scholarly journals A review of optimal prostate biopsy: indications and techniques

2019 ◽  
Vol 11 ◽  
pp. 175628721987007 ◽  
Author(s):  
Justin Streicher ◽  
Brian Lee Meyerson ◽  
Vidhya Karivedu ◽  
Abhinav Sidana
Keyword(s):  
Prostate Cancer ◽  
Patient Selection ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Diagnostic Technique ◽  
Fusion Biopsy ◽  
Advantages And Disadvantages ◽  
Software Platforms ◽  
Selection For

Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Patient selection for prostate biopsy is complex and is influenced by emerging use of prebiopsy imaging. The introduction of the magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion prostate biopsy has clear advantages over the historical standard of care. There are several biopsy techniques currently utilized with unique advantages and disadvantages. We review and summarize the current body of literature pertaining to when and how a prostate biopsy should be performed. We discuss current recommendations regarding patient selection for biopsy and discuss future directions regarding prebiopsy imaging. We offer a description of the MRI–TRUS fusion biopsy technique and a comparison of many of the currently available fusion software platforms. Articles pertaining to the title were obtained via PubMed index search with relevant keywords supplemented with personal collection of related publications. Prostate biopsy should be considered for patients with gross digital rectal exam (DRE) abnormality, patients with a prostate-specific antigen (PSA) greater than 4 ng/ml, and concomitant risk factors for prostate cancer or patients with lesions identified on multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System 2 (PI-RADS2) score of 4 or 5. MRI–TRUS fusion biopsy has demonstrated advantages in cancer detection when compared with TRUS-guided biopsy. There are currently several fusion software platforms available with a variety of biopsy approaches. Future efforts should detail the role of prebiopsy imaging as a triage tool for prostate biopsy. Consensus should be sought regarding the preferred modality of fusion biopsy. Additional data describing each fusion software platform would enable a more rigorous comparison of platform sensitivities.

Comparing magnetic resonance imaging/ultrasound-fusion biopsy and systemic 12-core transrectal ultrasound biopsy for whole gland pathology.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 84-84
Author(s):  
Daniel Su ◽  
Arvin George ◽  
Minhaj Siddiqui ◽  
Soroush Rais-Bahrami ◽  
Lambros Stamatakis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Prostate Biopsy ◽  
Core Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Low Grade ◽  
High Grade ◽  
Fusion Biopsy ◽  
Clinically Significant

84 Background: Historically, pathologic findings from standard 12-core prostate biopsies are upgraded in 25 to 33% of patients after radical prostatectomy (RP). MRI/US fusion prostate biopsy has been shown to upgrade prostate cancer compared to standard 12-core biopsy in 32% of patients. MRI/US fusion biopsy may offer a more accurate representation of whole gland pathology. We evaluate the rate of pathologic upgrade in standard 12-core biopsy and MRI/US fusion biopsy when compared with whole gland pathology from RP. Methods: Patients who underwent random prostate biopsy, fusion biopsy and subsequently RP for prostate cancer from 2012 to 2013 were included. Pathology was reviewed by a single pathologist. The cohort was divided into clinically significant high-grade (Gleason score 4+3 or higher) and clinically insignificant low-grade (Gleason score 3+4 or lower) sub cohorts. Pathological upgrade was defined as any increase in Gleason sum or primary Gleason score. McNemar’s test was used to compare the proportion of patients who were upgraded from random biopsy to RP versus the proportion that were upgraded from fusion biopsy to RP. Results: Sixty eight patients underwent 12-core and fusion prostate biopsy then subsequently RP. Mean prostate-specific antigen was 9.2ng/ml. There are total of 43 patients with clinically insignificant low-grade and 25 patients with clinically significant high-grade. Fusion biopsy upgraded 19 patients (28%) compared to 12-core biopsy, eight of these patients had negative 12-core biopsy. Pathology on the RP specimen upgraded 18 of the 12-core results (26%) compare to only eight fusion biopsy results (11%). (p =0.0095) 14 patients (20%) who had clinically insignificant low-grade disease on 12-core biopsy were upgraded to clinically significant high-grade on RP. Only two patients (3%) with clinically insignificant low-grade from fusion biopsy were upgraded on RP. (p< 0.0005) Conclusions: Prostate cancer detected on MRI/US fusion prostate biopsy has significantly lower rates of pathologic upgrade than standard 12-core biopsy when both were compared to prostatectomy specimens. MRI/US fusion biopsy may represent whole gland pathology more accurately compared to 12-core biopsy.

