scholarly journals Kezdeti tapasztalataink az mpMR fúziós ultrahangvezérelt prosztatabiopsziával

2020 ◽  
Vol 161 (52) ◽  
pp. 2188-2194
Author(s):  
András Béla Hüttl ◽  
Dávid Ádám Korda ◽  
M. Zsuzsanna Lénárd ◽  
Attila Szendrői ◽  
Gábor Rudas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Rate ◽  
Prostate Volume ◽  
Cost Effective ◽  
Peripheral Zone ◽  
Transitional Zone ◽  
Lesion Size ◽  
Fusion Biopsy ◽  
Extraprostatic Extension ◽  
Targeted Biopsies

Összefoglaló. Bevezetés: A prosztatarák diagnosztikájában az utóbbi években paradigmaváltás történt. Az MR-vizsgálat fejlődése lehetővé tette a prosztatatumor gyanús elváltozásainak célzott mintavételét. Az mpMR fúziós biopszia pontos és költséghatékony módszer. Célkitűzés: Célkitűzésünk az volt, hogy összegezzük az mpMR fúziós biopsziák terén szerzett tapasztalatainkat. Módszer: A Semmelweis Egyetem Urológiai Klinikáján 2017 és 2019 között 40, mpMR fúziós biopsziát végeztünk a BioJet-program segítségével, transperinealis behatolásból. Az MR-vizsgálatok kiértékelése a PI-RADS v2 ajánlása szerint történt. Megvizsgáltuk, hogy a laesiók PI-RADS-besorolása, elhelyezkedése, mérete, az extraprosztatikus terjedés jeleinek megléte, a páciensek PSA-, illetve PSAD-értékei, valamint a prosztata volumene befolyásolja-e a mintavételek kimenetelét. Eredmények: A célzott mintavételek során pácienseink 80%-ánál igazolódott malignitás. PI-RADS 5. és 4. besorolású laesiók esetén a detektációs ráta 91%, illetve 85%, míg PI-RADS 3. laesióknál 20% volt. A perifériás zóna elváltozásainál szignifikánsan magasabb volt a pozitív eredmény valószínűsége, mint a tranzicionális zóna laesióinál (khi2(1) = 6,555, p = 0,010, Fisher-féle egzakt p = 0,017, V = 0,355). Az extraprosztatikus terjedés jelei és a magasabb PSAD-értékek növelték a pozitív minták valószínűségét (khi2(1) = 7,704, p = 0,006, Fisher-féle egzakt p = 0,004, V = 0,355; illetve 0,47 ± 0,50 ng/ml2 vs. 0,18 ± 0,17 ng/ml2; Z = 3,447, p<0,001), míg az elváltozások mérete nem befolyásolta a kimenetelt. A prosztatavolumen szignifikánsan magasabb volt azoknál, akiknél nem igazolódott malignitás (50,9 ± 18,8 ml vs. 119,6 ± 91,6 ml; Z = –3,505, p<0,001). Következtetések: Az elvégzett fúziós biopsziák detektációs rátája magasabb volt az irodalmi átlagnál. Eredményeink alapján a mintavételek kimenetelét befolyásolhatja az elváltozások PI-RADS-besorolása, elhelyezkedése, az extraprosztatikus terjedés, a PSAD-értékek, valamint a prosztatatérfogat. A fenti szempontok figyelembevételével kiválaszthatók azok a páciensek, akik a legtöbbet profitálhatnak a beavatkozásból. Orv Hetil. 2020; 161(52): 2188–2194. Summary. Introduction: The past decade has seen some major changes in the diagnostics of prostate cancer. Progress in MR imaging has allowed us to better visualise prostate cancer and thus perform targeted biopsies of tumour suspect lesions. mpMRI-ultrasound fusion-guided prostate biopsy is a precise and cost-effective method to diagnose prostate cancer. Objective: The purpose of this study was to summarise our results in mpMRI-ultrasound fusion biopsy between 2017 and 2019 and compare them with the findings in the current literature. Method: Between 2017 and 2019, fully 40, mpMRI-ultrasound fusion biopsies were performed transperineally using the BioJet fusion system at Semmelweis University Urology Clinic. The MRI evaluations were done in line with the PI-RADS v2 guidelines. It was analysed whether the PI-RADS score, the location of the tumour, lesion size, the signs of extraprostatic extension, PSA/PSAD density and prostate volume have an influence on the outcome of mpMRI-ultrasound fusion biopsy. Results: Prostate cancer was diagnosed in 80% of the cases during targeted biopsies. The detection rate was 91%, 85%, and 20% for PI-RADS 5, 4 and 3 lesions, respectively. The detection rate was significantly higher for lesions located at the peripheral zone compared to the ones in the transitional zone (khi2(1) = 6.555, p = 0.010, Fisher-exact p = 0.017, V = 0.355). Signs of extraprostatic extension and higher PSAD correlated with better detection rate (khi2(1) = 7.704, p = 0.006, Fisher-exact p = 0.004, V = 0.355; and 0.47 ± 0.50 ng/ml2 vs. 0.18 ± 0.17 ng/ml2; Z = 3.447, p<0.001, respectively). The size of the lesions did not influence the outcome. The analysis showed a significant correlation between large prostate volumes and negative biopsies (50.9 ± 18.8 ml vs. 119.6 ± 91.6 ml; Z= –3.505, p<0.001). Conclusions: The detection rate of prostate cancer with targeted biopsies was higher than the data found in the international literature. The PI-RADS score, the location of the tumour, MRI signs of extraprostatic extension, PSAD and prostate volume had an influence on the detection rate. Our findings may promote a better selection of the best candidates for targeted biopsies in the future. Orv Hetil. 2020; 161(52): 2188–2194.

