scholarly journals Urinary PSA level and relative tumor volume after prostate biopsy

2009 ◽  
Vol 56 (2) ◽  
pp. 17-21 ◽  
Author(s):  
T. Pejcic ◽  
J. Hadzi-Djokic ◽  
B. Markovic ◽  
D. Dragicevic ◽  
B. Glisic ◽  
...  
Keyword(s):  
Gleason Score ◽  
Prostate Biopsy ◽  
Tumor Volume ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Preoperative Assessment ◽  
Tumor Grade ◽  
Peripheral Zone ◽  
Tumor Infiltration ◽  
Tumor Biopsy

Objectives: To estimate the ratio between urinary prostate specific antigen (uPSA) and tumor volume after prostate biopsy. Methods: From 2000 to July 2008, uPSA concentration was determined in 60 patients with clinically organ-confined prostate cancer (PCa). All patients underwent six-area transrectal ultrasound (TRUS) - guided biopsy, with at least 12 biopsy cores. Single pathologist determined tumor grade (G), Gleason score (GS), the percentage of tumor infiltration (% TI) and the percentage of positive cores (% PC) in all biopsy cores. Additionally, relative tumor-biopsy volume (RTV) was calculated by multiplying % PC, % TI and prostate ultrasound- derived volume (Vol). Forty-one patients underwent retropubic radical prostatectomy (RRP), while 19 patients underwent radiation therapy. Results: Average uPSA was 308.6+311.9 ng/ml (range 0.06-988 ng/ml), average PSA was 9.7+ 5.5 ng/ml (range 1.2-24.3 ng/ml), tumor grade 1.7+ 0.8, Gleason score 5.2 + 1.3, the percentage of tumor infiltration 27.6+21.8 %, and the percentage of positive cores, 52.2+30.7 %. Average RTV was 6.3+ 8.4 ml (0.29-56 ml). All patients were divided in two groups: I, with RTV 4 ml and II, with RTV = 4 ml. The patients with RTV 4 ml had lower G (1.4 0.6 vs. 2.1+0.8, p=0.0002), lower GS (4.5+1 vs. 5.8+1.3, p=0.003) and higher uPSA (389.4+340.8 vs. 193.1 +229.7, p=0.014). There were no differences in serum PSA levels between the groups. Conclusion: Relative tumor-biopsy volume (RTV) is useful parameter in the preoperative assessment of tumor volume. Patients with higher RTV had significantly higher G and GS. However, these patients had significantly lower uPSA. This phenomenon could be the consequence of compromised PSA drainage from the peripheral zone of the prostate, caused by the tumor.

scholarly journals Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6

2014 ◽  
Vol 8 (5-6) ◽  
pp. 342 ◽  
Author(s):  
Hasmet Sarici ◽  
Onur Telli ◽  
Orhan Yigitbasi ◽  
Musa Ekici ◽  
Berat Cem Ozgur ◽  
...  
Keyword(s):  
Gleason Score ◽  
Prostate Biopsy ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Radical Retropubic Prostatectomy ◽  
Small Sample ◽  
Ultrasound Guided ◽  
Increased Risk ◽  
Biopsy Gleason Score

Introduction: The discrepancy between prostate biopsy and prostatectomy Gleason scores is common. We investigate the predictive value of prostate biopsy features for predicting Gleason score (GS) upgrading in patients with biopsy Gleason scores ≤6 who underwent radical retropubic prostatectomy (RRP). Our aim was to determine predictors of GS upgrading and to offer guidance to clinicians in determining the therapeutic option.Methods: We performed a retrospective study of patients who underwent RRP for clinically localized prostate cancer at 2 major centres between January 2007 and March 2013. All patients with either abnormal digital examination or elevated prostate-specific antigen at screening underwent transrectal ultrasound-guided prostate biopsy. Variables were evaluated among the patients with and without GS upgrading. Our study limitations include its retrospective design, the fact that all subjects were Turkish and the fact that we had a small sample size.Results: In total, 321 men had GS ≤6 on prostate biopsy. Of these, 190 (59.2%) had GS ≤6 concordance and 131 (40.8%) had GS upgrading from ≤6 on biopsy to 7 or higher at the time of the prostatectomy. Independent predictors of pathological upgrading were prostate volume <40 cc (p < 0.001), maximum percent of cancer in any core (p = 0.011), and >1 core positive for cancer (p < 0.001).Conclusions: When obtaining an extended-core biopsy scheme, patients with small prostates (≤40 cc), greater than 1 core positive for cancer, and an increased burden of cancer are associated with increased risk of GS upgrading. Patients with GS ≤6 on biopsy with these pathological parameters should be carefully counselled on treatment decisions.