scholarly journals MRI-TRUS fusion biopsy in diagnostics of prostate cancer

2021 ◽  
Vol 14 (3) ◽  
pp. 86-93
Author(s):  
R.A. Romanov ◽  
◽  
A.V. Koryakin ◽  
A.V. Sivkov ◽  
B.Ya. Alekseev ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Prostate Biopsy ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Fusion Biopsy ◽  
Advantages And Disadvantages ◽  
Magnetic Resonance Imaging Mri ◽  
Targeted Biopsies

Introduction. Significant improvement in the quality of visualization of the prostate using magnetic resonance imaging (MRI), as well as the development of technologies for virtual combination of MRI and ultrasound images opens new horizons in the diagnosis of prostate cancer. The introduction of the PI-RADS system has allowed the standardization of MRI findings, and the development of fusion biopsy systems seeks to make diagnostics more accurate and less operator-dependent. Materials and methods. In this literature review, we evaluate the effectiveness of various biopsy approaches and discuss the prospects for targeted biopsies. The search for publications was carried out in the databases PubMed, e-library, Web of Scince et al. For citation, 55 literature sources were selected that met the search criteria for the keywords, «prostate cancer», «biopsy», «MRI», «TRUS», «fusion». Results. Diagnosis of prostate cancer using MRI. Modern technologies for radiological diagnosis of prostate cancer using magnetic resonance imaging (MRI) are based on the standardized PI-RADS protocol, using different modes (T2, diffusion-weighted images and contrast enhancement), which provides the best visualization of tumor-suspicious nodes in the prostate gland, allowing determination of lesion localization and size for subsequent targeted biopsy. Options for performing a prostate biopsy to diagnose prostate cancer. A description of the methods and effectiveness of transrectal and transperineal biopsy under ultrasound guidance is carried out - due to the fact that ultrasound diagnostics of prostate cancer has a rather low sensitivity due to small differences in the ultrasound structure of normal and tumor tissue of the prostate, an extended template biopsy technique was proposed, which involves puncture of the prostate through a special lattice. It also describes the technology of fusion biopsy and also provides literature data comparing the diagnostic accuracy of standard TRUS and fusion prostate biopsy, as well as the importance of transrectal / transperineal access. Questions for further study. Given the desire to reduce the number of biopsies while maintaining or even increasing the accuracy of diagnosing prostate cancer, data from studies investigating the feasibility of combining polyfocal (non-targeted) and targeted (targeted) biopsies are presented. Conclusion. The existing methods of non-targeted biopsy (polyfocal, saturation, template) and targeted (fusion biopsy) have their advantages and disadvantages, which currently do not allow making certain recommendations for their use, but a significant number of authors prefer MRI-as sisted, fusion -biopsy.

scholarly journals Independent Validation of a Diagnostic Noninvasive 3-MicroRNA Ratio Model (uCaP) for Prostate Cancer in Cell-Free Urine

2019 ◽  
Vol 65 (4) ◽  
pp. 540-548 ◽  
Author(s):  
Jacob Fredsøe ◽  
Anne K I Rasmussen ◽  
Emma B Laursen ◽  
Yunpeng Cai ◽  
Kenneth A Howard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Area Under The Curve ◽  
Extracellular Vesicle ◽  
Urine Samples ◽  
Ratio Model ◽  
Psa Testing ◽  
Diagnostic Potential

Abstract BACKGROUND Detection of prostate cancer (PC) based on serum prostate-specific antigen (PSA) testing leads to many unnecessary prostate biopsies, overdiagnosis, and overtreatment of clinically insignificant tumors. Thus, novel and more accurate molecular biomarkers are required. METHODS Using reverse transcription quantitative PCR, we measured the concentrations of 45 preselected microRNAs (miRNAs) in extracellular vesicle-enriched cell-free urine samples from 4 independent patient cohorts from Spain and Denmark, including 758 patients with clinically localized PC, 289 noncancer controls with benign prostatic hyperplasia (BPH), and 233 patients undergoing initial transrectal ultrasound (TRUS)-guided prostate biopsy owing to PC suspicion (101 with benign and 132 with malignant outcome). Diagnostic potential was assessed by ROC and decision curve analysis. RESULTS We identified and successfully validated 8 upregulated and 21 downregulated miRNAs in urine from PC patients. Furthermore, we validated a previously identified 3-miRNA diagnostic ratio model, uCaP (miR-222–3p*miR-24–3p/miR-30c-5p). High uCaP scores were distinctive of PC in urine samples from BPH vs PC patients in 3 independent cohorts [area under the curve (AUC) = 0.84, 0.71, 0.72]. Additionally, uCaP predicted TRUS biopsy results with greater accuracy than PSA (AUC uCaP = 0.644; AUC PSA = 0.527) for patients within the diagnostic gray zone (PSA ≤ 10 ng/mL). CONCLUSIONS We successfully validated a urine-based diagnostic 3-miRNA signature for PC (uCaP) in 3 independent patient cohorts from 2 countries. In the future, the simple and noninvasive uCaP test may be used to help more accurately select patients for prostate biopsy. Prospective clinical validation is warranted.

