MRI-guided fusion biopsy of the prostate resection bed among post-radical prostatectomy patients with rising PSA.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 208-208
Author(s):  
Cheyenne Williams ◽  
Nabila Khondakar ◽  
Michael Daneshvar ◽  
Luke P. O'Connor ◽  
Jillian Egan ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Gland ◽  
Lesion Size ◽  
Prostate Tissue ◽  
Gleason Grade ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Prostate Bed ◽  
Gland Tissue ◽  
Benign Prostate

208 Background: Following treatment of prostate cancer with radical prostatectomy (RP), biochemical recurrence (BCR) can be detected with elevated PSA. This may be attributed to either cancer recurrence or retained benign prostatic gland tissue. Options for detecting malignancy after RP currently entail diagnostic imaging and biopsy with transrectal ultrasound (TRUS). TRUS alone has limited accuracy in detecting recurrence in the prostate bed. MRI fusion-guided biopsy (Fbx) may be a more accurate method of detecting post-RP local recurrence. We hypothesize that Fbx for diagnosing benign versus malignant recurrence in the prostate bed is feasible and produces clinically meaningful results. Methods: Our institutional database was queried for patients who received RP and demonstrated BCR between February 2015 and July 2020. All patients with evidence of prostate bed recurrence on mpMRI were included in this analysis. Cancer detection via mpMRI-guided fusion biopsy using the UroNav platform was evaluated and patient variables including final Gleason Grade group (GG), margin involvement, PSA at BCR, and prostate bed lesion size were analyzed with univariate logistic regression. Results: 40 patients (median age = 68) with BCR underwent post-RP mpMRI. 25/40 (62.5%) patients had MRI-visible lesions, and among those, 17/25 (68%) patients underwent Fbx of the prostate bed. 15/17 (88.2%) Fbxs detected prostate tissue (either benign or cancer), 11/17 (64.7%) contained cancer, and 4/17 (23.5%) contained benign prostate glands. Median cores per biopsy was 4 (IQR 4-6). Among the 83 cores obtained, 57 (68.6%) cores contained prostate gland tissue and 26 (31.3%) contained fibromuscular tissue. Of those 57 with gland tissue, 33 (57.9%) cores contained cancer, and 24 (42.1%) contained benign prostate tissue. Among patients with benign biopsies, none had further evidence of metastasis at median follow-up of 13.5 months after Fbx and 182 months after RP. On final RP pathology, 4 patients had GG1 disease, 4 had GG2, 4 had GG3, 2 had GG4, and 3 had GG5. 6/17 (35%) patients had positive RP margins. Median prostate bed lesion size was 1.3 cm (IQR 0.9-1.5). Prostate bed lesion size (cm) was the only variable significantly associated with cancer on Fbx (OR = 2.20, 95% CI:1.29-3.76, p = 0.011). Conclusions: mpMRI-Fbx is a feasible method for reliably targeting prostate bed lesions. With this technique, we found improved accuracy for biopsy-proven recurrence in the prostate bed. This technique will help direct treatment planning of salvage therapies among patients with detectable PSA post-RP. [Table: see text]

Pathologic findings in additional prostatic and periprostatic tissue removed during radical prostatectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 172-172
Author(s):  
Henry Chen ◽  
Richard J. Kahnoski ◽  
Brian R. Lane
Keyword(s):  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Prostate Gland ◽  
Prostate Tissue ◽  
Complete Excision ◽  
Incomplete Removal ◽  
Biopsy Gleason Score ◽  
Pathology Reports ◽  
Practice Methods ◽  
Benign Prostate

172 Background: Additional prostatic and periprostatic tissue (PPT) can be removed during radical prostatectomy (RP) when there is concern for incomplete removal of the entire prostate gland or residual extraprostatic extension of cancer. The presence of cancer in PPT during RP is largely unknown. We analyzed the rate of positive PPT findings during RP in a community-based health system to determine the yield of PPT resection to inform future clinical practice. Methods: Retrospective review of pathology reports from 976patients undergoing RP between 1998-2011 was performed. Demographic and pathologic data were collected in an IRB-approved database. Results: Of 976 RP, 267 patients (27%) had PPT excised (median: 1, range: 1-4). Median PSA was 5.0 (IQR: 3.9-7), clinical stage was T1c in 69%, and biopsy Gleason score was 6 or lower in 39%, 7 in 52% and 8 or higher in 9%. Pathologic stage was pT2 in 85%, T3 in 13%, and LN positive in 2.6%. Among 177 bladder neck biopsies, 31% contained benign prostate and 3.4% (n=6) had adenocarcinoma. Of 37 urethral biopsies, 46% contained benign prostate and 16% (n=6) had adenocarcinoma. Of 21 prostatic apical excisions, 86% contained benign prostate and 14% (n=3) contained adenocarcinoma. Of 35 excisions of suspected residual (or fragmented) prostate (posterior-lateral, median, base, capsule, pedicle), 94% contained prostate and 0% contained adenocarcinoma. No prostate tissue or cancer was present in 15 samples labeled as “periprostatic fat” and 9 “neurovascular bundle”. Conclusions: Complete excision of adenocarcinoma during RP remains the primary surgical objective. Clinical suspicion of incomplete excision of benign or cancer-containing prostate tissue may lead to removal of additional PPT samples. In this single-center study, prostate tissue was present in 45% of such samples overall, supporting this practice. However, cancer is rarely present in such samples (5.6% of cases with PPT removed, 1.5% of RP overall), with apical/urethral regions appearing to be at highest risk (~15% of samples).

