Is one targeted biopsy core of the index lesion sufficient to accurately detect clinically significant prostate cancer across all PI-RADS scores?

2019 ◽  
Vol 18 (1) ◽  
pp. e1802-e1803
Author(s):  
P. Dell’Oglio ◽  
A. Stabile ◽  
L. Boeri ◽  
M. Soligo ◽  
G. Rosiello ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Targeted Biopsy ◽  
Index Lesion ◽  
Biopsy Core ◽  
Clinically Significant

scholarly journals MP36-14 IS ONE TARGETED BIOPSY CORE OF THE INDEX LESION SUFFICIENT TO ACCURATELY DETECT CLINICALLY SIGNIFICANT PROSTATE CANCER ACROSS ALL PI-RADS SCORES?

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Paolo Dell'Oglio* ◽  
Armando Stabile ◽  
Luca Boeri ◽  
Antonio Esposito ◽  
Matteo Soligo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Targeted Biopsy ◽  
Index Lesion ◽  
Biopsy Core ◽  
Clinically Significant

One and done?: Utility of PSA density as a predictor of number of cores needed to detect clinically significant prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 104-104
Author(s):  
Graham Hale ◽  
Jonathan Bloom ◽  
Amir H Lebastchi ◽  
Samuel A Gold ◽  
Sherif Mehralivand ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Time Interval ◽  
Targeted Biopsy ◽  
Psa Density ◽  
Biopsy Core ◽  
Multiple Cores ◽  
Specific Factors ◽  
Clinically Significant ◽  
Continuous Predictor

104 Background: MRI/US fusion guided prostate biopsy (FBx) has been shown to detect clinically significant prostate cancer (csCaP) at higher rates and with fewer cores than standard prostate biopsy. However, the number of targeted cores needed to accurately characterize lesions identified on multiparametric MRI (mpMRI) is unknown. This study sought to determine factors that predict the number of cores needed to accurately characterize lesions during FBx of patients on active surveillance. Methods: A retrospective analysis of a prospectively maintained database of all patients undergoing FBx at an academic referral center between May 2014 and January 2018 was conducted. At least two FBx cores were taken from each lesion identified on mpMRI. Patient and lesion specific factors were analyzed to determine factors that predict the necessity to obtain additional cores to detect csCaP. GEE-based univariate logistic regression model with exchangeable correlation was used to estimate the effects of clinical characteristics including race, BMI, PSA, PSA density (PSAD), lesion location, and PI-RADS score on the proportion of positive and negative agreement. Predictability of a significant continuous predictor was quantified by AUC. The most significant patient-level predictor (PSAD) was further analyzed to determine thresholds at which multiple cores per lesion are needed to avoid missing csCaP. Results: An analysis of a total of 1141 FBx were performed during the study time interval. PSA (OR=1.57, 1.20-2.05, p<0.01) and PSAD (OR=1.43, 1.11-1.85, p<0.01) significantly predicted positive agreement of csCaP. AUC for positive and negative agreement was 57.4 and 61.0 for PSA and 56.4 and 72.3 for PSAD, respectively. Using these thresholds, only 56% lesions would need double core targeted biopsy. In other words, up to 44% of lesions would be accurately characterized with a single biopsy core of the targeted lesion. Conclusions: These data indicate that in patients with a PSAD less than 0.11 ng/ml2 or greater than 0.26 ng/ml2, lesions may be acceptably characterized with a single targeted biopsy core.

Does size matter? Lesion size as an indicator of number of cores needed to detect clinically significant prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 283-283
Author(s):  
Amir H. Lebastchi ◽  
Luke P. O'Connor ◽  
Alex Z. Wang ◽  
Nitin Yerram ◽  
Sandeep Gurram ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Lesion Size ◽  
Time Interval ◽  
Targeted Biopsy ◽  
Biopsy Core ◽  
Multiple Cores ◽  
Clinically Significant ◽  
Size Matter ◽  
Continuous Predictor

283 Background: MRI/US fusion guided prostate biopsy (FBx) has been shown to detect clinically significant prostate cancer (csCaP) at higher rates and with fewer cores than standard prostate biopsy. Size plays an important role in assigning a suspicion level (PI-RADS) to lesions identified on MRI. However, tumor characteristics may pose challenges to accurately characterizing the lesion despite the size. This study sought to determine if there are size cutoffs at which a lesion may be accurately characterized as clinically significant cancer with a single biopsy core. Methods: A retrospective analysis of a prospectively maintained database of all patients undergoing FBx at an academic referral center between May 2014 and January 2018 was conducted. At least two FBx cores were taken from each lesion identified on mpMRI. GEE-based univariate logistic regression model with exchangeable correlation was used determine if size was a significant predictor of positive and negative agreement. Predictability of size as a significant continuous predictor was quantified by AUC. Size thresholds at which multiple cores per lesion are needed to avoid missing > 2% of csCaP were calculated, allowing for a 25% discordance rate. Results: An analysis of a total of 1141 FBx of 2200 lesions was performed during the study time interval. Size was a significant predictor of both positive (OR = 2.43, 1.83-3.23, p < 0.01) and negative (OR = 0.58, 0.44-0.76, p < 0.01) agreement of csCaP. AUC% for positive and negative agreement was 65.8 and 57.6, respectively. Size thresholds of 0.65 and 1.70 cm limited CS cancers missed by skipping a second targeted biopsy core to 2% while allowing for a 25% discordance. Conclusions: These data indicate that clinically significant prostate cancer in lesions less than 0.65 cm and greater than 1.70 cm may be characterized with a single targeted biopsy core, sparing 33.5% of lesions (21% patients) a double core targeted biopsy.