scholarly journals Tumor-Associated Release of Prostatic Cells into the Blood after Transrectal Ultrasound-Guided Biopsy in Patients with Histologically Confirmed Prostate Cancer

2019 ◽  
Vol 66 (1) ◽  
pp. 161-168 ◽  
Author(s):  
Simon A Joosse ◽  
Burkhard Beyer ◽  
Christin Gasch ◽  
Paulina Nastały ◽  
Andra Kuske ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Tumor Cells ◽  
Prostate Biopsy ◽  
Standard Procedure ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Ultrasound Guided ◽  
Systemic Spread

Abstract BACKGROUND Transrectal ultrasound-guided prostate biopsy (TRUS) is a standard procedure for prostate cancer diagnosis. Because prostate cancer is a multifocal disease in many patients, multiple sampling (n ≥ 10) is required, which may bear the risk of systemic spread of cancer cells. DESIGN Using the standardized CellSearch® system that allows for the detection of single epithelial cell adhesion molecule-positive circulating tumor cells (CTCs) in blood, we investigated whether prostate biopsy is associated with release of prostatic tumor cells into the circulation. Peripheral blood was obtained before and within 30 min after performing prostate biopsy from 115 men with increased serum prostate-specific antigen. RESULTS The number of CTCs significantly increased after biopsy in men with histologically confirmed prostate cancer (odds ratio, 7.8; 95% CI, 4.8–12.8), whereas no biopsy-related changes could be detected in men without confirmed prostate cancer. Multivariable analysis showed that biopsy-related increase of CTCs was significantly correlated with a worse progression-free survival (hazard ratio, 12.4; 95% CI, 3.2–48.6) within the median follow-up of 41 months. CONCLUSIONS Prostate biopsies may lead to a tumor-associated release of CTCs into the blood circulation. Larger confirmatory trials with longer follow-up periods are required before any change in clinical practice can be recommended.

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.

Racial variation in the reliability of prostate cancer indicators in men undergoing subsequent prostate biopsy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 115-115
Author(s):  
Robert Scott Libby ◽  
Hoang MT Nguyen ◽  
Jordan J. Kramer ◽  
Allison H. Feibus ◽  
Raju Thomas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Health Care Services ◽  
African American Men ◽  
Medical Center ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Veterans Health ◽  
Psa Testing ◽  
Incidence And Mortality

115 Background: Many men with an initial negative prostate biopsy have a persistently elevated prostate specific antigen (PSA) prompting physicians to perform repeat biopsies. African American men (AA) are at particular risk as they have a greater prostate cancer (PCa) incidence and mortality, yet traditional PSA testing may be less reliable in this cohort. We sought to determine the predictors of PCa and PCa severity in a racially diverse population on subsequent biopsy following an initial benign biopsy. Methods: Upon receiving Institutional Review Board approval, a retrospective analysis was performed on men with repeat prostate biopsies at Tulane Medical Center and Southeast Louisiana Veterans Health Care Services in New Orleans, Louisiana from 2003-2015. Inclusion criteria included patients with a benign initial prostate biopsy and underwent subsequent repeat prostate biopsy within 5 years. Race, age, serum PSA, PSA density (PSAD), and prostate volume by transrectal ultrasound (TRUS) were evaluated to determine if they correlate with the presence and severity of PCa. Aggressive PCa was defined as Gleason score >6. Results: A total of 209 men were included; 127 (61%) were AA, and 82 (39%) were Caucasian American men (CA). The two groups were similar with respect to PSA, PSAD, and TRUS. More AA (25.2% vs. 17.1%) had a repeat biopsy showing any PCa. Of those with PCa, 28.1% of AA and 28.6% of CA had aggressive PCa. PSAD positively correlated with any PCa (p=.015). TRUS negatively correlated with any PCa (p=.008). PSA levels (p<.001) and PSAD (p<.001) positively correlated with aggressive PCa in CA but not in AA. Conclusions: The goal of prostate biopsy particularly for those with a prior negative biopsy is to detect aggressive PCa. PSA and PSAD positively correlated with finding any PCa in both AA and CA but not with aggressive PCa in AA. PSA and PSAD are less accurate predictors of aggressive PCa in AA, and novel biomarkers are needed. [Table: see text]

Prediction of pathological outcome at radical prostatectomy for MRI-ultrasound fusion prostate biopsy versus standard transrectal ultrasound guided prostate biopsy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 73-73
Author(s):  
Hans Arora ◽  
Yaw A. Nyame ◽  
Ahmed El-Shafei ◽  
Onder Kara ◽  
Andrei Purysko ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Biopsy ◽  
Cleveland Clinic ◽  
Transrectal Ultrasound ◽  
Categorical Variables ◽  
Fusion Biopsy ◽  
Trus Biopsy ◽  
Prostate Size ◽  
Standard Template