scholarly journals Prostate Biopsy Strategies: Current State of the Art

2004 ◽  
Vol 2 (3) ◽  
pp. 213-222
Author(s):  
Badar M. Mian
Keyword(s):  
Early Detection ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Early Stage ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Intraepithelial Neoplasia ◽  
Peripheral Zone ◽  
Detection Rates ◽  
Psa Testing

Prostate-specific antigen testing and prostate biopsy have revolutionized our ability to detect prostate cancer at an early stage. The transrectal ultrasound-guided biopsy procedure has undergone a number of modifications over the past 10 years to meet our goal of early detection of cancer at a curable stage. Biopsy schemes have evolved from lesion-directed biopsies to systematic mapping of the peripheral zone of the prostate, which harbors almost all of the significant tumor foci. An increase in the number of biopsy cores from 6 to 10 (or 12) has resulted in a significant improvement in the detection of clinically localized cancer, without any appreciable increase in the number of indolent cancers. Current biopsy schemes also have enhanced our ability to determine the true prognostic value of pathologic lesions such as high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation which have been associated with cancer detection in repeat biopsies. I discuss the rationale behind, and the outcomes of, various biopsy strategies. More than 15 years after PSA testing was popularized for early detection, a number of men are presenting for evaluation regarding repeat prostate biopsy for various clinical indications. The indications, biopsy scheme, and cancer detection rates for repeat prostate biopsy are discussed in detail.

scholarly journals Analysis of the spatial distribution and clinical features of prostate cancer in transperineal prostate biopsy

2019 ◽  
Author(s):  
Chen Jia-Jun ◽  
Zhu Zai-Sheng ◽  
Zhu Yi-Yi ◽  
Zhou Yi-Bo ◽  
Shi Hong-Qi
Keyword(s):  
Prostate Cancer ◽  
Spatial Distribution ◽  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Peripheral Zone ◽  
Transperineal Prostate Biopsy ◽  
Total Prostate Specific Antigen ◽  
Study Results

Abstract Background Recently, most studies on the spatial distribution of the prostate cancer are based on the samples confirmed by transrectal prostate biopsy (TRBx), which could distinguish the distribution of cancer lesions between the apex, middle and basal parts of the prostate, but the distinction between lesions in the left and right sides of prostate cancer and the transitional and peripheral bands remains to be considered. Further, there has been little research on the specific proportion of cancer in prostate biopsy tissue. The current study aimed to analyze the clinical characteristics, diagnostic efficacy of relevant indicators, and reveal the spatial distribution of prostate cancer in transperineal prostate biopsy (TPBx). Methods A total of 810 patients underwent TPUS-guided 10-core prostate biopsy in our hospital from Oct. 2016-to Feb. 2019, participants' clinical data and the diagnostic yield of the cores were recorded and retrospectively analyzed as a cross-sectional study. Results Age, total prostate specific antigen (t-PSA), prostate volume (PV), prostatic inflammation, dysuria, hematuria, asymptomatic and MRI were independent factors in prostate cancer (Pca) patients compared with non-Pca patients (P<0.05). The cut-off points for age, t-PSA, free prostate specific antigen (f-PSA), PSA density (PSAD), free/total prostate specific antigen (f/t PSA) and PV were 73years old, 15.43ng/ml, 4.545ng/ml, 0.475ng/ml*cm3, 0.123 and 41.45ml, respectively. The PRPN of left peripheral zone (LPZ) prostate tumor was elevated regardless of the Gleason score. However, the PRPN of left transitional zone (LTZ) was lower than LPZ and similar to right peripheral zone (RZ), but PRCF and CFVR were significantly higher, especially in tumors with higher Gleason score (≥8). Conclusions For Chinese, the t-PSA standard and the PSAD standard in the puncture indication should be increased, while the f/t PSA standard should be reduced. At the same time, multi-factor assessment is needed to determine whether patients need a prostate biopsy or not. The spatial distribution of prostate cancer is asymmetrical, with more cancer lesion on the left than on the right. The PRPN of LPZ is relatively higher. LTZ has higher PRCF, and most of them were large lesions with high Gleason score (≥8).

