Changes in prostate cancer detection rate of fusion versus systematic biopsy over time: A single center experience.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 15-15
Author(s):  
Brian P. Calio ◽  
Abhinav Sidana ◽  
Dordaneh Sugano ◽  
Amit L Jain ◽  
Mahir Maruf ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Learning Curves ◽  
Low Risk ◽  
Fusion Biopsy ◽  
Detection Rates ◽  
Single Center Experience ◽  
Significant Difference ◽  
Clinically Significant ◽  
Systematic Biopsy

15 Background: To determine the effect of learning curves and changes in fusion platform during 9 years of NCI’s experience with multiparametric MRI (mpMRI)/TRUS fusion biopsy. Methods: A review was performed of a prospectively maintained database of patients undergoing mpMRI followed by fusion biopsy (Fbx) and systematic biopsy (Sbx) from 2007−2016. The patients were stratified based on the timing of first biopsy in 3 groups. Cohort 1 included patients biopsied between 7/2007−12/2010, accounting for learning curve at our institution. Cohort 2 included patients biopsied from 1/2011 up to the debut of UroNav (Invivo) platform in 5/2013. Cohort 3 included patients biopsied after 5/2013. Clinically significant (CS) disease was defined as Gleason 7 (3+4) or higher. Cancer detection rates (CDR) between Sbx and Fbx during different time periods were compared using McNemar’s test. Age and PSA standardized CDRs were calculated for comparison between 3 cohorts. Results: 1528 patients were included in the study with 219, 549 and 761 patients included in 3 respective cohorts. Mean age, PSA and race distribution were similar across 3 cohorts. In cohort 1 there was no significant difference between CDR of CS disease by Fbx (24.7%) vs Sbx (21.5%), p = 0.377. Fbx was significantly better than Sbx in detection of CS disease in cohort 2 and cohort 3 (31.5% vs 25.3%, p = 0.001; 36.5% vs 30.2%, p < 0.001, respectively). There was significant decline in detection of low risk disease by Fbx compared to Sbx in the same period (cohort 2: 14.2% vs 20.9%, p < 0.001; cohort 3: 12.5% vs 19.5%, p < 0.001). Age and PSA standardized CDR of CS cancer by Fbx increased significantly between each successive cohort (cohort 1 and 2: 5.2%, 95% CI [2.1-8.5]), 2 and 3 (5.2%, 95% CI [1.8-8.6]). Conclusions: Our results show that after an early learning period using Fbx, CS prostate cancer was detected at significantly higher rates with Fbx than with Sbx, and low risk disease was detected at lower rates. Advances in software allowed for even greater detection of CS disease in the last cohort. This study shows that accuracy of Fbx is dependent on multiple factors; surgeon/radiologist experience and software improvements together produce improved accuracy.

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.

scholarly journals Cancer Detection Rates of Systematic and Targeted Prostate Biopsies after Biparametric MRI

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Maudy C. W. Gayet ◽  
Anouk A. M. A. van der Aa ◽  
Harrie P. Beerlage ◽  
Bart Ph Schrier ◽  
Maaike Gielens ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Significant Difference ◽  
Significant Pathology ◽  
Study Population ◽  
Clinically Significant ◽  
Control Study

Objective. To compare prostate cancer detection rates (CDRs) and pathology results with targeted prostate biopsy (TB) and systematic prostate biopsy (SB) in biopsy-naive men. Methods. An in-patient control study of 82 men undergoing SB and subsequent TB in case of positive prostate MRI between 2015 and 2017 in the Jeroen Bosch Hospital, the Netherlands. Results. Prostate cancer (PCa) was detected in 54.9% with 70.7% agreement between TB and SB. Significant PCa (Gleason score ≥7) was detected in 24.4%. The CDR with TB and SB was 35.4% and 48.8%, respectively (p=0.052). The CDR of significant prostate cancer with TB and SB was both 20.7%. Clinically significant pathology upgrading occurred in 7.3% by adding TB to SB and 22.0% by adding SB to TB. Conclusions. There is no statistically significant difference between CDRs of SB and TB. Both SB and TB miss significant PCas. Moreover, pathology upgrading occurred more often by adding SB to TB than vice versa. This indicates that the omission of SB in this study population might not be justified.

