Is a sampling transition zone important to increase the detection of prostate cancer in systematic prostatic biopsies?

2020 ◽  
pp. 028418512093836
Author(s):  
Marcos RG Queiroz ◽  
Priscila M Falsarella ◽  
Leonardo G Moreira Valle ◽  
Guilherme Cayres Mariotti ◽  
Gustavo C Lemos ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Transition Zone ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Complication Rates ◽  
Treatment Change ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Biopsy Protocol

Background Use of transrectal ultrasound (US)-guided biopsies improved diagnosis and treatment for patients with high prostate-specific antigen (PSA) or abnormal digital rectal exam (DRE). Purpose To investigate whether taking two transition zone (TZ) biopsies in addition to routine prostate double-sextant biopsies (12-cores) would improve detection rates of prostate cancer (PCa). Material and Methods A retrospective analysis of 1107 in a single institution database after Institutional Review Board approval, which underwent US-guided prostate biopsies from January 2014 to June 2016. All patients with suspected PCa based on positive DRE or high PSA submitted to US-guided prostate biopsy (double-sextant 12-cores alone and 12-cores with two TZ extra cores) were included. Results A total of 1107 patients were included; 120 patients underwent double-sextant 12-cores alone and 987 underwent 12-cores with two TZ extra cores. Among patients submitted to two TZ extra cores, TZs of 755 (76.5%) patients were negative to neoplasia and 232 (23.5%) were positive to neoplasia. Among these patients, 26 (2.6%) had their final Gleason score increased with TZ core; TZ fragments of 20 (2.0%) patients led to a treatment change (re biopsy, active surveillance or from active surveillance to radiation therapy or radical prostatectomy). When the complication rate is analyzed (with or without hospital admission), among the patients submitted to TZ cores, 259 (26.2%) complications were observed; between those submitted to double-sextant 12-cores, 26 (21.7%) complications were observed ( P=0.279). Conclusion Extended core biopsy protocol with two TZ extra fragments improves detection rates of cancer when compared to double-sextant biopsy protocol without increasing complication rates. TZ routine cores should be considered.

scholarly journals What is the risk of prostate cancer mortality following negative systematic TRUS-guided biopsies? A systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040965
Author(s):  
Sandra Miriam Kawa ◽  
Signe Benzon Larsen ◽  
John Thomas Helgstrand ◽  
Peter Iversen ◽  
Klaus Brasso ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Data Extraction ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Population Based ◽  
Free Text ◽  
Medical Subject Headings ◽  
Prognostic Information ◽  
Prostate Biopsies

ObjectiveTo investigate the risk of prostate cancer-specific mortality (PCSM) following initial negative systematic transrectal ultrasound-guided (TRUS) prostate biopsies.DesignSystematic review.Data sourcesPubMed and Embase were searched using a string combination with keywords/Medical Subject Headings terms and free text in the search builder. Date of search was 13 April 2020.Study selectionStudies addressing PCSM following initial negative TRUS biopsies. Randomised controlled trials and population-based studies including men with initial negative TRUS biopsies reported in English from 1990 until present were included.Data extractionData extraction was done using a predefined form by two authors independently and compared with confirm data; risk of bias was assessed using the Newcastle–Ottawa Scale for cohort studies when applicable.ResultsFour eligible studies were identified. Outcomes were reported differently in the studies as both cumulative incidence and Kaplan-Meier estimates have been used. Regardless of the study differences, all studies reported low estimated incidence of PCSM of 1.8%–5.2% in men with negative TRUS biopsies during the following 10–20 years. Main limitation in all studies was limited follow-up.ConclusionOnly a few studies have investigated the risk of PCSM following initial negative biopsies and all studies included patients before the era of MRI of the prostate. However, the studies point to the fact that the risk of PCSM is low following initial negative TRUS biopsies, and that the level of prostate-specific antigen before biopsies holds prognostic information. This may be considered when advising patients about the need for further diagnostic evaluation.PROSPERO registration numberCRD42019134548.

scholarly journals Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Linghui Liang ◽  
Feng Qi ◽  
Yifei Cheng ◽  
Lei Zhang ◽  
Dongliang Cao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Efficiency ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Multivariable Logistic Regression Analysis ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Clinically Significant ◽  
Definition Of ◽  
Medical University

