scholarly journals Multiparametric Prostate MRI in Biopsy-Naïve Men: A Prospective Evaluation of Performance and Biopsy Strategies

2021 ◽  
Vol 11 ◽  
Author(s):  
Brage Krüger-Stokke ◽  
Helena Bertilsson ◽  
Sverre Langørgen ◽  
Torill Anita Eidhammer Sjøbakk ◽  
Tone Frost Bathen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Gleason Grade ◽  
Grade Group ◽  
Detection Rates ◽  
Prostate Mri ◽  
Multiparametric Prostate Mri

ObjectivesThis study aims to prospectively estimate the diagnostic performance of multiparametric prostate MRI (mpMRI) and compare the detection rates of prostate cancer using cognitive targeted transrectal ultrasound (TRUS) guided biopsies, targeted MR-guided in-bore biopsies (MRGB), or both methods combined in biopsy-naïve men.MethodsThe biopsy-naïve men referred for mpMRI (including T2-weighted, diffusion-weighted and dynamic contrast enhanced MRI) due to prostate cancer suspicion (elevated prostate-specific antigen or abnormal digital rectal examination) were eligible for inclusion. The images were scored according to Prostate Imaging Reporting and Data System (PI-RADS) v2, and men with PI-RADS 1–2 lesions were referred for routine systematic TRUS, while those with PI-RADS 3–5 lesions were randomized to MRGB or cognitive targeted TRUS. Men randomized to MRGB were referred to a secondary TRUS 2 weeks after MRGB. Gleason grade group ≥2 was defined as clinically significant prostate cancer. The performance of mpMRI was estimated using prostate cancer detected by any biopsy method as the reference test.ResultsA total of 210 men were included. There was no suspicion of prostate cancer after mpMRI (PI-RADS 1–2) in 48% of the men. Among these, significant and insignificant prostate cancer was diagnosed in five and 11 men, respectively. Thirty-five men who scored as PI-RADS 1–2 did not undergo biopsy and were therefore excluded from the calculation of diagnostic accuracy. The overall sensitivity, specificity, negative predictive value, and positive predictive value of mpMRI for the detection of significant prostate cancer were 0.94, 0.63, 0.92, and 0.67, respectively. In patients with PI-RADS 3–5 lesions, the detection rates for significant prostate cancer were not significantly different between cognitive targeted TRUS (68.4%), MRGB (57.7%), and the combination of the two biopsy methods (64.4%). The median numbers of biopsy cores taken per patient undergoing systematic TRUS, cognitive targeted TRUS, and MRGB were 14 [8-16], 12 [6-17], and 2 [1-4] respectively.ConclusionsmpMRI, in a cohort of biopsy-naïve men, has high negative predictive value, and our results support that it is safe to avoid biopsy after negative mpMRI. Furthermore, MRGB provides a similar diagnosis to the cognitive targeted TRUS but with fewer biopsies.

scholarly journals 541 Investigation of Suspected Prostate Cancer In UK; Evaluation of Local Practice and Feasibility of Moving Towards MRI As First Line Investigation – Re-Audit Following Change of Radiology Staffing

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Lee ◽  
A Luk ◽  
Y Kailash ◽  
B Chaplin
Keyword(s):  
Prostate Cancer ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gleason Grade ◽  
First Line ◽  
Grade Group ◽  
Prostate Mri ◽  
Radiology Service ◽  
Group 2 ◽  
Significant Disease

Abstract Introduction NICE recommends MRI as first-line investigation for suspected clinically localised prostate cancer (PCa); previous local audit findings suggest this to be safe and feasible to implement. Recent retirement of radiology staffing however had resulted in MRIs being reported by teleconsultation radiology service. There were concerns on whether this may lead to more missed significant PCa. We performed a re-audit on our prostate MRI and biopsy to assess if this is indeed the case. Method All patients with suspected PCa who have had prostate MRI and biopsy simultaneously from April-August 2019 were retrospectively analysed. Results 222 men were included. 36% of patients with negative MRI had positive biopsies; within this group 25% had significant disease (Gleason grade group ≥2). Compared with our previous audit, specificity for significant PCa has increased (from 34% to 46%), but with a reduced negative predictive value (from 97% to 91%). Conclusions If we are to implement MRI as first-line triage for potential subsequent biopsy, it would result in more men not going for a biopsy (from 18% to 25%), a reduction in diagnosis of non-significant PCa (from 21% to 36%), but at an expense of increase in missed significant PCa (from 3% to 9%).