Comparing magnetic resonance imaging/ultrasound-fusion biopsy and systemic 12-core transrectal ultrasound biopsy for whole gland pathology.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 84-84
Author(s):  
Daniel Su ◽  
Arvin George ◽  
Minhaj Siddiqui ◽  
Soroush Rais-Bahrami ◽  
Lambros Stamatakis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Prostate Biopsy ◽  
Core Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Low Grade ◽  
High Grade ◽  
Fusion Biopsy ◽  
Clinically Significant

84 Background: Historically, pathologic findings from standard 12-core prostate biopsies are upgraded in 25 to 33% of patients after radical prostatectomy (RP). MRI/US fusion prostate biopsy has been shown to upgrade prostate cancer compared to standard 12-core biopsy in 32% of patients. MRI/US fusion biopsy may offer a more accurate representation of whole gland pathology. We evaluate the rate of pathologic upgrade in standard 12-core biopsy and MRI/US fusion biopsy when compared with whole gland pathology from RP. Methods: Patients who underwent random prostate biopsy, fusion biopsy and subsequently RP for prostate cancer from 2012 to 2013 were included. Pathology was reviewed by a single pathologist. The cohort was divided into clinically significant high-grade (Gleason score 4+3 or higher) and clinically insignificant low-grade (Gleason score 3+4 or lower) sub cohorts. Pathological upgrade was defined as any increase in Gleason sum or primary Gleason score. McNemar’s test was used to compare the proportion of patients who were upgraded from random biopsy to RP versus the proportion that were upgraded from fusion biopsy to RP. Results: Sixty eight patients underwent 12-core and fusion prostate biopsy then subsequently RP. Mean prostate-specific antigen was 9.2ng/ml. There are total of 43 patients with clinically insignificant low-grade and 25 patients with clinically significant high-grade. Fusion biopsy upgraded 19 patients (28%) compared to 12-core biopsy, eight of these patients had negative 12-core biopsy. Pathology on the RP specimen upgraded 18 of the 12-core results (26%) compare to only eight fusion biopsy results (11%). (p =0.0095) 14 patients (20%) who had clinically insignificant low-grade disease on 12-core biopsy were upgraded to clinically significant high-grade on RP. Only two patients (3%) with clinically insignificant low-grade from fusion biopsy were upgraded on RP. (p< 0.0005) Conclusions: Prostate cancer detected on MRI/US fusion prostate biopsy has significantly lower rates of pathologic upgrade than standard 12-core biopsy when both were compared to prostatectomy specimens. MRI/US fusion biopsy may represent whole gland pathology more accurately compared to 12-core biopsy.

scholarly journals Histology results of systematic prostate biopsies by in-bore magnetic resonance imaging vs. transrectal ultrasound

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Alon Lazarovich ◽  
Gil Raviv ◽  
Yael Laitman ◽  
Orith Portnoy ◽  
Orit Raz ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Resonance Imaging ◽  
Rectal Examination ◽  
Number Of Patients ◽  
Clinically Significant

