scholarly journals MRI/US fusion prostate biopsy in men on active surveillance: Our experience

2021 ◽  
Vol 93 (1) ◽  
pp. 88-91
Author(s):  
Vito Lacetera ◽  
Angelo Antezza ◽  
Alessio Papaveri ◽  
Emanuele Cappa ◽  
Bernardino Cervelli ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Cancer Detection ◽  
Detection Rate ◽  
Cancer Detection Rate ◽  
Fusion Biopsy ◽  
Prostate Imaging ◽  
Diagnostic Role ◽  
Clinically Significant ◽  
Target Biopsy

Aim: The upgrading or staging in men with prostate cancer (PCA) undergoing active surveillance (AS), defined as Gleason score (GS) ≥ 3+4 or more than 2 area with cancer, was investigated in our experience using the software-based fusion biopsy (FB). Methods: We selected from our database, composed of 620 biopsies, only men on AS according to criteria of John Hopkins Protocol (T1c, < 3 positive cores, GS = 3+3 = 6). Monitoring consisted of PSA measurement every 3 months, a clinical examination every 6 months, confirmatory FB within 6 months and then annual FB in all men. The suspicious MRI lesions were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) classification version 2. FB were performed with a transrectal elastic free-hand fusion platform. The overall and clinically significant cancer detection rate was reported. Secondary, the diagnostic role of systematic biopsies was evaluated. Results: We selected 56 patients on AS with mean age 67.4 years, mean PSA 6.7 ng/ml and at least one follow-up MRI-US fusion biopsy (10 had 2 or 3 follow-up biopsies). Lesions detected by MRI were: PIRADS-2 in 5, PIRADS-3 in 28, PIRADS-4 in 18 pts and PIRADS-5 in 5 patients. In each MRI lesion, FB with 2.1 ± 1.1 cores were taken with a mean total cores of 13 ± 2.4 including the systematic cores. The overall cancer detection rate was 71% (40/56): 62% (25/40) in target core and 28% (15/40) in systematic core. The overall significant cancer detection rate was 46% (26/56): 69% (18/26) in target vs 31% (8/26) in random cores. Conclusions: The incidence of clinical significant cancer was 46% in men starting active surveillance, but it was more than doubled using MRI/US Target Biopsy 69% (18/26) rather than random cores (31%, 8/26). However, 1/3 of disease upgrades would have been missed if only the targeted biopsies were performed. Based on our experience, MRI/US fusion target biopsy must be associated to systematic biopsies to improve detection of significant cancer, reducing the risks of misclassification.

scholarly journals The role of MRI/TRUS fusion biopsy in the diagnosis of clinically significant prostate cancer

2020 ◽  
Vol 12 ◽  
pp. 175628722091661
Author(s):  
Andrea Benelli ◽  
Chiara Vaccaro ◽  
Sonia Guzzo ◽  
Carlotta Nedbal ◽  
Virginia Varca ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Cancer Detection ◽  
Detection Rate ◽  
Transrectal Ultrasound ◽  
Fusion Biopsy ◽  
Clinically Significant ◽  
Biopsy Gleason Score ◽  
Prostate Cancers ◽  
Negative Biopsies

Background: The aim of this work is to evaluate the detection rate of magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion-guided biopsy for clinically significant prostate cancers (Cs PCas), with particular interest in biopsy-naive patients and patients in active surveillance. MRI-targeted biopsy improves cancer detection rate (DR) in patients with prior negative biopsies; the current literature focuses on biopsy naive patients. We also evaluated the pathologic concordance between biopsies and surgical specimens. Methods: MRI/TRUS fusion-guided biopsies were performed between February 2016 and February 2019. Patients with previous negative biopsies, biopsy-naive or in active surveillance (AS) were included. Cs PCas were defined through Epstein’s criteria. Results: A total of 416 men were enrolled. The overall DRs and Cs PCa DRs were 49% and 34.3%, respectively. Cs PCas were 17.2%, 44.9% and 73.4%, respectively for PI-RADS 3, 4 or 5. Among biopsy-naive patients, 34.8% were found to have a Cs PCa, while a 43.6% tumour upgrading was achieved in men with a low risk of PCa. In patients who underwent radical prostatectomy (RP), the concordance between biopsy Gleason score (GS) (bGS) and pathological GS (pGS) was 90.8%. Conclusion: Our study highlights the role of MRI/TRUS fusion prostate biopsy in the detection of PCa in patients with previous negative biopsies focusing on Cs PCa diagnosis. The MRI/TRUS fusion biopsy is also emerging as a diagnostic tool in biopsy-naïve patients and deserves a fundamental role in AS protocols. A greater concordance between bGS and pGS can be achieved with targeted biopsies.