Concordance between MRI fusion versus TRUS prostate biopsy and final pathology at radical prostatectomy: Data from the PURC.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 354-354
Author(s):  
Ruchika Talwar ◽  
Katharine Michel ◽  
Aseem Malhotra ◽  
Claudette Fonshell ◽  
John Danella ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Needle Biopsy ◽  
Transrectal Ultrasound ◽  
Median Number ◽  
Concordance Rate ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Final Pathology ◽  
Prostate Needle Biopsy ◽  
Trus Biopsy

354 Background: Studies suggest that MRI-fusion guided biopsies are superior to the transrectal ultrasound guided (TRUS) technique. Herein, we present the Pennsylvania Urologic Regional Collaborative (PURC) experience with MRI fusion biopsy. We aimed to calculate concordance rates between TRUS prostate needle biopsy versus MRI fusion biopsy and final pathology at the time of radical prostatectomy within our cohort. Methods: Within PURC, a prospective quality improvement collaborative of urology practices in Pennsylvania and New Jersey, we identified all men who underwent a TRUS or MRI fusion prostate needle biopsy followed by radical prostatectomy for the treatment of prostate cancer from 2015 to 2018. We analyzed International Society of Urological Pathology Grade Group (GG) scoring and calculated the concordance and upgrading rates at the time of biopsy versus final pathology at radical prostatectomy. To assess for differences between our rates, we performed a test of equal proportions and Pearson's chi-squared test (significance = p<0.05). Results: We identified 1,437 men who underwent TRUS (n=1247) or MRI Fusion (n=196) biopsies followed by radical prostatectomy. Overall pathologic grading distribution at time of biopsy was: 35.8% (n=515) Grade Group (GG) 1, 28.5% (n=409) GG 2, 13.3% (n=191) GG 3, 11.5% (n=165) GG 4, and 10.9% (n=157) GG 5. Median number of cores at TRUS biopsy was 12 (IQR: 12,13). Median number of cores at MRI Fusion biopsy was 15 (IQR 13,18). Therefore, we inferred patients who underwent MRI Fusion biopsy also underwent standard TRUS biopsies at that time. On average, exact concordance rate between MRI Fusion biopsy and final pathology was 9.1% higher than concordance rate of TRUS biopsy (44.4% vs 35.3%, 95% CI: 1.6%-16.5%, p < 0.01). The overall rate of upgrading on final pathology for MRI fusion biopsies was 5.7% lower than for TRUS biopsies, but this was not statistically significant (35.2% vs 40.9%, 95% CI: 1.5-13.0%, p=0.06). Conclusions: MRI fusion biopsies demonstrated higher concordance rates with final pathology at the time of radical prostatectomy than TRUS prostate biopsies alone.

Concordance of MRI-guided and systematic prostate biopsy for the detection of prostate cancer (PCa).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 277-277
Author(s):  
Matthew Parsons ◽  
Bridget Foy ◽  
Ernest Chan ◽  
Bryan Crawford ◽  
Daniel Sommers ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Core Biopsy ◽  
Transrectal Ultrasound ◽  
Quality Assurance Program ◽  
Gleason Grade ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Continuous Quality ◽  
Continuous Quality Assurance ◽  
Intermountain Healthcare

277 Background: MRI/US guided biopsy (fusion biopsy) is increasingly utilized over systemic 12-core transrectal ultrasound biopsy (12-core biopsy) for men with MRI-visible prostate lesions. Methods: Patients with MRI visible prostate lesions who underwent fusion and 12-core biopsy from 2016-2020 in the Intermountain Healthcare (IHC) system were consecutively analyzed. This was in the setting of a continuous quality assurance initiative among the reading radiologists. Primary outcome was PCa detection defined by Gleason grade group (GGG) 1 or higher. Clinically significant cancer (CSC) was defined as GGG 2 or higher. Patients were stratified by date biopsy was performed, 2016-2017 and 2018-2020, and lesions were stratified by PI-RADS v2 category. For men with multiple lesions, the highest PI-RADS v2 category lesion was used. Results: A total of 142 men with 254 MRI-detectable lesions underwent both fusion and 12-core biopsies in the IHC system from 2016 to 2020. CSC was detected in 21.6% (55/254) of fusion biopsies. Comparing PI-RAD v2 categories 1-3 to PI-RADS v2 categories 4-5, the PPV for detecting CSC was 9% (15/162) compared to 44% (40/92) respectively. Fusion and 12-core biopsies were concordant for any PCa in 79% of men (112/142) and CSC in 83% (118/142). Fusion biopsy detected any PCa in 22/84 (26%) and CSC in 15/103 (15%) of men in whom 12-core biopsy was negative. 12-core biopsy detected any PCa in 8/70 (11%) and CSC in 9/97 (9%) of men in whom fusion was negative. In total, 15 patients (11%) had a CSC that would have been missed if fusion biopsy was omitted while 9 (6%) had a CSC that would have been missed without 12-core biopsy. Conclusions: Omitting fusion or 12-core biopsy for PI-RADS v2 lesions would have resulted in a missed CSC in 11% or 6% of patients from 2016-20, respectively. The combination of MRI/US-guided fusion biopsy and systematic 12-core biopsy increased detection rate of CSC. These results are in the setting of a continuous, multi-disciplinary quality assurance program and results are not necessarily applicable to other healthcare systems. [Table: see text]

A nationwide trend away from radical prostatectomy for Gleason grade group 1 prostate cancer

2021 ◽  
Author(s):  
Joseph B John ◽  
John Pascoe ◽  
Sarah Fowler ◽  
Thomas Walton ◽  
Mark Johnson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Grade ◽  
Grade Group ◽  
Group 1
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