A single centre service evaluation of the pre-biopsy mpMRI pathway for prostate cancer diagnosis

2022 ◽  
pp. 205141582110659
Author(s):  
Mark Kong ◽  
Louise Lee ◽  
Kevin Mulcahy ◽  
Arumugam Rajesh
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Waiting Times ◽  
Specific Antigen ◽  
Service Evaluation ◽  
Level Of Evidence ◽  
Prostate Cancer Diagnosis ◽  
Psa Density ◽  
Tertiary Centre ◽  
Clinically Significant

Aim: To study the efficacy and impact of the local pre-biopsy multiparametric magnetic resonance imaging (mpMRI) pathway for prostate cancer diagnosis. Methods: In this tertiary centre, 570 patients had prostate mpMRI across a 6-month period in 2019. A total of 511 patients met inclusion criteria for retrospective analysis. MRI reporting used the Prostate Imaging-Reporting and Data System (PI-RADS) v2.1. These were assessed alongside histological outcomes and diagnostic times. PI-RADS ⩾ 3 were recommended for biopsy consideration. Gleason scoring ⩾ 3 + 4 and 3 + 3 were used to define clinically and non-clinically significant prostate cancer (csPCa and nsPCa), respectively. Results: Overall prostate cancer prevalence was 40% (204/511, csPCa in 31.1%) with an overall biopsy avoidance of 32.1% (164/511). Around 69.7% (356/511) scored PI-RADS ⩾ 3 and 30.3% (155/511) scored PI-RADS 1–2. About 22.6% (35/155) of PI-RADS 1–2 patients proceeded to biopsy, demonstrating a negative predictive value of 91.43% for csPCa. For PI-RADS ⩾ 3 patients, 63.4% (197/312) of those biopsied had cancer (Gleason ⩾ 3 + 3), with 50% (156/312) demonstrating csPCa. Around 76.7% (102/133) of PI-RADS 5, 35.3% (48/136) of PI-RADS 4, 14.0% (6/43) of PI-RADS 3 and 8.6% (3/35) of PI-RADS 1–2 scores demonstrated csPCa. Overall median prostate-specific antigen (PSA) density was 0.15 ng/mL2 (IQR: 0.10–0.27/mL2). PSA density were significantly different across PI-RADS cohorts ( H = 118.8, p < 0.0001) and across all three biopsy outcomes ( H = 99.72, p < 0.0001). Only 34.3% (119/347) of biopsied patients met the NHS 28-day standard. MRI acquisition and reporting met the 14-day local standard in 96.1% (491/511). The biopsy was the most delayed component with a median of 20 days (IQR: 8–43). Conclusion: Pre-biopsy mpMRI with PI-RADS scoring safely avoided biopsy in almost one-third (32.1%) of patients. The use of PSA-density in risk stratifying PI-RADS 3 lesions has informed local practice in the period 2020–2021, with implementation of a PSA-density threshold of 0.12 ng/mL2. Biopsy scheduling issues and anaesthetic requirements need to be overcome to improve diagnostic waiting times. Level of evidence: 2

scholarly journals Is PSA density of the peripheral zone as a useful predictor for prostate cancer in patients with gray zone PSA levels?

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaegeun Lee ◽  
Seung Woo Yang ◽  
Long Jin ◽  
Chung Lyul Lee ◽  
Ji Yong Lee ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Prostate Biopsy ◽  
Peripheral Zone ◽  
Transitional Zone ◽  
Gray Zone ◽  
Prostate Cancer Diagnosis ◽  
Psa Density ◽  
Diagnosis Group ◽  
Predictive Rate

Abstract Background Serum prostate-specific antigen (PSA) is widely used in screening tests for prostate cancer. As the low specificity of PSA results in unnecessary and invasive prostate biopsies, we evaluated the clinical significance of various PSAs and PSA density (PSAD) related to peripheral zones in patients with gray zone PSA level (4–10 ng/mL). Methods A total of 1300 patients underwent transrectal ultrasonography-guided prostate biopsy from 2014 to 2019. Among them, 545 patients in the gray zone were divided into the prostate cancer diagnosis group and the non-prostate cancer diagnosis group, and PSA, relative extra transitional zone PSA (RETzPSA), estimated post holmium laser enucleation of the prostate PSA (EPHPSA), PSAD, peripheral zone PSA density (PZPSAD) and extra-transitional zone density (ETzD) were compared and analyzed using receiver-operating characteristics (ROC) analysis after 1:1 matching using propensity score. Results Area under the ROC curve values of PSA, EPHPSA, RETzPSA, PSA density, ETzD, and PZPSAD were 0.553 (95% CI: 0.495–0.610), 0.611 (95% CI: 0.554–0.666), 0.673 (95% CI: 0.617–0.725), 0.745 (95% CI: 0.693–0.793), 0.731 (95% CI: 0.677–0.780) and 0.677 (95% CI: 0.611–0.719), respectively. PSAD had 67.11% sensitivity, 71.71% specificity, and 70.34% positive predictive rate at 0.18 ng/mL/cc. ETzD had 69.08% sensitivity, 64.47% specificity, and 66.04% positive predictive rate at 0.04 ng/mL/cc. When the cut-off value of PSAD was increased to 0.18 ng/mL/cc, the best results were obtained with an odds ratio of 5.171 (95% CI: 3.171–8.432), followed by ETzD with 4.054 (95% CI: 2.513–6.540). Conclusions These results suggested that volume-adjusted parameters (ETzD and PSAD) might be more sensitive and accurate than various PSA in gray zone patients who required prostate biopsy to reduce unnecessary biopsy.