73 Background: Magnetic resonance imaging (MRI)-ultrasound (US) fusion prostate biopsy has been shown to be able to detect prostate cancer, with the goal of targeting specific lesions. Our objective was to evaluate the ability of this technique to accurately determine the final pathological outcome at the time of radical prostatectomy as compared to standard template 12-core transrectal ultrasound (TRUS) guided prostate biopsy. Methods: We performed a retrospective analysis of patients who underwent both prostate biopsy and prostatectomy at the Cleveland Clinic. Patients who underwent standard template 12-core TRUS biopsies between January 2005 through December 2013, and MRI-US fusion biopsies from January 2014 through June 2015 were included. Patients who had more than 12 cores taken during TRUS biopsy were excluded. Relevant covariates included patient demographics as well as pre-biopsy PSA and prostate size, which were collected from the electronic medical record. Continuous variables were compared using Wilcoxon rank-sum tests and categorical variables were assessed with χ2 test. Results: In total 543 patients were included. Of these, 491 underwent 12-core standard template TRUS biopsy whereas 54 underwent MRI-US fusion biopsy. Between the two groups there were no significant differences in age (median 62 years versus 63 years, p = 0.21), race (17.5% versus 12.3 % African American, p = 0.32), family history (31.5% versus 29.3% positive, p = 0.74), prostate size (47.75g, IQR 39.5-59 versus 42.7g, IQR 37-56, p = 0.08), pre-biopsy PSA (5.2 ng/mL, IQR 4.1-7.6 versus 4.97, IQR 3.24-6.95, p = 0.14). Of the fusion biopsy patients, 14 of 54 (25.9%) were upgraded from biopsy to prostatectomy, whereas 214 of 491 (43.6%) of TRUS biopsy patients were upgraded (p = 0.02). Conclusions: Of men undergoing transrectal biopsy for the diagnosis of prostate cancer, MRI-US fusion techniques have a lower rate of upgrading at final pathology at prostatectomy as compared to standard 12-core TRUS-guided biopsy.

The effect of urologic oncology fellowship training on type and yield of prostate biopsy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 135-135
Author(s):  
Molly Elmer DeWitt-Foy ◽  
Ahmed El-Shafei ◽  
Wendy Melissa Coronado ◽  
Robert Abouassaly
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Diagnostic Yield ◽  
Specific Antigen ◽  
Cleveland Clinic ◽  
Transrectal Ultrasound ◽  
Complete Information ◽  
Fellowship Training ◽  
Urologic Oncology ◽  
Positive Biopsy

135 Background: Prostate biopsy is a commonly performed procedure done in the evaluation of elevated prostate specific antigen (PSA), abnormal digital rectal exam (DRE), or for patients with a known prostate cancer diagnosis on active surveillance. The diagnostic yield of prostate biopsy is related to patient factors including age and race, but may also be correlated with provider factors, including clinical experience and training. We aim to determine the relationship between urologic oncology fellowship training (UOFT) and years of training with diagnostic yield of prostate biopsy. Methods: A retrospective review was conducted of patients who underwent prostate biopsy across the Cleveland Clinic between 2000 and 2018. Biopsies done by urologists with and without UOFT were detailed via descriptive statistics and with appropriate (chi square, Student t) tests. Logistic regression was performed, adjusting for last PSA, age, race, and type of biopsy. Results: A total of 11,255 biopsies performed by 129 urologists had complete information for review. The average patient age at biopsy was 65 years. The mean number of years in practice was 16 with a range from < 1 to 46 (SD 11.26). Of 129 urologists 16 (12.4%) had completed a urology oncology fellowship. Those with UOFT were more likely to use MRI guidance for biopsy (7.73% v 2.89%). Overall, 35.5% of all biopsies were positive for prostate cancer, with a significantly higher rate of positive biopsy for urologists with UOFT (40.7% v 32.43%, OR 1.4, p < 0.0001). Having completed greater than 5 years of clinical practice was correlated with greater odds of positive biopsy (OR 1.170, p < 0.0001), but significance of this association was lost when adjusting for oncology fellowship. UOFT remained a significant predictor of diagnostic yield even when adjusting for most recent PSA, age and race of patient, provider years in practice, and type of biopsy (MRI v transrectal ultrasound). Conclusions: Urologic oncology fellowship training is associated with a higher diagnostic yield on prostate biopsy, and a higher uptake of MRI guided biopsy. Higher rate of positivity on biopsy may be attributable to more nuanced patient selection for biopsy or to biopsy technique.

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