scholarly journals The Role of Saturation Transperineal Biopsy in the Diagnosis of Prostate Cancer in the Era of Targeted Fusion Biopsies

2018 ◽  
Vol 8 (2) ◽  
pp. 27-32
Author(s):  
A. A. Keln ◽  
A. V. Zyryanov ◽  
P. V. Zotov ◽  
A. V. Ponomarev ◽  
A. S. Surikov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Imaging Techniques ◽  
Specific Antigen ◽  
Sufficient Information ◽  
Gleason Grading ◽  
Saturation Biopsy ◽  
Transrectal Prostate Biopsy ◽  
Degree Of Malignancy ◽  
Transperineal Biopsy

Introduction. One of the biggest problems in the diagnosis of prostate cancer (PCa), which distinguishes it from many other solid tumour conditions, is the difficulty of detecting the tumour using standard imaging techniques. The primary method of diagnosis of PCa, which allows timely treatment, is prostate biopsy. However, under certain clinical situations a saturation biopsy allows a more accurate prediction of the volume and degree of malignancy of the tumour, which can be used to plan the tactics of treatment.Materials and methods. 81 patients were examined, whose mean age was 63.5 ± 7.4. The average volume of the prostate was 59 ± 24.2 cm3 , while the average level of the prostate-specific antigen was 12.5 ± 8.9 ng/ml. All patients underwent at least one transrectal prostate biopsy. The average duration of the transperineal saturation biopsy of the prostate was 25.2 ± 7.4 minutes. The average number of biopsies was 25.Results and discussion. Based on the results of transperineal saturation biopsy, prostate cancer was detected in 34 patients (43.2 %). Adenocarcinoma was detected in all patients with confirmed malignant pathology. Gleason grading was 6 points in 22 (27.1 %) patients, 7 in 9 (9.9 %) and 8 in 4 (4.9 %). Aggressive tumour types (Gleason 7 and 8) corresponded to PIRADS 4 and 5. In PIRADS 2 and 3, 80 % and 50 %, respectively, manifested prostatic adenoma without malignant manifestation. Following radical prostatectomy, the results of a planned morphological conclusion were studied alongside biopsy data. It was determined that in 80.0 % (n = 12) of cases the tumour did not go beyond the prostate capsule and in only 20.0 % (n = 3) of cases was not confined to the prostate. The coincidence of diagnosis based on biopsy results and morphological conclusion was 86.7 %.Conclusion. The study showed that saturation transperineal biopsy is often a reference diagnostic method when, despite the presence of clinical suspicion of PCa, a standard biopsy, including targeted fusion biopsies, fails to provide sufficient information to confirm or exclude PCa. In such situations, the proposed technique provides an alternative approach, with a good frequency of detection of prostate cancer.

A non-randomized prospective study on the diagnostic performance of perineal prostatic biopsy, directed via diffusion nuclear resonance, in patients with suspected prostate cancer and previous negative transrectal prostate biopsy

2020 ◽  
pp. 039156032096288
Author(s):  
Roberto Castellucci ◽  
Ana I. Linares Quevedo ◽  
Francisco J. Sánchez Gómez ◽  
Isidro Cogollos Acuña ◽  
Isabel Salmerón Béliz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prospective Study ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Prostatic Biopsy ◽  
Negative Results ◽  
Transrectal Prostate Biopsy ◽  
Definition Of ◽  
Almost All ◽  
The University

Background: A definition of the best strategy is necessary to optimize the follow-up of patients with previous negative transrectal guided ultrasound biopsy (TRUS-GB) and the persistence of raised prostate-specific antigen (PSA).The purpose of this study was to evaluate the prostate cancer (PCa) diagnostic rate of targeted transperineal ultrasound guided biopsy (TPUS-GB) with cognitive multiparametric magnetic resonance imaging (mpMRI) registration with concurrent systematic biopsy in patients with previous negative systematic TRUS-GB and persistently elevated PSA levels. Materials and methods: In this prospective study conducted at the University Infanta Sofia Hospital from April 2016 to November 2017, patients with one previous negative systematic TRUS-GB and persistently high PSA levels were referred for mpMRI prostate scans. All patients underwent systematic TPUS-GB and those patients with suspicious findings on mpMRI scans, Pirads 3 and 4-5, underwent a subsequent cognitive guidance mpMRI-TPUS-GB. Results: In total, 71 patients were included in this study. Suspicious findings on mpMRI scans prior to TPUS-GB were found in 50 patients (70.4%). 16 patients were diagnosed with prostate cancer (22.5%), of whom 14 (87.5%) had a mpMRI scan with Pirads 3 or Pirads 4-5. Patients with Pirads 3, 4 or 5 showed negative results in almost all cores taken by concurrent systematic TPUS-GB. Conclusions: Cognitive mpMRI-TPUS fusion biopsy is a useful tool to diagnose PCa in patients with previous negative prostate biopsy. The samples obtained from the suspicious areas in the mpMRI detect more cases of intermediate and high risk PCa compared to the samples obtained at random or from non-suspicious areas.