AbstractTo analyze the clinical characteristics of patients with negative biparametric magnetic resonance imaging (bpMRI) who didn’t need prostate biopsies (PBs). A total of 1,012 male patients who underwent PBs in the First Affiliated Hospital of Nanjing Medical University from March 2018 to November 2019, of 225 had prebiopsy negative bpMRI (defined as Prostate Imaging Reporting and Data System (PI-RADS 2.1) score less than 3). The detection efficiency of clinically significant prostate cancer (CSPCa) was assessed according to age, digital rectal examination (DRE), prostate volume (PV) on bpMRI, prostate-specific antigen (PSA) and PSA density (PSAD). The definition of CSPCa for Gleason score > 6. Univariate and multivariable logistic regression analysis were used to identify predictive factors of absent CSPCa on PBs. Moreover, absent CSPCa contained clinically insignificant prostate cancer (CIPCa) and benign result. The detection rates of present prostate cancer (PCa) and CSPCa were 27.11% and 16.44%, respectively. Patients who were diagnosed as CSPCa had an older age (P < 0.001), suspicious DRE (P < 0.001), a smaller PV (P < 0.001), higher PSA value (P = 0.008) and higher PSAD (P < 0.001) compared to the CIPCa group and benign result group. PSAD < 0.15 ng/ml/cm3 (P = 0.004) and suspicious DRE (P < 0.001) were independent predictors of absent CSPCa on BPs. The negative forecast value of bpMRI for BP detection of CSPCa increased with decreasing PSAD, mainly in patients with naive PB (P < 0.001) but not in prior negative PB patients. 25.33% of the men had the combination of negative bpMRI, PSAD < 0.15 ng/ml/cm3 and PB naive, and none had CSPCa on repeat PBs. The incidence of PB was determined, CSPCa was 1.59%, 0% and 16.67% in patients with negative bpMRI and PSAD < 0.15 ng/ml/cm3, patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and biopsy naive and patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and prior negative PB, separately. We found that a part of patients with negative bpMRI, a younger age, no suspicious DRE and PSAD < 0.15 ng/ml/cm3 may securely avoid PBs. Conversely PB should be considered in patients regardless of negative bpMRI, especially who with a greater age, obviously suspicious DRE, significantly increased PSA value, a significantly small PV on MRI and PSAD > 0.15 ng/ml/cm3.

Comparison of prostate cancer detection rates between the Vienna nomogram and the 10-core biopsy protocol

2019 ◽  
Vol 87 (3) ◽  
pp. 155-159
Author(s):  
Ersan Arda ◽  
Zafer Demir ◽  
Ilkan Yuksel ◽  
Mete Cek
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Tissue Sampling ◽  
Exclusion Criteria ◽  
Detection Rates ◽  
Biopsy Protocol ◽  
Lower Urinary

Objective: To compare the Vienna nomogram and the 10-core prostate biopsy protocol regarding whether there is superiority in prostate cancer detection. Methods: Between January and December 2012, a total of 215 patients applying to our outpatient clinic with lower urinary tract symptoms were evaluated, prospectively. Patients with a prostate-specific antigen level of 2.5–10 ng/mL and/or suspicious digital rectal examination were included in the study. Exclusion criteria were determined as recent pelvic radiotherapy, lower urinary tract surgery, history of acute urinary retention, or indwelling urinary catheter. Biopsies were taken systematically with at least 10 cores considering prostate volume and patient age. According to Vienna nomogram, in patients requiring 6- or 8-core biopsies, tissue sampling was completed to 10 cores (our standard protocol), whereas in patients requiring more than 10 cores additional tissue sampling was performed. Results: After the determination of inclusion/exclusion criteria, 170 patients were enrolled in our study. The median (min–max) age, prostate-specific antigen value, and prostate volume were 65 (48–86) years, 7.6 ng/dL (2.5–10), and 55 cc (17–150), respectively. Prostate cancer was detected in 49 (28.8%) patients with transrectal ultrasound–guided prostate biopsy according to the Vienna nomogram. We found that our standard 10-core biopsy protocol would have diagnosed prostate cancer in 46 (27.1%) patients in the same study group showing no statistically significant difference (p > 0.005). Conclusion: The findings of this study suggest that considering cancer detection rates no statistically significant differences were found between both methods. Further prospective research in this aspect is needed to define the ultimate prostate biopsy protocol.