scholarly journals Magnetic resonance/ultrasound fusion targeted biopsy of the prostate can be improved by adding systematic biopsy

2021 ◽  
Author(s):  
Victor Mihail Cauni ◽  
Dan Stanescu ◽  
Florin Tanase ◽  
Bogdan Mihai ◽  
Cristian Persu
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Cancer Detection ◽  
Detection Rate ◽  
Specific Antigen ◽  
Cancer Detection Rate ◽  
Targeted Biopsy ◽  
Detection Rates ◽  
Clinically Significant ◽  
Systematic Biopsy

Aim: Magnetic resonance/ ultrasound fusion targeted biopsy (Tbs) is widely used for diagnosing prostate cancer (PCa). The aim of our study was to compare the cancer detection rate (CDR) and the clinically significant prostate cancer detection rate (csPCa) of the magnetic resonance/ultrasound fusion targeted biopsy with those of the standard systematic biopsy (Sbs) and of the combination of both techniques.Material and methods: A total of 182 patients underwent magnetic resonance/ultrasound fusion Tbs on the prostate for PCa suspicion based on multiparametric magnetic resonance imaging (mMRI) detection of lesions with PI-RADSv2 score ≥3. A total of 78 patients had prior negative biopsies. Tb was performed by taking 2-4 cores from each suspected lesion, followed by Sb with 12 cores. We evaluated the overall detection rate of PCa and clinically significant prostate cancer, defined as any PCa with Gleason score ≥3+4.Results: Median prostate specific antigen (PSA) level pre-biopsy was 7.4 ng/ml and median free-PSA/PSA ratio was 10.2%. Patient median age was 62 years old. PIRADSv2 score was 3 in 54 cases, 4 in 96 cases and 5 in 32 cases. PI-RADS-dependent detection rate of Tbs for scores 3, 4 and 5 was 25.9%, 65.6% and 84.4%, respectively, with csPCa detection rates of 24.1%, 54.2%, and 71.9%. Overall detection rate was 57.1% for Tbs, which increased to 60.4% by adding Sbs results. Detection rate for clinically significant prostate cancer (csPCa) was 48.4% and increased to 51.1% by adding Sbs. Overall detection rate for repeated biopsy was 50% and 68.3% for biopsy in naïve patients. Sbs detection rate was 55.5%, 8 patients having a negative biopsy on Tbs.Conclusions: When Tbs is considered due to a PI-RADS ≥3 lesion on mMRI, combined Tbs + Sbs increases the overall CDR and csPCa detection rates.

Role of core location in targeted MRI-ultrasound fusion biopsy of prostate lesions.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 136-136
Author(s):  
Amanda Lu ◽  
Kamyar Ghabili ◽  
Kevin Nguyen ◽  
Preston Sprenkle
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
High Volume ◽  
Central Core ◽  
Lesion Volume ◽  
Fusion Biopsy ◽  
Detection Rates ◽  
Clinically Significant ◽  
Targeted Mri