scholarly journals Treatment of nonmetastatic castration-resistant prostate cancer: focus on second-generation androgen receptor inhibitors

2021 ◽  
Author(s):  
Fred Saad ◽  
Martin Bögemann ◽  
Kazuhiro Suzuki ◽  
Neal Shore
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Second Generation ◽  
Imaging Techniques ◽  
Specific Antigen ◽  
Conventional Imaging ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Therapeutic Decisions ◽  
Consensus Statements

Abstract Background Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined as a rising prostate-specific antigen concentration, despite castrate levels of testosterone with ongoing androgen-deprivation therapy or orchiectomy, and no detectable metastases by conventional imaging. Patients with nmCRPC progress to metastatic disease and are at risk of developing cancer-related symptoms and morbidity, eventually dying of their disease. While patients with nmCRPC are generally asymptomatic from their disease, they are often older and have chronic comorbidities that require long-term concomitant medication. Therefore, careful consideration of the benefit–risk profile of potential treatments is required. Methods In this review, we will discuss the rationale for early treatment of patients with nmCRPC to delay metastatic progression and prolong survival, as well as the factors influencing this treatment decision. We will focus on oral pharmacotherapy with the second-generation androgen receptor inhibitors, apalutamide, enzalutamide, and darolutamide, and the importance of balancing the clinical benefit they offer with potential adverse events and the consequential impact on quality of life, physical capacity, and cognitive function. Results and conclusions While the definition of nmCRPC is well established, the advent of next-generation imaging techniques capable of detecting hitherto undetectable oligometastatic disease in patients with nmCRPC has fostered debate on the criteria that inform the management of these patients. However, despite these developments, published consensus statements have maintained that the absence of metastases on conventional imaging suffices to guide such therapeutic decisions. In addition, the prolonged metastasis-free survival and recently reported positive overall survival outcomes of the three second-generation androgen receptor inhibitors have provided further evidence for the early use of these agents in patients with nmCRPC in order to delay metastases and prolong survival. Here, we discuss the benefit–risk profiles of apalutamide, enzalutamide, and darolutamide based on the data available from their pivotal clinical trials in patients with nmCRPC.

scholarly journals Pattern of failure in prostate cancer previously treated with radical prostatectomy and post-operative radiotherapy: a secondary analysis of two prospective studies using novel molecular imaging techniques

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lindsay S. Rowe ◽  
Stephanie Harmon ◽  
Adam Horn ◽  
Uma Shankavaram ◽  
Soumyajit Roy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Pet Imaging ◽  
Biochemical Recurrence ◽  
Imaging Techniques ◽  
Specific Antigen ◽  
Definitive Treatment ◽  
Pattern Of Failure ◽  
Link Type ◽  
Psma Pet

Abstract Background Prostate Membrane Specific Antigen (PSMA) positron emission tomography (PET) and multiparametric MRI (mpMRI) have shown high accuracy in identifying recurrent lesions after definitive treatment in prostate cancer (PCa). In this study, we aimed to outline patterns of failure in a group of post-prostatectomy patients who received adjuvant or salvage radiation therapy (PORT) and subsequently experienced biochemical recurrence, using 18F-PSMA PET/CT and mpMRI. Methods PCa patients with biochemical failure post-prostatectomy, and no evident site of recurrence on conventional imaging, were enrolled on two prospective trials of first and second generation 18F-PSMA PET agents (18F-DCFBC and 18F-DCFPyL) in combination with MRI between October 2014 and December 2018. The primary aim of our study is to characterize these lesions with respect to their location relative to previous PORT field and received dose. Results A total of 34 participants underwent 18F-PSMA PET imaging for biochemical recurrence after radical prostatectomy and PORT, with 32/34 found to have 18F-PSMA avid lesions. On 18F-PSMA, 17/32 patients (53.1%) had metastatic disease, 8/32 (25.0%) patients had locoregional recurrences, and 7/32 (21.9%) had local failure in the prostate fossa. On further exploration, we noted 6/7 (86%) of prostate fossa recurrences were in-field and were encompassed by 100% isodose lines, receiving 64.8–72 Gy. One patient had marginal failure encompassed by the 49 Gy isodose. Conclusions 18F-PSMA PET imaging demonstrates promise in identifying occult PCa recurrence after PORT. Although distant recurrence was the predominant pattern of failure, in-field recurrence was noted in approximately 1/5th of patients. This should be considered in tailoring radiotherapy practice after prostatectomy. Trial registrationwww.clinicaltrials.gov, NCT02190279 and NCT03181867. Registered July 12, 2014, https://clinicaltrials.gov/ct2/show/NCT02190279 and June 8 2017, https://clinicaltrials.gov/ct2/show/NCT03181867.