Introduction: We aimed to compare systematic biopsies (SBs) of in-bore magnetic resonance-guided prostate biopsy (MRGpB) with those performed under transrectal ultrasound (TRUS) guidance in the clinical setting. Methods: Data on all 161 consecutive patients undergoing prostate biopsy in our institution between November 2017 and July 2019 were retrospectively collected. The patients were referred to biopsy due to elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination and/or at least one Prostate Imaging Reporting and Data System (PI-RADS) lesion score of ≥3 on multiparametric magnetic resonance imaging (mpMRI). We included patients with PSA levels ≤20 ng/ml and those with 8–12 core biopsies. Histology results of SBs performed by in-bore MRGpB were compared to TRUS SBs. Chi-squared, Fischer’s exact, and multivariate Pearson regression tests were used for statistical analysis (SPSS, IBM Corporation). Results: In total, 128 patients were eligible for analysis. Their median age was 68 years (interquartile range [IQR] 61.5–72), mean prostate size 55±29 cc, and mean PSA and PSA density levels 7.6±3.5 ng/ml and 0.18±0.13 ng/ml/cc, respectively. Thirty-five patients (27.3%) had suspicious digital rectal examination findings. Both biopsy groups were similar for these parameters. Thirty-eight (62.3%) MRGpB patients had a previous biopsy vs. 5 (7.1%) TRUS-SB patients (p<0.0001). The number of patients diagnosed with clinically significant and non-significant disease was similar for both groups. High-risk disease was more prevalent in the TRUS-SB group (22.4% vs. 4.9%, p<0.01). Conclusions: Our data suggest that in-bore MRGpB is no better than TRUS for guiding SBs for the detection of clinically significant prostate cancer.

scholarly journals A review of optimal prostate biopsy: indications and techniques

2019 ◽  
Vol 11 ◽  
pp. 175628721987007 ◽  
Author(s):  
Justin Streicher ◽  
Brian Lee Meyerson ◽  
Vidhya Karivedu ◽  
Abhinav Sidana
Keyword(s):  
Prostate Cancer ◽  
Patient Selection ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Diagnostic Technique ◽  
Fusion Biopsy ◽  
Advantages And Disadvantages ◽  
Software Platforms ◽  
Selection For

Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Patient selection for prostate biopsy is complex and is influenced by emerging use of prebiopsy imaging. The introduction of the magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion prostate biopsy has clear advantages over the historical standard of care. There are several biopsy techniques currently utilized with unique advantages and disadvantages. We review and summarize the current body of literature pertaining to when and how a prostate biopsy should be performed. We discuss current recommendations regarding patient selection for biopsy and discuss future directions regarding prebiopsy imaging. We offer a description of the MRI–TRUS fusion biopsy technique and a comparison of many of the currently available fusion software platforms. Articles pertaining to the title were obtained via PubMed index search with relevant keywords supplemented with personal collection of related publications. Prostate biopsy should be considered for patients with gross digital rectal exam (DRE) abnormality, patients with a prostate-specific antigen (PSA) greater than 4 ng/ml, and concomitant risk factors for prostate cancer or patients with lesions identified on multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System 2 (PI-RADS2) score of 4 or 5. MRI–TRUS fusion biopsy has demonstrated advantages in cancer detection when compared with TRUS-guided biopsy. There are currently several fusion software platforms available with a variety of biopsy approaches. Future efforts should detail the role of prebiopsy imaging as a triage tool for prostate biopsy. Consensus should be sought regarding the preferred modality of fusion biopsy. Additional data describing each fusion software platform would enable a more rigorous comparison of platform sensitivities.

scholarly journals Independent Validation of a Diagnostic Noninvasive 3-MicroRNA Ratio Model (uCaP) for Prostate Cancer in Cell-Free Urine

2019 ◽  
Vol 65 (4) ◽  
pp. 540-548 ◽  
Author(s):  
Jacob Fredsøe ◽  
Anne K I Rasmussen ◽  
Emma B Laursen ◽  
Yunpeng Cai ◽  
Kenneth A Howard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Area Under The Curve ◽  
Extracellular Vesicle ◽  
Urine Samples ◽  
Ratio Model ◽  
Psa Testing ◽  
Diagnostic Potential