136 Background: Targeted mpMRI fusion biopsy has gained adoption with superior clinically significant cancer detection rates and accuracy over template biopsy. We sought to establish the role of biopsy location within a prostate lesion to detect clinically significant prostate cancer. Methods: From Nov 2016-Aug 2017, 110 patients with positive multiparametric-MRI (mpMRI) underwent targeted and systematic MRI-US fusion biopsy at our institution for clinical suspicion or known history of prostate cancer. Lesions were scored by Prostate imaging reporting and data system (PI-RADS) classification schema by experienced genitourinary radiologists. Biopsy was performed by an oncology-trained urologist (PS) performing a high volume of fusion biopsies. 5 cores were taken from each lesion, each corresponding to a predetermined location (central, medial, lateral, apex, and base of the lesion). Cancer detection rates (CDR) were calculated on a per lesion basis from biopsy histology. Results: 154 prostate lesions were identified and biopsied with an average volume of 1.31 mL. Detection of clinically significant cancer (G>3+4) did not differ significantly among the 5 locations (Table 1). The central core detected slightly more G≥3+4 cancers than the apex core. No concordance of pathology grade was found between the central core and location of the peripheral core (medial, lateral, apex, or base). In 32% (50/154) of lesions, the peripheral cores had a higher Gleason score than the central core. Biopsy of only the central core missed 40% (21/52) of G≥3+4 cancers and 17% (4/24) of G>3+4 cancers. Lesions with higher PIRADs score were more likely to detect cancer in both the central and peripheral cores, but lesion volume was not a significant predictor. Conclusions: Location of biopsy cores within mpMRI-identified prostate lesions has little correlation with detection of clinically significant cancer. However, targeted biopsy of only the center of a lesion can miss 17% of Gleason >3+4 cancers. [Table: see text]

Concordance of systematic and fusion biopsy with surgical pathology.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 93-93 ◽  
Author(s):  
Alice Yu ◽  
Tammer Yamany ◽  
Nawar Hanna ◽  
Eduoard Nicaise ◽  
Amirkasra Mojtahed ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Cancer Detection ◽  
Surgical Pathology ◽  
Targeted Biopsy ◽  
Fusion Biopsy ◽  
Exact Test ◽  
Significant Difference ◽  
Clinically Significant ◽  
Systematic Biopsy

93 Background: Multiparametric MRI is increasingly used in prostate cancer detection. Previous studies have shown that detection rate of clinically significant cancer is higher in MRI targeted biopsy than systematic biopsy. However, the concordance between the Gleason score on fusion biopsy and radical prostatectomy is less well known. The objective of this study is to look for predictors of histopathologic concordance between biopsy (fusion and systematic) and radical prostatectomy. Methods: We used an institutional database of men who underwent mpMRI-ultrasound fusion targeted and systematic biopsy followed by radical prostatectomy. Gleason score on targeted, systematic and combination (targeted + systematic) biopsy were compared with Gleason score on radical prostatectomy, and concordance was recorded. The McNemar test was used to compare concordance and upgrade rates. Predictors of concordance and upgrade such as age, prostate volume, PSA, PSA density, Gleason score on biopsy, number of targets reported on mpMRI, and PI-RADS score were evaluated with Fisher’s exact test and logistic regression. Results: Surgical pathology was concordant with 47.4% of systematic biopsies, 52.0% of targeted biopsies and 58.4% of combination biopsies. There was no significant difference in concordance rates between systematic and targeted biopsy (P = 0.37). However, combination biopsy was superior to both systematic (RR 1.23, 95% CI 1.08-1.40, P = 0.03) and targeted biopsy (RR 1.12, 95% CI 1.02 – 1.24, P = 0.03) in predicting concordance with surgical pathology. Risk of upgrade to a higher Gleason score on surgical pathology was significantly lower with combination biopsy compared to systematic (RR 0.57, 95% CI 0.46-0.69, P < 0.001) or targeted biopsy alone (RR 0.72, 95% CI 0.61-0.84, P = 0.001). Upgrade rates were 43.9% for systematic biopsy, 34.7% for targeted, and 24.9% for combination. Lastly, we found no significant predictors of concordance or upgrade. Conclusions: Combination biopsy is associated with the highest concordance rate between biopsy and radical prostatectomy when compared with systematic or targeted biopsy alone. Performing targeted biopsy alone will underestimate tumour aggressiveness on surgical pathology.

