increase in prostate biopsy with no change in cancer detection rate.

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Complications and Prostate Cancer Diagnosis Rate of TRUS Prostate Biopsies Using 16 and 18G Needles by Clavien Scoring

Urologia Journal ◽

10.5301/uj.5000238 ◽

2017 ◽

Vol 84 (4) ◽

pp. 236-239 ◽

Cited By ~ 1

Author(s):

Serkan Ozcan ◽

Mehmet Akif Diri ◽

Murat Bagcioglu ◽

Tolga Karakan ◽

Arif Aydın

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Daily Basis ◽

Cancer Detection Rate ◽

Detection Rates ◽

Prostate Biopsies ◽

Group 2 ◽

Group 1

Aim We aimed to compare the 18 and 16-Gauge (G) needles used in transrectal ultrasonography (TRUS)-guided needle biopsy for cancer detection rates and complications using the Clavien Scoring System. Materials and Methods The 80 patients who were included in the study were randomized and divided into two groups. Group 1 (n = 36) had a TRUS-guided prostate biopsy with an 18G needle and Group 2 had a 16G needle (n = 44). The hematuria, bleeding assessment, and infection events were evaluated on a daily basis. These complications were graded according to the Clavien Scoring. Results In Group 1, only five (13%) patients were diagnosed with prostate cancer, and three patients were reported to have atypical small acinar proliferation (ASAP). In Group 2, 16 (36%) patients were diagnosed with prostate cancer and one patient was reported to have ASAP. The difference in the prostate cancer detection rate between the groups was statistically significant. According to the Clavien grading system, the complications were at the Grade 1 level in 25 people in Group 1 in 29 people in Group 2. Grade 2 level complications were not observed in either group. While one person was Grade 3 in Group 1, two people in Group 2 had this rate. There were no significant differences between the groups. Conclusions We found that cancer detection rate increased by increasing the thickness of the needle used in TRUS-guided prostate biopsy without any increase in the complications.

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Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study

BMC Urology ◽

10.1186/s12894-019-0539-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Guan-Lin Huang ◽

Chih-Hsiung Kang ◽

Wei-Ching Lee ◽

Po-Hui Chiang

Keyword(s):

Prostate Cancer ◽

Local Anesthesia ◽

Visual Analog Scale ◽

Cancer Detection ◽

Local Anesthetic ◽

Prostate Biopsy ◽

Detection Rate ◽

Cancer Detection Rate ◽

Analog Scale ◽

Detection Rates

Abstract Background Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis. Transrectal (TR) biopsy is a regular modality, while transperineal (TP) biopsy is an alternative for the patients who display persistently high levels of prostate-specific antigen (PSA) and thus have to undergo repeat biopsy. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. Besides, the feasibility of performing TP biopsies under local anesthesia was also evaluated. Methods A total of 238 outpatient visits meeting the criteria for prostate cancer biopsy were enrolled for this study. They were divided into two groups: the TP group (n = 130) consists of patients destined to undergo local anesthetic TP biopsy; and the TR group (n = 108) contained those who received TR biopsy as comparison. Age, PSA level, digital rectal exam (DRE) finding, prostate volume, and biopsy core number were used as the parameters of the multivariable analyses. The comparable items included cancer detection rate, complication rate, admission rate and visual analog scale (VAS) score. Results The cancer detection rates between TP and TR groups were quite comparable (45% v.s. 49%) (p = 0.492). However, the TP group, as compared to the TR group, had significantly lower incidence of infection-related complications (except epididymitis and prostatitis) that commonly occur after biopsies. None of the patients in the TP group were hospitalized due to the post-bioptic complications, whereas there was still a minor portion of those in the TR group (7.4%) requiring hospitalization after biopsy. Medians (25–75% quartiles) of visual analog scale (VAS) were 3 [3, 4] and 4 [3–5] respectively for the TP and TR procedures under local anesthesia, but no statistical significance existed between them (p = 0.085). Conclusions Patients receiving TP biopsy are less likely to manifest infection-related complications. Therefore, TP biopsy is a more feasible local anesthetic approach for prostate cancer detection if there are concerns for infectious complications and/or the risk of general anesthesia.

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Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted

Canadian Urological Association Journal ◽

10.5489/cuaj.4308 ◽

2017 ◽

Vol 11 (9) ◽

pp. E330-7 ◽

Cited By ~ 5

Author(s):

Franck Bladou ◽

Cora Fogaing ◽

Mark Levental ◽

Samuel Aronson ◽

Mona Alameldin ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Cancer Detection ◽

Prostate Biopsy ◽

Detection Rate ◽

Specific Antigen ◽

Resonance Imaging ◽

Negative Biopsy ◽

Clinically Significant

Introduction: Magnetic resonance imaging (MRI) is being more widely used in the detection of prostate cancer (PCa), particularly after an initial negative biopsy. In this study, we compared 12-core systematic biopsy (SYS), MRI-targeted biopsy (TAR), and the association of systematic and MRI-targeted (SYS+TAR) prostate biopsy in patients with previous biopsy and those who were biopsy-naive to evaluate the differences in terms of cancer detection and clinically significant cancer detection between the three modalities.Methods: Overall, 203 consecutive patients with suspicion of PCa were analyzed; 48.2% were biopsy-naive and 51.7% had at least one previous negative prostate biopsy. The median age was 66 years, median prostate-specific antigen (PSA) level was 7.9 ng/mL and median prostate volume was 46 mL. 38.9% had SYS, 19.2% TAR only, and 41.8% had SYS+TAR biopsy.Results: Overall, the PCa detection (PCaDR) was 63%. The SYS+TAR biopsy detected significantly more cancer than SYS and TAR only biopsies (72.9% vs. 56.9% and 53.8% respectively; p=0.03). Detection rate of clinically significant cancer (csPCaDR) was 50.7% overall; 65.8% in the SYS+TAR biopsy vs. 39.2% in the SYS and 48.7% in the TAR groups (p=0.002). In the biopsy-naive group, PCaDR and csPCaDR were significantly higher in the SYS+TAR group than in the SYS and TAR groups (p=0.01). In the repeat biopsy group, PCaDR and csPCaDR were equivalent in the TAR and SYS+TAR groups and higher than in the SYS group (p=0.001).Conclusions: TAR biopsy, when added to SYS biopsy, was associated with a higher detection rate of csPCa in biopsy-naive patients when compared to TAR and SYS only biopsies. In patients after previous negative biopsy, detection rates of csPCa were equivalent for SYS+TAR and TAR only biopsies, but higher than SYS.

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