Detection of clinically significant prostate cancer after negative fusion and systematic biopsy.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 288-288
Author(s):  
Jeffrey Twum-Ampofo ◽  
Carl Ceraolo ◽  
Andrew Gusev ◽  
Adam S. Feldman
Keyword(s):  
Prostate Cancer ◽  
False Negative ◽  
High Rate ◽  
Repeat Biopsy ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Suspicious Lesion ◽  
Sextant Biopsy ◽  
Clinically Significant ◽  
Systematic Biopsy

288 Background: MRI/Ultrasound fusion biopsy of the prostate has enhanced the detection of clinically significant prostate cancer (csPCa). Detection of csPCa is greatest when fusion and systematic biopsies are combined. However, the finding of a negative fusion and negative systematic biopsy in patients with suspicious lesion on imaging raises the question of either falsely positive imaging or a false negative biopsy. Methods: We retrospectively reviewed our database of patients undergoing MRI/transrectal US-guided fusion biopsy. All images were graded according to the Prostate Imaging Reporting and Data System version (PIRADS) 2.0. Patients underwent targeted biopsy followed by systematic 12-core double sextant biopsy within the same session. csPCa was defined as Grade Group (GG) ≥2 PCa. Patients with no prostate cancer (PCa) found on biopsies were followed. MRI studies with PIRADS v2 score ≤ 2 were considered to have no MRI evidence of PCa. Results: A total of 400 patients had at least one PIRADS ≥3 lesion and underwent fusion/systematic biopsy. Of these, 113 (28.3%) patients had no evidence of PCa on either fusion or systematic biopsy. Median follow-up was 32.5 months. 44 (39%) patients underwent repeat MRI and of these, 24 (54%) had no evidence of PCa on repeat MRI. PIRADS lesion disappearance was associated with lower PSA Density (PSAd) (0.12 vs 0.20; P = 0.0319) and decreased progression to repeat biopsy (8.33% vs 95%; P < 0.0001). Patients who had a repeat biopsy had a greater PSAd ( 0.21 vs 0.12; P = 0.0054). Of 113 patients with negative initial biopsy, 23 (20.4 %) underwent repeat biopsy: 16 (14.2 %) had PCa and 11 (9.7%) had csPCa. Thus, 48% of patients who underwent repeat biopsy had csPCa. Among patients with a PCa on repeat biopsy, cancer was sampled by MRI targeted cores in 80% of patients. Conclusions: Despite a negative initial fusion/systematic biopsy, at least 10% of patients were subsequently diagnosed with clinically significant PCa. The combination of elevated PSAd and the persistence of a suspicious lesion on repeat MRI appears selective for previously missed PCa. However, after negative fusion biopsy, repeat MRI yields a high rate of PIRADS lesion disappearance in patients with low PSAd.

Naive patients with suspicious prostate cancer and positive multiparametric magnetic resonance imaging (mp-MRI): is it time for fusion target biopsy alone?

2021 ◽  
pp. 205141582110237
Author(s):  
Enrico Checcucci ◽  
Sabrina De Cillis ◽  
Daniele Amparore ◽  
Diletta Garrou ◽  
Roberta Aimar ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Detection Rate ◽  
Resonance Imaging ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Final Pathology ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Clinically Significant

Objectives: To determine if standard biopsy still has a role in the detection of prostate cancer or clinically significant prostate cancer in biopsy-naive patients with positive multiparametric magnetic resonance imaging. Materials and methods: We extracted, from our prospective maintained fusion biopsy database, patients from March 2014 to December 2018. The detection rate of prostate cancer and clinically significant prostate cancer and complication rate were analysed in a cohort of patients who underwent fusion biopsy alone (group A) or fusion biopsy plus standard biopsy (group B). The International Society of Urological Pathology grade group determined on prostate biopsy with the grade group determined on final pathology among patients who underwent radical prostatectomy were compared. Results: Prostate cancer was found in 249/389 (64.01%) and 215/337 (63.8%) patients in groups A and B, respectively ( P=0.98), while the clinically significant prostate cancer detection rate was 57.8% and 55.1% ( P=0.52). No significant differences in complications were found. No differences in the upgrading rate between biopsy and final pathology finding after radical prostatectomy were recorded. Conclusions: In biopsy-naive patients, with suspected prostate cancer and positive multiparametric magnetic resonance imaging the addition of standard biopsy to fusion biopsy did not increase significantly the detection rate of prostate cancer or clinically significant prostate cancer. Moreover, the rate of upgrading of the cancer grade group between biopsy and final pathology was not affected by the addition of standard biopsy. Level of evidence: Not applicable for this multicentre audit.

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.