mpMRI-targeted biopsy versus systematic biopsy for clinically significant prostate cancer diagnosis

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Willy Baccaglini ◽  
Felipe P.A. Glina ◽  
Cristiano L. Pazeto ◽  
Wanderley M. Bernardo ◽  
Rafael Sanchez-Salas
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Targeted Biopsy ◽  
Prostate Cancer Diagnosis ◽  
Clinically Significant ◽  
Systematic Biopsy

A circulating miRNA signature to help prognosticate at prostate cancer diagnosis.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 108-108 ◽  
Author(s):  
Ailsa Roberg Sita-Lumsden ◽  
Damien Leach ◽  
Andrea Zivi ◽  
Jonathan Waxman ◽  
Mathias Winkler ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Diagnosis ◽  
Survival Rates ◽  
Benign Prostatic Hypertrophy ◽  
Serum Levels ◽  
The Cancer Genome Atlas ◽  
Prostate Cancer Diagnosis ◽  
Circulating Mirna ◽  
Clinically Significant ◽  
Prostate Cancers

108 Background: Prostate cancer (PCa) is the most commonly diagnosed cancer in men. Around 80% of PCas are diagnosed as early, localised stage yet a subset of these will metastasise and eventually prove fatal. Management decisions are based on risk stratification systems. However, these systems are not able to clearly distinguish indolent from aggressive PCa’s and as a result many patients with indolent cancers may be over treated. Circulating microRNAs (miRNA) may be an easily accessible, suitable biomarker to distinguish true indolent from clinically significant early prostate cancers (PCa) thus reducing overtreatments. Methods: Blood samples from 24 men with benign prostatic hypertrophy (BPH, n = 8), localised PCa (n = 8) or metastatic PCa (n = 8) were collected at time of diagnosis. All men had intact prostates and were naïve to any endocrine or other cancer therapy. A platform of circulating miRNAs were analysed in serum using Abcam Firefly technology. Data collected were independently verified using real-time qPCR (Exiqon). The miRNAs identified as being significantly different between groups were then analysed in a published dataset. Results: Serum levels of seven of the miRs examined were significantly different in patients with prostate cancer compared to control across both platforms (miR-10b, miR-125b, miR-210, miR-21, miR-378a, miR-483 and miR93 all with P values < 0.005). A further four miRNAs could differentiate between the benign and metastatic cohorts (miR-126 P = 0.008, miR-150 P = 0.05, miR375 P = 0.007). Kaplein-Meier analysis further identified that the serum levels of four miRNAs showed significant association with survival rates (miR-21 P = 0.032, miR-126 P = 0.032, miR-150 P = 0.032, miR-93 P = 0.019). On examination in a cohort of 280 men from The Cancer Genome Atlas (TCGA), four miRs from the cohort had significantly different expression in patients who eventually relapsed (miR-21 P = 0.048, miR-375 P = 0.021, miR-210 P = 0.0003, miR-93 P = 0.008) Conclusions: Our circulating miRNA based signature could be used to stratify men at prostate cancer diagnosis and help identify those who are likely to harbour micro metastases and would benefit more from an early radical treatment. The data is being validated in larger cohorts.

UP.42: Correlation of Pre-operative Prostate Specific Antigen (PSA) With Gleason Grading in Prostate Cancer Diagnosis

Urology ◽  
2008 ◽  
Vol 72 (5) ◽  
pp. S122-S123
Author(s):  
K. Gyasi-Sarpong ◽  
K. Boateng ◽  
K. Aboah ◽  
P. Opoku ◽  
M. Adu-Gyamfi
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Cancer Diagnosis ◽  
Specific Antigen ◽  
Prostate Cancer Diagnosis ◽  
Gleason Grading
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