A Prospective Study Comparing Cancer Detection Rates of Transperineal Prostate Biopsies Performed by Junior Urologists Versus a Senior Consultant in a Real World-setting

2020 ◽  
Author(s):  
Jiaao Song ◽  
Bi-ming He ◽  
Hu-sheng Li ◽  
Zhen-kai Shi ◽  
Guan-yu Ren ◽  
...  
Keyword(s):  
Specific Antigen ◽  
Daily Practice ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Significant Difference ◽  
Procedural Time ◽  
Practice Method ◽  
A Prospective Study

Abstract Background: Prostate biopsy (PB) is a typical daily practice method for the diagnosis of prostate cancer (PCa). This study was to compare the PCa detection rate and peri- and post-operative complications of PB among three residents and a consultant.Methods: A total of 343 patients who underwent PB between August 2018 with July 2019 were involved in this study. Residents were systematically trained two weeks by the consultant for performing systemic biopsy (SB) and targeted biopsy (TB). And then, three residents and the consultant performed PB independently every quarter due to routine rotation in daily practice. The peri- and post-operative data was prospectively collected. The primary outcome and secondary outcome were to compare the PCa-detection rates and complications between residents and consultant, respectively. Results: There was no significant difference between the residents and consultant in terms of overall PCa-detection rates of SB, TB or further stratified by prostate specific antigen value, prostate imaging reporting and data system (PI-RADS) scores. We found the consultant had more TB cores compared with residents (175 cores versus 86 to 114 cores, P=0.043) and shorter procedural time versus residents (mean 16 min versus 19.7 to 20.1 min, P <0.001). The complication rate for consultant was 6.7%, and 5% to 8.2% for residents, respectively (P = 0.875).Conclusions: The residents could get a similar PCa detection and complication rates compared with the consultant after a two-week training. However, the residents still need more cases to shorten the time of biopsy procedure.

scholarly journals Prostate cancer detection and complication rates with transrectal ultrasound-guided prostate biopsies among different operators

2012 ◽  
Vol 23 (3) ◽  
pp. 78-81
Author(s):  
I-Shen Huang ◽  
Alex T.L. Lin ◽  
Howard H.H. Wu ◽  
Hsiao-Jen Chung ◽  
Junne-Yih Kuo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Transrectal Ultrasound ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Prostate Cancer Detection ◽  
Prostate Biopsies

scholarly journals Magnetic Resonance Image-Guided Biopsies with a High Detection Rate of Prostate Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Dirk G. Engehausen ◽  
Karl Engelhard ◽  
Siegfried A. Schwab ◽  
Michael Uder ◽  
Sven Wach ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Magnetic Resonance Image ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Ultrasound Guided ◽  
High Detection Rate ◽  
Prostate Biopsies ◽  
Mri Guided ◽  
Total Psa

Aim. To explore the potential of transrectal magnetic resonance image- (MRI-) guided biopsies of the prostate in a patient cohort with prior negative ultrasound guided biopsies.Patients and Methods. Ninety-six men with suspected prostate cancer underwent MRI-guided prostate biopsies under real-time imaging control in supine position.Results. Adenocarcinoma of the prostate was detected in 39 of 96 patients. For individual core biopsies, MRI yielded a sensitivity of 93.0% and a specificity of 94.4%. When stratifying patients according to the free-to-total prostate-specific antigen (PSA) ratio, the prostate cancer discovery rate was significantly higher in the group with ratios less than 0.15 (57.1%).Conclusion. MRI-guided biopsy of the prostate is a diagnostic option for patients with suspected prostate cancer and a history of repeatedly negative transrectal ultrasound-guided biopsies. Combined with the free-to-total PSA ratio, it is a highly effective method for detecting prostate cancer.

