PD32-03 OUTCOMES OF MRI-US FUSION TARGETED PROSTATE BIOPSY IN MEN WITH HISTORY OF PREVIOUS NEGATIVE BIOPSY: IMPROVED CANCER DETECTION AND RISK STRATIFICATION.

Multiparametric MRI (mpMRI) has superb sensitivity in prostate cancer detection. mpMRI is increasingly used not only for primary diagnostics, but for location of suspicious lesion before biopsy in case of targeted biopsy (TB). In many recent studies have been shown higher level of TB accuracy in prostate cancer detection in comparison with traditional systemic biopsy. In recent EAU, NICE, ACR recommendations mpMRI is indicated for men with high level of prostate cancer suspicion with previous negative results of systemic biopsy. However, it is not absolutely clear, whether mpMRI is indicated for biopsy-naïve men. This study is dedicated for prostate biopsy planning in the groups of biopsy-naïve men and with the history of previous biopsy.

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Repeat Prostate Biopsy Strategies after Initial Negative Biopsy: Meta-Regression Comparing Cancer Detection of Transperineal, Transrectal Saturation and MRI Guided Biopsy

PLoS ONE ◽

10.1371/journal.pone.0057480 ◽

2013 ◽

Vol 8 (2) ◽

pp. e57480 ◽

Cited By ~ 48

Author(s):

Adam W. Nelson ◽

Rebecca C. Harvey ◽

Richard A. Parker ◽

Christof Kastner ◽

Andrew Doble ◽

...

Keyword(s):

Cancer Detection ◽

Prostate Biopsy ◽

Negative Biopsy ◽

Guided Biopsy ◽

Meta Regression ◽

Mri Guided

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Can a supervised algorithmic assessment of men for prostate cancer improve the quality of care? A retrospective evaluation of a prostate assessment pathway in Saskatchewan

Canadian Urological Association Journal ◽

10.5489/cuaj.4237 ◽

2017 ◽

Vol 11 (9) ◽

pp. E338-43

Author(s):

Bonnie Liu ◽

Kunal Jana ◽

Gary Groot

Keyword(s):

Prostate Cancer ◽

Risk Stratification ◽

Cancer Detection ◽

Prostate Biopsy ◽

Wait Time ◽

Low Risk ◽

Time Data ◽

Significant Difference ◽

High Risk Cancer ◽

Biopsy Rate

Introduction: The Saskatoon Prostate Assessment Pathway (SPAP) was developed in 2013 in part to decrease the wait times between physician referral and biopsy for patients with suspected prostate cancer. Using an algorithm carefully designed to optimize appropriate prostate biopsy rates, physicians can directly refer patients for biopsy through the SPAP without seeing a urologist. All other patients are referred to the Saskatoon Urology Associates (SUA). The present study evaluates the performance of the algorithm.Methods: 971 patients seen at the SUA and 302 patients seen through the SPAP were identified. Information on age, biopsy status and outcome, risk stratification, and time between referral and biopsy was collected. Biopsy wait time data was analyzed using gamma distribution. Association between referral method and biopsy rate, and between referral method and risk stratification, was analyzed using Z-test.Results: The expected wait time from referral to biopsy for patients seen through SUA was 2.63 times longer than those seen through SPAP (34 vs. 91 days). The biopsy rate of patients seen in the SPAPwas significantly higher than those by SUA (88% vs. 69%, 95% confidence interval [CI] 0.14–0.26; p<0.00001). There was no significant difference in positive biopsy rates for patients seen through the SPAP vs. SUA (81% vs. 74%, 95% CI -0.011,0.14; p=0.095), for detection of low-risk cancer, (12% vs. 10%, 95% CI -0.034,0.080; p=0.44), or for clinically relevant cancer, i.e., intermediate- and high-risk cancer, for SPAP vs. SUA (56.54% vs. 56.68%, 95% CI -0.091,0.089; p=0.49).Conclusions: The algorithm used in the SPAP is effective in decreasing wait time to prostate biopsy and has the same cancer/pre-cancer detection rate, but at the cost of a higher biopsy rate. Both referralmechanisms result in few low-risk cancer detection biopsies, finding primarily cases of high- or intermediate-risk cancer.

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Risk Stratification by Urinary Prostate Cancer Gene 3 Testing Before Magnetic Resonance Imaging-Ultrasound Fusion-targeted Prostate Biopsy Among Men With No History of Biopsy

Urology ◽

10.1016/j.urology.2016.08.022 ◽

2017 ◽

Vol 99 ◽

pp. 174-179 ◽

Cited By ~ 24

Author(s):

Michael Fenstermaker ◽

Neil Mendhiratta ◽

Marc A. Bjurlin ◽

Xiaosong Meng ◽

Andrew B. Rosenkrantz ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Risk Stratification ◽

Prostate Biopsy ◽

Cancer Gene ◽

Resonance Imaging ◽

History Of ◽

Prostate Cancer Gene 3

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Repeated biopsy in the detection of prostate cancer: When and how many cores

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.4.311 ◽

2014 ◽

Vol 86 (4) ◽

pp. 311 ◽

Cited By ~ 1

Author(s):