scholarly journals Race and prostate imaging: implications for targeted biopsy and image-based prostate cancer interventions

2019 ◽  
Vol 1 (1) ◽  
pp. e000010
Author(s):  
Michael D Gross ◽  
Bashir Al Hussein Al Awamlh ◽  
Jonathan E Shoag ◽  
Elizabeth Mauer ◽  
Samprit Banerjee ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Asian Americans ◽  
Asian American ◽  
Specific Antigen ◽  
Gleason Grade ◽  
Targeted Biopsy ◽  
Grade Group ◽  
Prostate Mri ◽  
Prostate Imaging ◽  
Asian American Men

PurposeFor men with an elevated prostate-specific antigen (PSA), there is a strong evidence for prostate MRI to assess the risk of clinically significant prostate cancer (CSPC) and guide targeted-biopsy interventions. Prostate MRI is assessed using the Prostate Imaging-Reporting and Data System (PI-RADS), which is scored from 1 to 5. Equivocal or suspicious findings (PI-RADS 3–5) are recommended for subsequent targeted biopsy, for which the risk of infection and sepsis is increasing. However, PI-RADS was developed primarily in men of European descent. We sought to elucidate PI-RADS and MRI-targeted biopsy outcomes in Asian men, a rapidly growing population in the USA, Europe, Australia and internationally.Materials and methodsA prospective cohort of 544 men with elevated PSA without a diagnosis of prostate cancer who underwent MRI-targeted biopsy at our institution from January 2012 to December 2018 was analyzed. We categorized the cohort by self-designated race then used a validated algorithm which uses surname lists to identify a total of 78 (14%) Asian-Americans. The primary outcome was the likelihood of diagnosing CSPC (Gleason grade group >1) in Asian-Americans versus non-Asian-Americans. Multivariable logistic regression was used to determine the association of demographic and other characteristics with CSPC.ResultsOverall, MRI-targeted biopsy identified CSPC in 17% of Asian-American men versus 39% of non-Asian-American men (p<0.001). Notably for PI-RADS 3, only 6% of Asian-Americans versus 15% of others were diagnosed with CSPC. In adjusted analyses, Asian-American men were less likely to be diagnosed on MRI-targeted biopsy with CSPC (OR 0.30, 95% CI 0.14 to 0.65, p=0.002) and indolent prostate cancer (OR 0.37, 95% CI 0.15 to 0.91, p=0.030) than other races. Regardless of race those who were biopsy naïve were more likely (OR 2.25, 95% CI 1.45 to 3.49, p<0.001) to be diagnosed with CSPC.ConclusionWe found that PI-RADS underperforms in Asian-American men. For instance, only 2 of 35 (6%) Asian-American men with PI-RADS 3 were diagnosed with CSPC on MRI targeted biopsy. This has significant implications for overuse of diagnostic and image-guided interventional approaches in Asian-Americans, given the increasing risk of infectious complications from biopsy. Additional validation studies are needed to confirm our findings.

Optimization of Risk Stratification in Localized Prostate Cancer

2018 ◽  
Vol 36 (6) ◽  
pp. 528-532 ◽  
Author(s):  
Alicia Katherine Morgans
Keyword(s):  
Prostate Cancer ◽  
Relevant Literature ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Localized Prostate Cancer ◽  
Gleason Grade ◽  
Management Options ◽  
Grade Group ◽  
The Right