Abstract BACKGROUND Detection of prostate cancer (PC) based on serum prostate-specific antigen (PSA) testing leads to many unnecessary prostate biopsies, overdiagnosis, and overtreatment of clinically insignificant tumors. Thus, novel and more accurate molecular biomarkers are required. METHODS Using reverse transcription quantitative PCR, we measured the concentrations of 45 preselected microRNAs (miRNAs) in extracellular vesicle-enriched cell-free urine samples from 4 independent patient cohorts from Spain and Denmark, including 758 patients with clinically localized PC, 289 noncancer controls with benign prostatic hyperplasia (BPH), and 233 patients undergoing initial transrectal ultrasound (TRUS)-guided prostate biopsy owing to PC suspicion (101 with benign and 132 with malignant outcome). Diagnostic potential was assessed by ROC and decision curve analysis. RESULTS We identified and successfully validated 8 upregulated and 21 downregulated miRNAs in urine from PC patients. Furthermore, we validated a previously identified 3-miRNA diagnostic ratio model, uCaP (miR-222–3p*miR-24–3p/miR-30c-5p). High uCaP scores were distinctive of PC in urine samples from BPH vs PC patients in 3 independent cohorts [area under the curve (AUC) = 0.84, 0.71, 0.72]. Additionally, uCaP predicted TRUS biopsy results with greater accuracy than PSA (AUC uCaP = 0.644; AUC PSA = 0.527) for patients within the diagnostic gray zone (PSA ≤ 10 ng/mL). CONCLUSIONS We successfully validated a urine-based diagnostic 3-miRNA signature for PC (uCaP) in 3 independent patient cohorts from 2 countries. In the future, the simple and noninvasive uCaP test may be used to help more accurately select patients for prostate biopsy. Prospective clinical validation is warranted.

Is routine prostate biopsy needed prior to radical cystectomy?

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 223-223
Author(s):  
Yasuhiro Hashimoto ◽  
Yuichiro Suzuki ◽  
Atsushi Imai ◽  
Akiko Okamoto ◽  
Hayato Yamamoto ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Invasive Bladder Cancer ◽  
Negative Group ◽  
Group I

223 Background: Prostate cancer (Pca) can be detected coincidentally in radical cystoprostatectomy (RCP) specimens for invasive bladder cancer. However, there is no uniformity of opinion on the need for prostate biopsy prior to RCP. We evaluated the necessity of preoperative prostate biopsy in invasive bladder cancer. Methods: From 1998 through 2009, of 300 patients undergoing radical cystectomy for muscle-invasive bladder cancer, 252 were male. Of these, we focused 212 patients, whose prostate-specific antigen (PSA) was measured preoperatively. Results: The median age was 66years and median follow-up period was 46 months. Thirty-five patients with PSA > 4.0 ng/mL or digital rectal examination (DRE) positive were all subjected to transrectal ultrasound (TRUS)-guided prostate biopsy (Pbx), and Pca was detected in 7 cases (20%) (Group I). Pca was also detected in 5 patients (17.9%) in RCP specimens of the 28 whose Pbx results were negative (Group II). Seventy-seven of the 177 patients with PSA ≤ 4.0ng/mL and DRE negative were underwent TRUS-guided Pbx, and Pca was detected in 1 case (1.3%) (Group III). Pca was detected in 10 patients (13.2%) out of the 76 whose Pbx results were negative (Group IV). Of the 177 patients, 100 underwent RCP without prostate biopsy, and Pca was detected in 16 cases (16%) (Group V). The average Gleason score of each Group, I, II, III, IV, and V were 6.6, 6.6, 7, 6.2, and 6.5, respectively. Tumor volumes of each Group, I, II, III, IV, and V were 3.12mL, 1.0mL, 0.65mL, 0.43mL, and 0.19mL, respectively. No patients experienced recurrence of PC, including biochemical recurrence. Conclusions: In cases with PSA ≤4.0 ng/mL and/or DRE negative, Pbx is not considered necessary. In cases with PSA > 4.0 ng/mL or DRE positive, Pca with an average volume of 3.12 mL were detected by Pbx in 20% of the patients. However, most are localized Pca, and postoperative recurrence of the Pca is not seen during follow-up period. The question of whether all patients in this group require Pbx needs to be examined through further stratification.

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