scholarly journals Magnetic resonance/ultrasound fusion targeted biopsy of the prostate can be improved by adding systematic biopsy

2021 ◽  
Author(s):  
Victor Mihail Cauni ◽  
Dan Stanescu ◽  
Florin Tanase ◽  
Bogdan Mihai ◽  
Cristian Persu
Keyword(s):  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Cancer Detection ◽  
Detection Rate ◽  
Specific Antigen ◽  
Cancer Detection Rate ◽  
Targeted Biopsy ◽  
Detection Rates ◽  
Clinically Significant ◽  
Systematic Biopsy

Aim: Magnetic resonance/ ultrasound fusion targeted biopsy (Tbs) is widely used for diagnosing prostate cancer (PCa). The aim of our study was to compare the cancer detection rate (CDR) and the clinically significant prostate cancer detection rate (csPCa) of the magnetic resonance/ultrasound fusion targeted biopsy with those of the standard systematic biopsy (Sbs) and of the combination of both techniques.Material and methods: A total of 182 patients underwent magnetic resonance/ultrasound fusion Tbs on the prostate for PCa suspicion based on multiparametric magnetic resonance imaging (mMRI) detection of lesions with PI-RADSv2 score ≥3. A total of 78 patients had prior negative biopsies. Tb was performed by taking 2-4 cores from each suspected lesion, followed by Sb with 12 cores. We evaluated the overall detection rate of PCa and clinically significant prostate cancer, defined as any PCa with Gleason score ≥3+4.Results: Median prostate specific antigen (PSA) level pre-biopsy was 7.4 ng/ml and median free-PSA/PSA ratio was 10.2%. Patient median age was 62 years old. PIRADSv2 score was 3 in 54 cases, 4 in 96 cases and 5 in 32 cases. PI-RADS-dependent detection rate of Tbs for scores 3, 4 and 5 was 25.9%, 65.6% and 84.4%, respectively, with csPCa detection rates of 24.1%, 54.2%, and 71.9%. Overall detection rate was 57.1% for Tbs, which increased to 60.4% by adding Sbs results. Detection rate for clinically significant prostate cancer (csPCa) was 48.4% and increased to 51.1% by adding Sbs. Overall detection rate for repeated biopsy was 50% and 68.3% for biopsy in naïve patients. Sbs detection rate was 55.5%, 8 patients having a negative biopsy on Tbs.Conclusions: When Tbs is considered due to a PI-RADS ≥3 lesion on mMRI, combined Tbs + Sbs increases the overall CDR and csPCa detection rates.

Pathologic outcomes of MRI invisible tumors in prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 282-282
Author(s):  
Sandeep Gurram ◽  
Amir H. Lebastchi ◽  
Michael Ahdoot ◽  
Alex Z. Wang ◽  
Bradford J. Wood ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Detection Rate ◽  
Transrectal Ultrasound ◽  
Cancer Detection Rate ◽  
Diagnostic Challenge ◽  
Fusion Biopsy ◽  
Sextant Biopsy ◽  
Magnetic Resonance Imaging Mri ◽  
Over Time

282 Background: Magnetic resonance imaging (MRI) invisible tumors are a diagnostic challenge in prostate cancer due to the lack of ability to reliably monitor these lesions radiographically or pathologically. The progression and natural history of these lesions are unknown and outcomes over time are unclear. Methods: Men with multiparametric MRI of the prostate and MRI/Transrectal ultrasound (TRUS) fusion guided biopsy were assessed for the presence of MRI invisible tumors (MIT). An MIT is defined as cancer detected only on extended sextant biopsy and not visible on MRI. All men first underwent an MRI/TRUS fusion biopsy with tracked extended sextant biopsy which originally detected the MIT. The original biopsy needle course sampling these MITs was tracked and set as a future target using the MRI/TRUS fusion platform. Men subsequently underwent a combined MRI/TRUS fusion biopsy, systematic extended sextant biopsy, and a Targeted Tracked biopsy of the MIT (TT-MIT) that was recorded and tracked from the original biopsy. We describe the outcomes of tracking these MITs and compare the ability to monitor them with TT-MIT biopsy as opposed to systematic extended sextant biopsy. Results: 105 MITs were identified, 84 (80%) of which were originally Gleason 6 tumors. The median time between biopsies was 16.6 months. The overall cancer detection rate with TT-MIT was 77.4% compared to 59.7% using systematic extended sextant biopsy. Using TT-MIT, these invisible tumors showed higher Gleason scores in 16 (15.2%) tumors. When TT-MIT was compared to the systematic extended sextant biopsy sampling the corresponding location, it showed increased Gleason scores in 30 (28.6%) MITs while 58 (55.2%) showed concordant pathology and 17 (16.2%) showed less aggressive pathology. Conclusions: The ability to follow MRI invisible tumors suggests that these tumors are more effectively tracked using TT-MIT biopsy technique. These MITs change over time and 15% of them will upgrade to higher Gleason scores. Tracking these tumors with TT-MIT biopsy increases cancer detection rate compared to standard sextant biopsy and more accurately samples these MITs, unveiling a more aggressive pathology.