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 67-year-old retired engineering professor was found to have a prostate-specific antigen (PSA) level of 11 ng/mL on a screening test at his annual physical examination. A digital rectal examination revealed a nodule on the right side. He underwent a transrectal ultrasound-guided prostate biopsy that was notable for prostate adenocarcinoma, Gleason 3 + 4 = 7 (Gleason grade group 2; 30% Gleason 4 component) involving two cores (60% and 20% core involvement). A bone scan and pelvic computed tomography scan were negative for evidence of metastatic disease. (Should he undergo prostate magnetic resonance imaging? That seems rather common these days.) He was diagnosed with cT2b intermediate-risk localized prostate cancer (PCa) by National Comprehensive Cancer Network (NCCN) risk group and was seen in the multidisciplinary clinic to discuss management options (Table 1).

scholarly journals Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Linghui Liang ◽  
Feng Qi ◽  
Yifei Cheng ◽  
Lei Zhang ◽  
Dongliang Cao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Efficiency ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Multivariable Logistic Regression Analysis ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Clinically Significant ◽  
Definition Of ◽  
Medical University

AbstractTo analyze the clinical characteristics of patients with negative biparametric magnetic resonance imaging (bpMRI) who didn’t need prostate biopsies (PBs). A total of 1,012 male patients who underwent PBs in the First Affiliated Hospital of Nanjing Medical University from March 2018 to November 2019, of 225 had prebiopsy negative bpMRI (defined as Prostate Imaging Reporting and Data System (PI-RADS 2.1) score less than 3). The detection efficiency of clinically significant prostate cancer (CSPCa) was assessed according to age, digital rectal examination (DRE), prostate volume (PV) on bpMRI, prostate-specific antigen (PSA) and PSA density (PSAD). The definition of CSPCa for Gleason score > 6. Univariate and multivariable logistic regression analysis were used to identify predictive factors of absent CSPCa on PBs. Moreover, absent CSPCa contained clinically insignificant prostate cancer (CIPCa) and benign result. The detection rates of present prostate cancer (PCa) and CSPCa were 27.11% and 16.44%, respectively. Patients who were diagnosed as CSPCa had an older age (P < 0.001), suspicious DRE (P < 0.001), a smaller PV (P < 0.001), higher PSA value (P = 0.008) and higher PSAD (P < 0.001) compared to the CIPCa group and benign result group. PSAD < 0.15 ng/ml/cm3 (P = 0.004) and suspicious DRE (P < 0.001) were independent predictors of absent CSPCa on BPs. The negative forecast value of bpMRI for BP detection of CSPCa increased with decreasing PSAD, mainly in patients with naive PB (P < 0.001) but not in prior negative PB patients. 25.33% of the men had the combination of negative bpMRI, PSAD < 0.15 ng/ml/cm3 and PB naive, and none had CSPCa on repeat PBs. The incidence of PB was determined, CSPCa was 1.59%, 0% and 16.67% in patients with negative bpMRI and PSAD < 0.15 ng/ml/cm3, patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and biopsy naive and patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and prior negative PB, separately. We found that a part of patients with negative bpMRI, a younger age, no suspicious DRE and PSAD < 0.15 ng/ml/cm3 may securely avoid PBs. Conversely PB should be considered in patients regardless of negative bpMRI, especially who with a greater age, obviously suspicious DRE, significantly increased PSA value, a significantly small PV on MRI and PSAD > 0.15 ng/ml/cm3.

scholarly journals Potential synergy between PSMA uptake and tumour blood flow for prediction of human prostate cancer aggressiveness

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mads Ryø Jochumsen ◽  
Jens Sörensen ◽  
Lars Poulsen Tolbod ◽  
Bodil Ginnerup Pedersen ◽  
Jørgen Frøkiær ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Blood Flow ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Standardized Uptake Value ◽  
Tumour Blood Flow ◽  
Combined Model ◽  
Grade Group ◽  
Cancer Aggressiveness ◽  
Tumour Blood