scholarly journals MRI/US fusion prostate biopsy: Our initial experience

2016 ◽  
Vol 88 (4) ◽  
pp. 296 ◽  
Author(s):  
Vito Lacetera ◽  
Bernardo Cervelli ◽  
Antonio Cicetti ◽  
Giuliana Gabrielloni ◽  
Michele Montesi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Prostate Volume ◽  
Initial Experience ◽  
Fusion Biopsy ◽  
Negative Biopsy ◽  
Group A ◽  
Group B ◽  
Target Biopsy

Aim: The objective of this study is to present our initial experience with magnetic resonance imaging/ultrasound (MRI/US) fusion biopsy using the Koelis Trinity device after the first consecutive 59 patients. Materials and methods: 59 consecutive patients with suspected prostate cancer (PCA) underwent prostate biopsy using Trinity Koelis® (Koelis, Grenoble, France). We divided the patients into 2 groups: patients with a previous negative mapping underwent to a MRI/US fusion re-biopsy (Group A); and biopsy-naïve patients who underwent to a first stereotactic 3-D mapping of the prostate (Group B). Group A (22 patients):mean age 64 years (CI 48-73), mean PSA = 7.7 ng/ml (CI 4.2- 9.9); mean prostate volume 55 ml(CI 45-82), Digital Rectal Examination (DRE) positive in 2/22, number of lesions detected by MRI 1.4, mean cores from each MRI target lesion 3 (CI 2-5), mean total cores 15 ( CI 12-19). Group B (37 patients): mean age 66 years (CI 49-77), mean PSA= 4.7 (3.2- 7.9); mean prostate volume 45 ml (33-67), DRE positive in 5/37, mean total cores 14 ( CI 10-16) Results: In Group A 10/22 patients were positive for PCA (overall detection rate of 45.5%): 6 PCA were detected by target biopsy and 4 cancer by random biopsy. Significant prostate cancer (defined as the presence of Gleason pattern 4) was detected in 4/10 patients (Significant PCA detection rate of 40%) and all significant PCA were detected by MRI target biopsy. All PCA detected by random biopsy had Gleason score 3 + 3 = 6. In Group B (biopsy naïve patients) 14/37 patients were positive for PCA (overall detection rate of 37.8%), Significant prostate cancer was detected in 5/14 patients (Significant PCA detection rate of 35,7%). No significant side effects were recorded. Conclusions: Our overall detection rate was 45.5% and 37.8% in Group A (patients with previous negative biopsy and persistent suspicion of PCA) and in Group B (biopsy naïve patients) respectively; clinical significant PCA detection rate was respectively 40% and 35.7%. These results are similar to current literature and promising for the future. We believe that using platforms of co-registered MRI/US fusion biopsy can potentially improve risk stratification and reduces understaging, undergrading and the need for repeat biopsies in biopsy naïve patients (using a stereotactic first mapping) and in patients with previous negative biopsy and persistent suspicion of PCA ( using a second MRI/US fusion biopsy).