scholarly journals Study protocol for a single-centre non-inferior randomised controlled trial on a novel three-dimensional matrix positioning-based cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy for the detection rate of clinically significant prostate cancer in men without a prior biopsy

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041427
Author(s):  
Biming He ◽  
Rongbing Li ◽  
Dongyang Li ◽  
Liqun Huang ◽  
Xiaofei Wen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Rate ◽  
Three Dimensional ◽  
Multiparametric Mri ◽  
Fusion Method ◽  
Targeted Biopsy ◽  
Cognitive Fusion ◽  
Single Centre ◽  
Clinically Significant ◽  
Randomised Controlled

IntroductionThe classical pathway for diagnosing prostate cancer is systematic 12-core biopsy under the guidance of transrectal ultrasound, which tends to underdiagnose the clinically significant tumour and overdiagnose the insignificant disease. Another pathway named targeted biopsy is using multiparametric MRI to localise the tumour precisely and then obtain the samples from the suspicious lesions. Targeted biopsy, which is mainly divided into cognitive fusion method and software-based fusion method, is getting prevalent for its good performance in detecting significant cancer. However, the preferred targeted biopsy technique in detecting clinically significant prostate cancer between cognitive fusion and software-based fusion is still beyond consensus.Methods and analysisThis trial is a prospective, single-centre, randomised controlled and non-inferiority study in which all men suspicious to have clinically significant prostate cancer are included. This study aims to determine whether a novel three-dimensional matrix positioning cognitive fusion-targeted biopsy is non-inferior to software-based fusion-targeted biopsy in the detection rate of clinically significant cancer in men without a prior biopsy. The main inclusion criteria are men with elevated serum prostate-specific antigen above 4–20 ng/mL or with an abnormal digital rectal examination and have never had a biopsy before. A sample size of 602 participants allowing for a 10% loss will be recruited. All patients will undergo a multiparametric MRI examination, and those who fail to be found with a suspicious lesion, with the anticipation of half of the total number, will be dropped. The remaining participants will be randomly allocated to cognitive fusion-targeted biopsy (n=137) and software-based fusion-targeted biopsy (n=137). The primary outcome is the detection rate of clinically significant prostate cancer for cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy in men without a prior biopsy. The clinically significant prostate cancer will be defined as the International Society of Urological Pathology grade group 2 or higher.Ethics and disseminationEthical approval was obtained from the ethics committee of Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. The results of the study will be disseminated and published in international peer-reviewed journals.Trial registration numberClinicalTrials.gov Registry (NCT04271527).

scholarly journals Evaluation of the Ginsburg Scheme: Where Is Significant Prostate Cancer Missed?

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2502
Author(s):  
August Sigle ◽  
Cordula A. Jilg ◽  
Timur H. Kuru ◽  
Nadine Binder ◽  
Jakob Michaelis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Detection ◽  
Logistic Regression Analysis ◽  
Anterior Region ◽  
Targeted Biopsy ◽  
Detection Rates ◽  
Clinically Significant ◽  
Systematic Biopsy

Background: Systematic biopsy (SB) according to the Ginsburg scheme (GBS) is widely used to complement MRI-targeted biopsy (MR-TB) for optimizing the diagnosis of clinically significant prostate cancer (sPCa). Knowledge of the GBS’s blind sectors where sPCa is missed is crucial to improve biopsy strategies. Methods: We analyzed cancer detection rates in 1084 patients that underwent MR-TB and SB. Cancerous lesions that were missed or underestimated by GBS were re-localized onto a prostate map encompassing Ginsburg sectors and blind-sectors (anterior, central, basodorsal and basoventral). Logistic regression analysis (LRA) and prostatic configuration analysis were applied to identify predictors for missing sPCa with the GBS. Results: GBS missed sPCa in 39 patients (39/1084, 3.6%). In 27 cases (27/39, 69.2%), sPCa was missed within a blind sector, with 17/39 lesions localized in the anterior region (43.6%). Neither LRA nor prostatic configuration analysis identified predictors for missing sPCa with the GBS. Conclusions: This is the first study to analyze the distribution of sPCa missed by the GBS. GBS misses sPCa in few men only, with the majority localized in the anterior region. Adding blind sectors to GBS defined a new sector map of the prostate suited for reporting histopathological biopsy results.

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