Abstract Background Both prostate-specific membrane antigen (PSMA) uptake and tumour blood flow (TBF) correlate with International Society of Urological Pathology (ISUP) Grade Group (GG) and hence prostate cancer (PCa) aggressiveness. The aim of the present study was to evaluate the potential synergistic benefit of combining the two physiologic parameters for separating significant PCa from insignificant findings. Methods From previous studies of [82Rb]Rb positron emission tomography (PET) TBF in PCa, the 43 patients that underwent clinical [68Ga]Ga-PSMA-11 PET were selected for this retrospective study. Tumours were delineated on [68Ga]Ga-PSMA-11 PET or magnetic resonance imaging. ISUP GG was recorded from 52 lesions. Results [68Ga]Ga-PSMA-11 maximum standardized uptake value (SUVmax) and [82Rb]Rb SUVmax correlated moderately with ISUP GG (rho = 0.59 and rho = 0.56, both p < 0.001) and with each other (r = 0.65, p < 0.001). A combined model of [68Ga]Ga-PSMA-11 and [82Rb]Rb SUVmax separated ISUP GG > 2 from ISUP GG 1–2 and benign with an area-under-the-curve of 0.85, 96% sensitivity, 74% specificity, and 95% negative predictive value. The combined model performed significantly better than either tracer alone did (p < 0.001), primarily by reducing false negatives from five or six to one (p ≤ 0.025). Conclusion PSMA uptake and TBF provide complementary information about tumour aggressiveness. We suggest that a combined analysis of PSMA uptake and TBF could significantly improve the negative predictive value and allow non-invasive separation of significant from insignificant PCa.

scholarly journals Community Screening of Prostate Cancer in Eastern Nepal

2017 ◽  
Vol 1 (1) ◽  
pp. 53-57
Author(s):  
Narayan Belbase ◽  
C.S. Agrawal
Keyword(s):  
Prostate Cancer ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Healthy Population ◽  
District Hospitals ◽  
Incidence And Mortality ◽  
Trucut Biopsy

Background: Prostate cancer incurs a substantial incidence and mortality burden, and it ranks among the top ten specific causes of death in males. Objectives: To explore the situation of prostate cancer in a cohort of healthy population in Eastern Nepal. Methods: This study was conducted in the Department of General surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal in the department of surgery from July 2010 to June 2011. Males above 50 years visiting Surgical Outpatient Department in BPKIHS were enrolled in the study. Screening camps were organized in four Teaching district hospitals of BPKIHS in Eastern Nepal. Digital rectal examination (DRE) was done by the trained professionals after collecting blood for serum prostatic specific antigen (PSA). Trucut biopsy was done for all individuals with abnormal PSA, DRE or both findings. Results: A total of 1521 males more than 50 years of age were assessed and screened after meeting inclusion criteria. Maximum individuals 1452 (96.2% ) had PSA ≤ 4.0 ng/ml. Abnormal PSA ( > 4 ng/ml) was found in 58 (3.8%) individuals. Abnormal DRE was found in 26 (1.72%) individuals. Both DRE and PSA was abnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals were subjected to digitally guided trucut biopsy. Biopsy report revealed Benign Prostatic Hyperplasia in 47 (3.11%) individuals and adenocarcinoma prostate in 11 (0.73%) individuals. The specificity of DRE was 65.95% sensitivity 90.9% and positive predictive value 38.46%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostate was 100% and the positive predictive value for serum PSA was 18.96%. Conclusion: The overall cancer detection rate in this study was 0.73% and those detected were locally advanced. Larger community-based studies are highly warranted specially among high-risk groups.

scholarly journals CDK12-Mutated Prostate Cancer: Clinical Outcomes With Standard Therapies and Immune Checkpoint Blockade

2020 ◽  
pp. 382-392 ◽  
Author(s):  
Michael T. Schweizer ◽  
Gavin Ha ◽  
Roman Gulati ◽  
Landon C. Brown ◽  
Rana R. McKay ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Checkpoint Inhibitors ◽  
Specific Antigen ◽  
High Rate ◽  
Gleason Grade ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Grade Group ◽  
Distinct Subgroup