scholarly journals MRI-Targeted Biopsies versus Systematic Transrectal Ultrasound Guided Biopsies for the Diagnosis of Localized Prostate Cancer in Biopsy Naïve Men

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alexandre Peltier ◽  
Fouad Aoun ◽  
Marc Lemort ◽  
Félix Kwizera ◽  
Marianne Paesmans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Cancer Detection ◽  
Detection Rate ◽  
Transrectal Ultrasound ◽  
Cancer Detection Rate ◽  
Targeted Biopsy ◽  
Clinically Significant ◽  
A Prospective Study ◽  
Significant Disease

Introduction. To compare, in the same cohort of men, the detection of clinically significant disease in standard (STD) cores versus multiparametric magnetic resonance imaging (mpMRI) targeted (TAR) cores.Material and Methods. A prospective study was conducted on 129 biopsy naïve men with clinical suspicion of prostate cancer. These patients underwent prebiopsy mpMRI with STD systematic biopsies and TAR biopsies when lesions were found. The agreement between the TAR and the STD protocols was measured using Cohen’s kappa coefficient.Results. Cancer detection rate of MRI-targeted biopsy was 62.7%. TAR protocol demonstrated higher detection rate of clinically significant disease compared to STD protocol. The proportion of cores positive for clinically significant cancer in TAR cores was 28.9% versus 9.8% for STD cores (P<0.001). The proportion of men with clinically significant cancer and the proportion of men with Gleason score 7 were higher with the TAR protocol than with the STD protocol (P=0.003;P=0.0008, resp.).Conclusion. mpMRI improved clinically significant prostate cancer detection rate compared to STD protocol alone with less tissue sampling and higher Gleason score. Further development in imaging as well as multicentre studies using the START recommendation is needed to elucidate the role of mpMRI targeted biopsy in the management of prostate cancer.

scholarly journals Detection rate for significant cancer at confirmatory biopsy in men enrolled in Active Surveillance protocol: 20 cores vs 30 cores vs MRI/TRUS fusion prostate biopsy

2016 ◽  
Vol 88 (4) ◽  
pp. 300 ◽  
Author(s):  
Pietro Pepe ◽  
Sebastiano Cimino ◽  
Antonio Garufi ◽  
Giandomenico Priolo ◽  
Giorgio Ivan Russo ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Detection Rate ◽  
Targeted Biopsy ◽  
3.0 Tesla ◽  
Fusion Biopsy ◽  
Saturation Biopsy ◽  
Positive Biopsy ◽  
Positive Core ◽  
Single Positive ◽  
Clinically Significant

Introduction: The detection rate for significant prostate cancer of extended vs saturation vs mMRI/TRUS fusion biopsy was prospectively evaluated in men enrolled in active surveillance (AS) protocol. Mterials and methods: From May 2013 to September 2016 75 men aged 66 years (median) with very low risk PCa were enrolled in an AS protocol and elegible criteria were: life expectancy greater than 10 years, cT1C, PSA below 10 ng/ml, PSA density &lt; 0.20, 2 &lt; unilateral positive biopsy cores, Gleason score (GS) equal to 6, greatest percentage of cancer (GPC) in a core &lt; 50%. All patients underwent 3.0 Tesla pelvic mpMRI before confirmatory transperineal extended (20 cores) or saturation biopsy (SPBx; 30 cores) combined with mpMRI/TRUS fusion targeted biopsy (4 cores) of suspicious lesions (PI-RADS 3-5). Results: 21/75 (28%) patients were reclassified by SPBx based on upgraded GS ≥ 7; mpMRI lesions PI-RADS 4-5 vs PI-RADS 3-5 diagnosed 9/21 (42.8%) vs 16/21 (76.2%) significant PCa with 2 false positives (6.5%). The detection rate for significant PCa was equal to 76.2% (mpMRI/TRUS fusion biopsy) vs 81% (extended) vs 100% (SPBx) (p = 0.001); mpMRI/TRUS targeted biopsy and extended biopsy missed 5/21 (23.8%) and 4/21 (19%) significant PCa which were found by SPBx (p = 0.001) being characterised by the presence of a single positive core of GS ≥ 7 with GPC &lt; 10%. Conclusions: Although mpMRI improve the diagnosis of clinically significant PCa, SPBx is provided of the best detection rate for PCa in men enrolled in AS protocols who underwent confirmatory biopsy.

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