scholarly journals Integrated predictive model for prostatic cancer using clinical, laboratory and ultrasound data

2016 ◽  
Vol 43 (6) ◽  
pp. 430-437
Author(s):  
GUSTAVO DAVID LUDWIG ◽  
HENRIQUE PERES ROCHA ◽  
LÚCIO JOSÉ BOTELHO ◽  
MAIARA BRUSCO FREITAS
Keyword(s):  
Prostate Cancer ◽  
Predictive Model ◽  
Prostate Biopsy ◽  
Clinical Laboratory ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Roc Curves ◽  
Rectal Examination ◽  
Psa Density

ABSTRACT Objective: to develop a predictive model to estimate the probability of prostate cancer prior to biopsy. Methods: from September 2009 to January 2014, 445 men underwent prostate biopsy in a radiology service. We excluded from the study patients with diseases that could compromise the data analysis, who had undergone prostatic resection or used 5-alpha-reductase inhibitors. Thus, we selected 412 patients. Variables included in the model were age, prostate specific antigen (PSA), digital rectal examination, prostate volume and abnormal sonographic findings. We constructed Receiver Operating Characteristic (ROC) curves and calculated the areas under the curve, as well as the model's Positive Predictive Value (PPV) . Results: of the 412 men, 155 (37.62%) had prostate cancer (PC). The mean age was 63.8 years and the median PSA was 7.22ng/ml. In addition, 21.6% and 20.6% of patients had abnormalities on digital rectal examination and image suggestive of cancer by ultrasound, respectively. The median prostate volume and PSA density were 45.15cm3 and 0.15ng/ml/cm3, respectively. Univariate and multivariate analyses showed that only five studied risk factors are predictors of PC in the study (p<0.05). The PSA density was excluded from the model (p=0.314). The area under the ROC curve for PC prediction was 0.86. The PPV was 48.08% for 95%sensitivity and 52.37% for 90% sensitivity. Conclusion: the results indicate that clinical, laboratory and ultrasound data, besides easily obtained, can better stratify the risk of patients undergoing prostate biopsy.

scholarly journals Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer

2020 ◽  
Vol 42 (2) ◽  
pp. 76-79
Author(s):  
Dinesh Chataut ◽  
Babin Basnet ◽  
Benu Lohani ◽  
Sundar Suwal ◽  
Sharma Paudel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Gold Standard ◽  
Detection Rate ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Elderly Male ◽  
Common Cancer ◽  
In Trans ◽  
Focus Detection

Introduction Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings. MethodsProspective study was done in 66 males of age >40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA >4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings. ResultsTwenty three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%. ConclusionTRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer.

Urinary miR-183 and miR-205 do not surpass PCA3 in urine as predictive markers for prostate biopsy outcome despite their highly dysregulated expression in prostate cancer tissue

2015 ◽  
Vol 53 (7) ◽  
Author(s):  
Carsten Stephan ◽  
Monika Jung ◽  
Silke Rabenhorst ◽  
Ergin Kilic ◽  
Klaus Jung
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Critical Evaluation ◽  
Sample Size Calculation ◽  
Digital Rectal Examination ◽  
Predictive Marker ◽  
Testing Procedure ◽  
Cancer Tissue ◽  
Few Data

AbstractMicroRNAs (miRNAs) have shown to be promising novel biomarkers in various cancers. We aimed to translate the results of an own previous tissue-based miRNA profile of prostate carcinoma (PCa) with upregulated miR-183 and downregulated miR-205 into a urine-based testing procedure for diagnosis of PCa.Urine sediments were prepared from urine samples collected after a standardized digital-rectal examination (DRE) of patients undergoing prostate biopsy with PSA (prostate-specific antigen) values <20 μg/L in consecutive order. According to the sample-size calculation (α=0.05, power=0.95), 38 patients each with PCa and without PCa were randomly enrolled in this study. PCA3 (prostate cancer associated 3) in urine as Food and Drug Administration-approved assay was determined as reference standard for comparison. The miRNAs were measured by RT-qPCR using TaqMan assays and normalized using different approaches.Both miRNAs were correlated to the mRNA PSA concentrations in the sediments indicating a relationship to the released prostate cells after DRE. However, they had no discriminating capacity between patients with and without PCa. In contrast, PCA3 clearly differentiated between these two patients groups. There was also no significant correlation between miRNAs and standard clinicopathologic variables like Gleason score and serum PSA.The data of our study show that miR-183 and miR-205 failed to detect early and aggressive PCa despite their highly dysregulated expression in cancer tissue. Our results and the critical evaluation of the few data of other studies raise serious doubts concerning the capability of urinary miRNAs to replace or improve PCA3 as predictive marker for prostate biopsy outcome.

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