scholarly journals Systematic and MRI-Cognitive Targeted Transperineal Prostate Biopsy Accuracy in Detecting Clinically Significant Prostate Cancer after Previous Negative Biopsy and Persisting Suspicion of Malignancy

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 57
Author(s):  
Alvydas Vėželis ◽  
Gediminas Platkevičius ◽  
Marius Kinčius ◽  
Liutauras Gumbys ◽  
Ieva Naruševičiūtė ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Targeted Biopsy ◽  
Negative Biopsy ◽  
Prostate Biopsies ◽  
Clinically Significant ◽  
Systematic Biopsy ◽  
Targeted Biopsies

Background and objectives: Overdiagnosis, overtreatment, and the need for repeated procedures caused by transrectal ultrasound guided prostate biopsies and their related complications places a heavy burden on healthcare systems. This was a prospective cohort validating study to access the clinical accuracy of systematic and MRI-cognitive targeted transperineal prostate biopsies in detecting clinically significant prostate cancer after a previous negative biopsy and persistent suspicion of malignancy. The primary goal was to assess the ability of multiparametric magnetic resonance imaging (mpMRI) to detect clinically significant prostate cancer with an additional goal to assess the diagnostic value of systematic and MRI-cognitive transperineal biopsies. Materials and Methods: In total, 200 patients were enrolled who had rising serum prostate specific antigen (PSA) levels for at least 4 months after a previous negative transrectal ultrasound (TRUS) biopsy. All eligible men underwent 1.5T prostate mpMRI, reported using the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), followed by a 20-region transperineal prostate systematic biopsy and additional targeted biopsies. Results: Systematic 20-core transperineal prostate biopsies (TPBs) were performed for 38 (19%) patients. Systemic 20-core TPB with additional cognitive targeted biopsies were performed for 162 (81%) patients. Clinically significant prostate cancer (csPC) was detected for 31 (15.5%) patients, of which 20 (64.5%) cases of csPC were detected by systematic biopsy, eight (25.8%) cases were detected by targeted biopsy, and three (9.7%) both by systematic and targeted biopsies. Conclusions: Cognitive mpMRI guided transperineal target biopsies increase the detection rate of clinically significant prostate cancer after a previously negative biopsy. However, in a repeat prostate biopsy setting, we recommend applying a cognitive targeted biopsy with the addition of a systematic biopsy.

scholarly journals Current Status of MRI and PET in the NCCN Guidelines for Prostate Cancer

2019 ◽  
Vol 17 (5) ◽  
pp. 506-513 ◽  
Author(s):  
Brandon R. Mason ◽  
James A. Eastham ◽  
Brian J. Davis ◽  
Lance A. Mynderse ◽  
Thomas J. Pugh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
The United States ◽  
Current Status ◽  
Low Grade ◽  
Nccn Guidelines ◽  
Psa Testing ◽  
Pet Ct

Prostate cancer (PCa) represents a significant source of morbidity and mortality for men in the United States, with approximately 1 in 9 being diagnosed with PCa in their lifetime. The role of imaging in the evaluation of men with PCa has evolved and currently plays a central role in diagnosis, treatment planning, and evaluation of recurrence. Appropriate use of multiparametric MRI (mpMRI) and MRI-guided transrectal ultrasound (MR-TRUS) biopsy increases the detection of clinically significant PCa while decreasing the detection of clinically insignificant PCa. This process may help patients with clinically insignificant PCa avoid the adverse effects of unnecessary therapy. In the setting of a known PCa, patients with low-grade disease can be observed using active surveillance, which often includes a combination of prostate-specific antigen (PSA) testing, serial mpMRI, and, if indicated, follow-up systematic and targeted TRUS-guided tissue sampling. mpMRI can provide important information in the posttreatment setting, but PET/CT is creating a paradigm shift in imaging standards for patients with locally recurrent and metastatic PCa. This article examines the strengths and limitations of mpMRI for initial PCa diagnosis, active surveillance, recurrent disease evaluation, and image-guided biopsies, and the use of PET/CT imaging in men with recurrent PCa. The goal of this review is to provide a rational basis for current NCCN Clinical Practice Guidelines in Oncology for PCa as they pertain to the use of these advanced imaging modalities.

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