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.

Prostate Volume Index Stratified Prostate Cancer Risk in Patients Elected to a First Random Biopsy Set

2017 ◽  
Vol 103 (4) ◽  
pp. 374-379 ◽  
Author(s):  
Antonio B. Porcaro ◽  
Paolo Corsi ◽  
Nicolò de Luyk ◽  
Marco Sebben ◽  
Alessandro Tafuri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Goodness Of Fit ◽  
Prostate Volume ◽  
Digital Rectal Examination ◽  
Prostate Cancer Risk ◽  
Peripheral Zone ◽  
Transitional Zone ◽  
Volume Index ◽  
Multivariate Logistic Regression Model ◽  
Random Biopsy

Objective To investigate prostate volume index (PVI), defined as the ratio of volume of the transitional zone on that of the peripheral zone, as a factor stratifying prostate cancer (PCA) risk in patients elected to a first random biopsy set. Methods The study evaluated 596 patients who were elected to a first random biopsy set because of suspected PCA in a period between September 2010 and September 2015. Prostate volume index was dichotomized to PVI ≤1 vs PVI >1. The multivariate logistic regression model investigated clinical factors with dichotomized PVI associating with PCA. Results The detection rate of PCA was 49%. The dichotomized PVI >1 stratified PCA risk (odds ratio [OR] 0.455; p<0.0001) beyond age (OR 1.062; p<0.0001), PSA (OR 1.167; p<0.0001), PV (OR 0.957; p<0.0001), and abnormal digital rectal examination (OR 2.094; p<0.0001). The goodness of fit statistics assessed model efficacy. Conclusions A large cohort of patients elected to a first random biopsy set had PCA risk stratified by dichotomized PVI beyond other clinical independent factors. Confirmatory studies are required.

Cancer detection between peripheral zone and transitional zone targeted biopsies: Preliminary results from a prospective cohort of men undergoing MRI-US fusion biopsy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 56-56
Author(s):  
Bruno Nahar ◽  
Nachiketh Soodana-Prakash ◽  
Nicola Pavan ◽  
Samarpit Rai ◽  
Felipe Munera ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prospective Cohort ◽  
Peripheral Zone ◽  
Transitional Zone ◽  
False Positives ◽  
Fusion Biopsy ◽  
Detection Rates ◽  
Increased Risk ◽  
Risk Of Cancer

56 Background: Multiparametric MRI has emerged as a popular imaging modality to localize prostate cancer. Nevertheless, interpretation of MRI is subjective, with concerns for false positives, particularly in the transitional zone (TZ), where hyperplastic changes may be confused for suspicion of cancer. We analyzed a prospective cohort of men undergoing MRI-US fusion biopsy and compared cancer detection rate between lesions seen in the peripheral zone (PZ) and the TZ. Methods: 133 men with elevated PSA or positive DRE underwent MRI-US fusion biopsy with average of 2 cores taken per target for the detection of prostate cancer between October 2014 and July 2015. Each targeted lesion in the PZ and TZ was previously classified by radiologists according to the MRI PI-RADS score and grouped according to their level of suspicion as probably benign (1-2), indeterminate (3) or probably malignant (4-5). Histopathology from targeted cores were categorized as no cancer, non-significant cancer (Gleason 6) and significant cancer (Gleason ≥ 7). We compared the cancer detection rates between lesions in PZ and TZ lesions, based on PI-RADS score. Results: We identified 143 lesions in the PZ and 82 lesions in the TZ. Among lesions found in the TZ, 57.3% were reported as probably malignant, compared to 44.7% of lesions seen in the PZ. Cancer was diagnosed in 23% of the lesions in the PZ, compared to only in 9.7% in the TZ (p<0.01). With respect to significant cancer there was a trend towards higher detection of significant cancer in the PZ (13.29% vs. 6.10% p=0.12) compared to TZ. Furthermore, lesions in the PZ with a PI-RADS score > 4 were associated with a three-fold increase in the odds of detecting cancer compared to lesions with PI-RADS < 4 (OR 3.08; CI 95% 1.29 – 7.31, p<0.011), whereas in the TZ there was no increased risk of cancer with higher PI-RADS scores (OR 1.0 CI 95% 0.20 – 4.84, p<1.0). Conclusions: To our knowledge this is the first study to address a concern regarding an increased likelihood of false positives when reporting the presence and aggressiveness of cancer in the TZ versus the PZ. This may lead to unnecessary biopsies in men undergoing MRI of the prostate.