Are all biopsies created equal? comparison of extended sextant prostate biopsies performed with and without MRI-TRUS fusion biopsy system.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 117-117
Author(s):  
Graham R. Hale ◽  
Jonathan Bloom ◽  
Vikram Sabarwal ◽  
Samuel Gold ◽  
Kareem Rayn ◽  
...  
Keyword(s):  
Cancer Detection ◽  
Clinical Stage ◽  
Time Intervals ◽  
Fusion Biopsy ◽  
Detection Rates ◽  
Inherent Risk ◽  
Prostate Biopsies ◽  
Benign Pathology ◽  
Under Sampling ◽  
Systematic Biopsy

117 Background: Extended sextant systematic prostate biopsies have the inherent risk of under-sampling prostate cancer. Fusion guided multiparametric magnetic resonance imaging (mpMRI) biopsies have been employed to better represent the disease and guide treatment. We sought to determine if due to heightened suspicion of cancer and/or visualization of mpMRI there were any discrepancies between systematic biopsies done with a Fusion System as compared to those done without (TRUS alone). Methods: From a prospectively collected database, we performed a review collecting age, race, clinical stage, PSA, and time until repeat systematic biopsy as part of fusion guided biopsy (IB). We also collected pathology results reported as Gleason Score (GS), for both the patients’ OB and our IB. Patients were stratified into groups based on time between OB and IB/fusion biopsy ( < 6 months, < 1 year and < 2 years). Results: 69 patients with a previous OB underwent combined fusion and IB within our designated time intervals. Cancer detection rates between the OB and IB results were similar at 6 months, 1 year and 2 years (80 vs 90%, 87.5 vs 87.5% and 65 vs 69%). Detection rates of GS ≥ 3+4 were higher with IB within 12 months compared with IB from 12-24 months (72.7 vs 40.9%, p = 0.03 OR 3.85 (1.09-13.66). Of the patients who were upgraded (n = 24), 54.2% (n = 13) went from benign pathology to a diagnosis of prostate adenocarcinoma. Of all OB GS 3+3 (n = 31), 29% were restaged to higher risk disease on IB. Rates of IB upgrading were similar within 6 months, 1 year and 2 year, 40%, 33.33% and 31.91%). Patients who were upgraded on IB compared to those who were not upgraded were of similar age (67.0 ± 6.53 vs 66.50 ± 6.47), race (17.4% African-American vs 13%), PSA (7.60 ± 5.61 vs 7.50 ± 4.39) and prostate volume on MRI (51.30 ± 26.87 vs 59.26 ± 38.52). Conclusions: A systematic biopsy at our referral center during a mpMRI fusion biopsy was over 3.5 times more likely to detect GS ≥ 3+4 when done within 1 year of the outside biopsy. There continued to be a risk, 34.7% overall, of disease upgrading in all time periods. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH

scholarly journals 3D versus 2D Systematic Transrectal Ultrasound-Guided Prostate Biopsy: Higher Cancer Detection Rate in Clinical Practice

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Alexandre Peltier ◽  
Fouad Aoun ◽  
Fouad El-Khoury ◽  
Eric Hawaux ◽  
Ksenija Limani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Transrectal Ultrasound ◽  
Daily Practice ◽  
Cancer Detection Rate ◽  
Prior History ◽  
Detection Rates ◽  
Significant Difference

Objectives. To compare prostate cancer detection rates of extended 2D versus 3D biopsies and to further assess the clinical impact of this method in day-to-day practice.Methods. We analyzed the data of a cohort of 220 consecutive patients with no prior history of prostate cancer who underwent an initial prostate biopsy in daily practice due to an abnormal PSA and/or DRE using, respectively, the classical 2D and the new 3D systems. All the biopsies were done by a single experienced operator using the same standardized protocol.Results. There was no significant difference in terms of age, total PSA, or prostate volume between the two groups. However, cancer detection rate was significantly higher using the 3D versus the 2D system, 50% versus 34% (P<0.05). There was no statistically significant difference while comparing the 2 groups in term of nonsignificant cancer detection.Conclusion. There is reasonable evidence demonstrating the superiority of the 3D-guided biopsies in detecting prostate cancers that would have been missed using the 2D extended protocol.

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