Vincenzo Scattoni ◽

Andrea Russo ◽

Ettore Di Trapani ◽

Umberto Capitanio ◽

Giovanni La Croce ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

English Language ◽

Transrectal Ultrasound ◽

Targeted Biopsy ◽

Negative Biopsy ◽

Transperineal Prostate Biopsy ◽

The Future ◽

Critical Literature

Purpose: We performed an analysis of the literature about the optimal prostate biopsy (PBX) scheme in the repeated setting Methods: We performed a clinical and critical literature review by searching Medline Database from January 2005 up to January 2014. Electronic searches were limited to the English language. The keywords were: prostate cancer, prostate biopsy, transrectal ultrasound, transperineal prostate biopsy. Results: The recommended approach in repeated setting is still the extended scheme (EPBx) (12 cores). An approach with more than 12 cores according to the clinical characteristics of the patients may optimize cancer detection. Saturation PBx (> 20 cores) clearly improves cancer detection if clinical suspicion persists after previous negative biopsy. Nevertheless international guidelines do not strongly recommended SPBx in all situations of repeated setting. EPBx or SPBX may be, in the future, substituted by multiparametric MRI-targeted biopsies. Conclusions: Since the scenario in which a PBx is changing, the issue about the number and location of the cores in PBx is still a matter of debate in repeated setting. At present, EPBx are still the gold standard even if SPBx seems to be necessary in many cases. However, random PBx does not represent the approach of the future, but rather imaging targeted biopsy.

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Prediction of Prostate Cancer for Patients Receiving Finasteride: Results From the Prostate Cancer Prevention Trial

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.6836 ◽

2007 ◽

Vol 25 (21) ◽

pp. 3076-3081 ◽

Cited By ~ 72

Author(s):

Ian M. Thompson ◽

Donna Pauler Ankerst ◽

Chen Chi ◽

Phyllis J. Goodman ◽

Catherine M. Tangen ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Family History ◽

Prostate Biopsy ◽

Factors Associated ◽

Negative Biopsy ◽

Prostate Cancer Prevention ◽

Increased Risk ◽

History Of ◽

The Impact

Purpose Using data from men in the finasteride group of the Prostate Cancer Prevention Trial (PCPT), we evaluated the impact of prostate-specific antigen (PSA) and other risk factors on the risk of prostate cancer. Methods Four thousand four hundred forty men in the finasteride group of the PCPT underwent prostate biopsy, had at least one PSA and a digital rectal exam (DRE) during the year before biopsy, had at least two PSA values from the 3 years before biopsy, and were on finasteride at the time of PSA evaluation. Logistic regression was conducted using the variables age, race, family history of prostate cancer, PSA, PSA velocity, and DRE adjusting for history of prior prostate biopsy. Results Six hundred forty-nine (14.6%) of 4,440 men were diagnosed with prostate cancer; 250 had Gleason 7 or higher cancer. Factors associated with an increased risk of prostate cancer included high PSA value and a rising PSA (24.9% risk for PSA value of 1.0 ng/mL and 24.8% risk for a rising PSA), family history of prostate cancer, abnormal DRE result, African American race, and older age. Factors associated with an increased risk of Gleason 7 or higher grade prostate cancer included PSA, abnormal DRE, and older age. A prior negative biopsy was associated with decreased risk of prostate cancer and high-grade prostate cancer. Conclusion Risk factors for prostate cancer on biopsy for men receiving finasteride include PSA, DRE, age, race, family history, and history of a prior negative biopsy. With the exception of the approximate reduction of PSA by half with finasteride, the impact of these risk factors is similar to men who do not receive finasteride.

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MRI-US fusion targeted biopsy results in patients with a history of a prior negative biopsy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.90 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 90-90

Author(s):

Cayce Nawaf ◽

Amanda Lu ◽

James Rosoff ◽

Jeffrey Weinreb ◽

Peter Schulam ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Prostate Biopsy ◽

Statistical Significance ◽

Test Results ◽

Targeted Biopsy ◽

Chi Square ◽

History Of ◽

Biopsy Methods ◽

Clinically Significant

90 Background: Patients with an elevated PSA but negative prostate biopsy present a diagnostic and management dilemma. We evaluated the capability of multi-parametric (MP) MRI and MRI-USG Fusion prostate biopsy to detect clinically significant (CS) prostate cancer in men who have had a prior negative 12-core standard biopsy. Methods: Between 12/2012 and 06/2015, 374 men with an indication for prostate biopsy underwent pre-biopsy mpMRI followed by 12-core standard trans-rectal mapping biopsy (Mbx) and MRI-Ultrasound fusion targeted biopsy (Tbx) of lesions identified on mpMRI. The combination of Mbx and Tbx, when both occurred, constitutes a fusion biopsy (Fbx). Men who underwent both Mbx with or without Tbx using the Artemis/Pro-Fuse system with a previous biopsy but no diagnosis of prostate cancer were included. Patients without a lesion on MRI underwent Mbx only. Maximum Gleason scores (GS) was assigned on a per patient basis with Mbx GS available for all patients in the cohort and Tbx GS available only for patients with a lesion visible on MP-MRI. CS cancer was defined as GS ≥ 3+4. GS per patient was compared by chi-square and McNemar’s test. Results: 138 men (mean age = 64.0, mean psa = 11.6) met inclusion criteria. Fbx cancer detection rate in this population was 42%. 17 men (12%) were missed by Mbx but picked up on Tbx. Of these 17 men, 13 had Gleason ≥ 7.In comparison, 15 men were missed by Tbx, but only 2 were Gleason ≥ 7. Tbx had a higher rate of detection of CS cancer than Mbx, but this did not reach statistical significance (86% vs 68%, p = 0.09). MRI suspicion level correlated with the detection of CS cancer (p = 0.012). None of the 20 men with a negative MRI had GS ≥ 7 cancer detected on Mbx. The number of prior negative biopsies was not related to the likelihood of finding CS cancer on Fbx (p = 0.47). Conclusions: MRI suspicion score predicts detection of CS prostate cancer when paired with MRI-USG Fbx of the prostate, with a negative MRI correlating with no evidence of CS cancer on biopsy. MRI is a biomarker in this population that may, with more corroborative data, allow for men with a negative MRI to avoid repeat biopsies. [Table: see text]

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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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