Is PI-RADS 3/total lesion ratio associated with clinically-significant prostate cancer in patients with equivocal-risk lesions on multi-parametric MRI?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 149-149
Author(s):  
Kamyar Ghabili ◽  
Matthew Swallow ◽  
Alfredo Suarez-Sarmiento ◽  
Jamil Syed ◽  
Michael Leapman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
Area Under The Curve ◽  
Lesion Volume ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Psa Density ◽  
Increased Risk ◽  
Positive Core ◽  
Clinically Significant

149 Background: Prostate imaging reporting and data system (PI-RADS) category 3 (P3) provides an equivocal assessment of prostate cancer (PCa). We aimed to investigate imaging parameters including the ratio of P3-to-total regions of interest (ROI) that may assist in identifying P3 lesions harboring clinically-significant PCa (csPCa). Methods: We retrospectively queried our institutional MRI-ultrasound fusion biopsy database to identify patients without a prior diagnosis of PCa and with at least one P3 lesion on multi-parametric MRI (mpMRI) who underwent fusion biopsy during Feb 2015-Oct 2017. mpMRI findings were assessed, including prostate and P3 volumes, number of ROIs, and P3-to-total ROIs ratio (P3 lesion volume/total ROIs volumes). Logistic regression and area under the curve (AUC) were used to assess the ability of clinical and mpMRI characteristics to predict csPCa, defined as any grade group (GG)≥2 cancer or GG 1 cancer in > 2 cores or > 50% of any positive core from targeted biopsy of the P3 lesion. Results: Of 127 men with at least one P3 lesion, 29 (22.8%) had csPCa on the biopsy of P3 lesions. Patients with csPCa in P3 lesions had smaller prostate volumes (42.1mL vs 56mL, p = 0.003), lower P3/total ROIs ratios (0.46 vs 1.00, p < 0.001), and higher numbers of total ROIs (2 vs 1, p = 0.004). Compared with patients who had a P3/total ROIs ratio > 0.58, men with ratios < 0.58 were more likely to be diagnosed with csPCa in a P3 lesion (57.1% vs 9%, p < 0.001). Using a threshold of 0.58, P3/total ROIs ratio was 76.1% sensitive and 80.6% specific for csPCa in a P3 lesion. On multivariate analysis, smaller prostate volume (OR1.04, 95%CI 1.01-1.07, p = 0.01) and lower P3/total ROIs ratio (OR1.04, 95%CI 1.02-1.07, p = 0.003) were associated with an increased risk of csPCa in P3 lesions. P3/total ROIs ratio (AUC 0.73) and prostate volume (AUC 0.70) were superior to PSA density (AUC 0.65) for the prediction of csPCa in P3 lesions. Conclusions: Our data indicated that prostate volume and P3/total ROIs ratio outperformed PSA density in and were associated with detecting csPCa in P3 lesions. P3/total ROIs ratio could be used to avoid 80.6% of unnecessary biopsies of a P3 lesion in men with multiple ROIs.

scholarly journals Cognitive mpMRI/TRUS biopsy of the prostate with using strain elastography

2019 ◽  
pp. 100-108
Author(s):  
A. V. Vasilev ◽  
A. V. Mishchenko ◽  
R. A. Kadyrleev ◽  
A. S. Petrova ◽  
A. K. Nosov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
False Positive ◽  
Detection Rate ◽  
Peripheral Zone ◽  
Additional Parameter ◽  
Gleason Grade ◽  
Targeted Biopsy ◽  
Fusion Biopsy ◽  
Clinically Significant ◽  
Systematic Biopsy

Purpose. To evaluate the effectiveness of prostate cancer detection with method of cognitive mpMRI/TRUS fusion biopsy using strain sonoelastography.Materials and methods. Cognitive transrectal fusion biopsy of prostate was performed in 32 patients. According to the data of a preliminary conducted mpMRI, 33 foci suspicious of prostate cancer were included (PIRADSv2 = 3–5). Before the biopsy, all patients underwent ultrasound planning using compression sonoelastography.Results. The overall sensitivity was 76% for the targeted biopsy, and 49% for systematic biopsy. The number of biopsy specimens with a clinically significant Gleason grade in the targeted biopsy group was 85% of all columns with cancer specimens, in the systematic biopsy group this number was 68%. On average, the Gleason grade after targeted biopsy was 7.5 ± 0.9, and it was 7.2 ± 0.9 in the columns after systematic biopsy. On average, the percentage of tumor in the columns after targeted biopsy was 72% ± 29% and it was 55% ± 35% in the columns after systematic biopsy. The false positive for mpMRI was 15%. The overall sensitivity for the strain sonoelastography was 69% in this study, clinically significant cancer was detected in 71% of all columns with cancer specimens. False positive for elastography was observed in 18% of cases.Conclusion. Comparing with systematic biopsy, cognitive mpMRI / TRUS fusion biopsy can improve the detection rate of clinically significant prostate cancer and reduce the number of detected cases of clinically insignificant cancer. In cases of a total or subtotal tumor lesion in the peripheral zone detected on mpMRI, it is possible to take fewer columns for morphological verification of the tumor. The use of compression sonoelastography as an additional parameter of navigation in cognitive mpMRI/TRUS fusion biopsy can be considered as a promising way to increase the detection rate of clinically significant prostate cancer.