Prostate Volume Index and Chronic Inflammation of the Prostate Type IV with Respect to the Risk of Prostate Cancer

2014 ◽  
Vol 94 (3) ◽  
pp. 270-285 ◽  
Author(s):  
Antonio B. Porcaro ◽  
Giovanni Novella ◽  
Alberto Molinari ◽  
Alessandro Terrin ◽  
Anila Minja ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Normal Growth ◽  
Peripheral Zone ◽  
Transitional Zone ◽  
Growth Patterns ◽  
Volume Index ◽  
Type Iv

Background: Benign prostatic hyperplasia and prostate cancer (PCA) alter the normal growth patterns of zonal anatomy with changes of prostate volume (PV). Chronic inflammatory infiltrates (CII) type IV are the most common non-cancer diagnosis of the prostate after biopsy. Objective: To evaluate associations of both PV index (PVI), i.e. the ratio of transitional zone volume (TZV) to peripheral zone volume (PZV), and CII with PCA in patients undergoing biopsy. Subjects and Methods: Between January 2007 and December 2008, 268 consecutive patients who underwent prostate biopsy were retrospectively evaluated. PV and TZV were measured by transrectal ultrasound. PZV was computed by subtracting the PV from the TZV. CII were evaluated according to standard criteria. Significant associations of PVI and the presence of CII (CII+) with PCA risk were assessed by statistical methods. Results and Limitations: We evaluated 251 patients after excluding cases with painful rectal examinations, prostate-specific antigen (PSA) >20 μg/ml and metastases. The PCA detection rate was 41.1%. PVI was a negative independent predictor of PCA. A PVI ≤1.0 was directly [odds ratio (OR) = 2.36] associated with PCA, which was detected more frequently in patients with a PVI ≤1.0 (29.1%) than in those with a PVI >1.0 (11.9%). CII+ was inversely (OR = 0.57) and independently associated with PCA, which was detected less frequently in cases with CII (9.9%) than in those without CII (21.1%). Potential study limitations might relate to the fact that PV was not measured by prostatectomy specimens and there was PSA confounding for CII and PCA. Conclusions: Low values of PVI are directly associated with risk of PCA, which was almost 2.5 times higher in patients with a PVI ≤1.0. The PVI might be an effective parameter for clustering patients at risk of PCA. CII+ was inversely associated with risk of PCA and decreased the probability of detecting PCA by 43%. The role of the PVI and CII in PCA carcinogenesis needs further research.

The influence of MRI lesion size on the detection rate of prostate cancer using MRI/US fusion biopsy

2018 ◽  
Vol 17 (12) ◽  
pp. e2627-e2628
Author(s):  
V. Adamcová ◽  
M. Záleský ◽  
J. Stejskal ◽  
A. Pavličko ◽  
J. Votrubová ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Rate ◽  
Lesion Size ◽  
Fusion Biopsy

scholarly journals Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies

Cancer ◽  
2016 ◽  
Vol 122 (6) ◽  
pp. 884-892 ◽  
Author(s):  
Christopher P. Filson ◽  
Shyam Natarajan ◽  
Daniel J.A. Margolis ◽  
Jiaoti Huang ◽  
Patricia Lieu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Cancer Detection ◽  
Fusion Biopsy ◽  
Prostate Cancer Detection ◽  
Targeted Biopsies

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.

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.

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