PURPOSE Translational studies have shown that CDK12 mutations may delineate an immunoresponsive subgroup of prostate cancer, characterized by high neo-antigen burden. Given that these mutations may define a clinically distinct subgroup, we sought to describe outcomes to standard drugs and checkpoint inhibitors (CPI). PATIENTS AND METHODS Clinical data from consecutive patients with CDK12 mutations were retrospectively collected from 7 centers. Several clinical-grade sequencing assays were used to assess CDK12 status. Descriptive statistics included PSA50 response rate (≥ 50% decline in prostate-specific antigen from baseline) and clinical/radiographic progression-free survival (PFS). RESULTS Of 52 patients with CDK12-mutated prostate cancer, 27 (52%) had detected biallelic CDK12 alterations. At diagnosis, 44 (88%) had Gleason grade group 4-5, 52% had T3-T4, and 14 (27%) had M1 disease. Median follow-up was 8.2 years (95% CI, 5.6 to 11.1 years), and 49 (94%) developed metastatic disease. Median overall survival from metastasis was 3.9 years (95% CI, 3.2 to 8.1 years). Unconfirmed PSA50 response rates to abiraterone and enzalutamide in the first-line castration-resistant prostate cancer setting were 11 of 17 (65%) and 9 of 12 (75%), respectively. Median PFS on first-line abiraterone and enzalutamide was short, at 8.2 months (95% CI, 6.6 to 12.6 months) and 10.6 months (95% CI, 10.2 months to not reached), respectively. Nineteen patients received CPI therapy. PSA50 responses to CPI were noted in 11%, and PFS was short; however, the estimated 9-month PFS was 23%. PFS was higher in chemotherapy-naïve versus chemotherapy-pretreated patients (median PFS: not reached v 2.1 months, P = .004). CONCLUSION CDK12 mutations define an aggressive prostate cancer subgroup, with a high rate of metastases and short overall survival. CPI may be effective in a minority of these patients, and exploratory analysis supports using anti–programmed cell death protein 1 drugs early. Prospective studies testing CPI in this subset of patients with prostate cancer are warranted.

2187 CORRELATING MULTIPARAMETRIC PROSTATE MRI (MP-MRI) SUSPICION FOR PROSTATE CANCER WITH MRI/ULTRASOUND (MR/US) FUSION GUIDED BIOPSY RESULTS AND GLEASON GRADE

2013 ◽  
Vol 189 (4S) ◽  
Author(s):  
Soroush Rais-Bahrami ◽  
M. Minhaj Siddiqui ◽  
Lambros Stamatakis ◽  
Srinivas Vourganti ◽  
Anthony N. Hoang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Grade ◽  
Prostate Mri ◽  
Guided Biopsy ◽  
Multiparametric Prostate Mri

scholarly journals The role of mpMRI in qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Łukasz Nyk ◽  
Omar Tayara ◽  
Tomasz Ząbkowski ◽  
Piotr Kryst ◽  
Aneta Andrychowicz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Digital Rectal Examination ◽  
Gleason Grade ◽  
Shared Decision ◽  
Grade Group ◽  
Final Pathology ◽  
Radical Treatment ◽  
Pathological Report

Abstract Background To investigate the role of mpMRI and high PIRADS score as independent triggers in the qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy. Methods Between January 2017 and June 2019, 494 laparoscopic radical prostatectomies were performed in our institution, including 203 patients (41.1%) with ISUP 1 cT1c-2c PCa on biopsy. Data regarding biopsy results, digital rectal examination, PSA, mpMRI and postoperative pathological report have been retrospectively analysed. Results In 183 cases (90.1%) mpMRI has been performed at least 6 weeks after biopsy. Final pathology revealed ISUP Gleason Grade Group upgrade in 62.6% of cases. PIRADS 5, PIRADS 4 and PIRADS 3 were associated with Gleason Grade Group upgrade in 70.5%, 62.8%, 48.3% of patients on final pathology, respectively. Within PIRADS 5 group, the number of upgraded cases was statistically significant. Conclusions PIRADS score correlates with an upgrade on final pathology and may justify shared decision of radical treatment in patients unwilling to repeated biopsies. However, the use of PIRADS 5 score as a sole indicator for prostatectomy may result in nonnegligible overtreatment rate.

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