MRI targeted biopsy dramatically increases detection of clinically significant prostate cancer while reducing the risk of indolent cancer detection.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 108-108
Author(s):  
Michael Ahdoot ◽  
Amir H Lebastchi ◽  
Sandeep Gharam ◽  
Patrick H Gomella ◽  
John Dibianco ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Volume ◽  
Targeted Biopsy ◽  
Grade Group ◽  
Patient Demographics ◽  
Sextant Biopsy ◽  
Group 3 ◽  
Male Patients ◽  
Clinically Significant

108 Background: MRI fusion prostate biopsy has been shown to improve detection of clinically significant prostate cancer, however the degree of this benefit is poorly characterized in large clinical trials. Methods: 1750 MRI targeted plus sextant biopsies were performed in 1742 male patients from 2007 to 2017. Patient demographics, PSA, prostate volume, primary and secondary Gleason scores, Johns Hopkins Grade Groups, number of MRI targeted lesions, number of cores obtained, and biopsy yield were recorded. Results: The patient population consisted of men averaging 62.9-year-old (36-86) with a mean PSA 9.6ng/mL, and prostate volume of 59.2 ml. A total of 804 cancers were detected on sextant biopsy and 839 were detected on MRI targeted biopsy. Relative to targeted biopsy, sextant biopsy detected only significantly more Gleason 6 disease (14% vs 21.5%, p < 0.0001) than targeted biopsy. Targeted biopsy detected more Gleason 7 (21% vs 16.6%, p = 0.0009) and Gleason 8-10 (13.4% vs 9.4%). Additionally, Gleason 7 sub-stratification demonstrated substantially more Gleason 4+3 detection in targeted group vs sextant biopsy (4% vs 0.5%, p < 0.0001). When stratified by Grade Group targeted biopsy detected 76% more Grade Group 3-5 cancers (p < 0.0001) and 17.7% less Gleason Group 1-2 cancers (p < 0.0001). Only 1.7% of Grade Group 3-5 cancers were detected on sextant biopsy alone, where as 15.7% of Grade Group 3-5 cancers were detected on targeted biopsy alone. Conclusions: MRI targeted biopsy significantly increases the likelihood of detecting clinically significant cancer and decreases the risk of indolent cancer detection. These finding strongly support the use of MRI targeted biopsy when possible.

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 Patient-level detection of grade group ≥2 prostate cancer using quantitative diffusion MRI

2021 ◽  
Author(s):  
Allison Y Zhong ◽  
Leonardino A Digma ◽  
Troy Hussain ◽  
Christine H Feng ◽  
Christopher C Conlin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Characteristic Curve ◽  
Grade Group ◽  
Bootstrap Confidence Intervals ◽  
Patient Level ◽  
Apparent Diffusion ◽  
Spectrum Imaging ◽  
Group 2 ◽  
Clinically Significant ◽  
Group 1

Purpose: Multiparametric MRI (mpMRI) improves detection of clinically significant prostate cancer (csPCa), but the qualitative PI-RADS system and quantitative apparent diffusion coefficient (ADC) yield inconsistent results. An advanced Restrictrion Spectrum Imaging (RSI) model may yield a better quantitative marker for csPCa, the RSI restriction score (RSIrs). We evaluated RSIrs for patient-level detection of csPCa. Materials and Methods: Retrospective analysis of men who underwent mpMRI with RSI and prostate biopsy for suspected prostate cancer from 2017-2019. Maximum RSIrs within the prostate was assessed by area under the receiver operating characteristic curve (AUC) for discriminating csPCa (grade group ≥2) from benign or grade group 1 biopsies. Performance of RSIrs was compared to minimum ADC and PI-RADS v2-2.1via bootstrap confidence intervals and bootstrap difference (two-tailed α=0.05). We also tested whether the combination of PI-RADS and RSIrs (PI-RADS+RSIrs) was superior to PI-RADS, alone. Results: 151 patients met criteria for inclusion. AUC values for ADC, RSIrs, and PI-RADS were 0.50 [95% confidence interval: 0.41, 0.60], 0.76 [0.68, 0.84], and 0.78 [0.71, 0.85], respectively. RSIrs (p=0.0002) and PI-RADS (p<0.0001) were superior to ADC for patient-level detection of csPCa. The performance of RSIrs was comparable to that of PI-RADS (p=0.6). AUC for PI-RADS+RSIrs was 0.84 [0.77, 0.90], superior to PI-RADS or RSIrs, alone (p=0.008, p=0.009). Conclusions: RSIrs was superior to conventional ADC and comparable to (routine, clinical) PI-RADS for patient-level detection of csPCa. The combination of PI-RADS and RSIrs was superior to either alone. RSIrs is a promising quantitative marker worthy of prospective study in the setting of csPCa detection.

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