Biopsy Schemes with the Fewest Cores for Detecting 95% of the Prostate Cancers Detected by a 24-Core Biopsy

Scattoni, Vincenzo; Raber, Marco; Abdollah, Firas; Roscigno, Marco; Dehò, Federico; Angiolilli, D.; Maccagnano, Carmen; Gallina, Andrea; Capitanio, Umberto; Freschi, Massimo; Doglioni, Claudio; Rigatti, Patrìzio; Montorsi, Francesco

doi:10.1016/j.eururo.2009.08.011

Cited by 96 publications

(76 citation statements)

References 24 publications

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“…All patients provided written, informed consent to collect clinical, pathologic, and follow-up information in accordance with approval by the Institutional Review Board. Inclusion criteria were high grade prostate cancer identified on a Ն10 core biopsy (extended pattern biopsy) [15]. High grade disease was defined as primary pattern 4 or 5 in any single core; therefore, patients with 4ϩ3 and 8 -10 were included.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with downgrading in patients with high grade prostate cancer

Whitson

Porten

Cowan

et al. 2013

Urologic Oncology: Seminars and Original Investigations

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Objective: To determine the factors associated with downgrading between biopsy and prostatectomy in the contemporary era using extended-template biopsy techniques. Materials and methods:The UCSF Urologic Oncology Database was used to identify subjects diagnosed with high grade prostate cancer (primary pattern 4 or 5) in at least one core on extended-pattern biopsy. Multivariable logistic regression analysis was performed to identify independent factors associated with downgrading at radical prostatectomy, defined as a change from primary pattern 4 or 5 to primary pattern 3.Results: Downgrading occurred in 68 (34%) of 202 subjects who met the study criteria. Fourteen (47%) of 30 subjects with Յ25% of cores that were high grade and 9 (43%) of 21 subjects with Ͻ10% of total tissue containing cancer were downgraded. In a multivariable model, patients with mixed grade cores had much higher odds of downgrading than those with all high grade cores (OR 3.0 95% 1.3-7.1), P Ͻ 0.01). The proportion (per 10% increment) of positive cores containing high grade cancer (OR 0.8 95% CI 0.7-0.9 P Ͻ 0.01) and the percent (per 10% increment) of total tissue containing cancer (OR 0.7 95% CI 0.6 -0.9 P ϭ 0.01) were significantly associated with lower odds of downgrading.Conclusions: Downgrading following radical prostatectomy is a common event. Biopsy over-grading may preclude men from active surveillance or lead to unnecessary lymphadenectomy, excess radiation, or prolonged hormone therapy. The proportion of positive biopsy cores that are high grade and the percent of total tissue containing cancer should be incorporated into decision making.

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Section: Methodsmentioning

confidence: 99%

Factors associated with downgrading in patients with high grade prostate cancer

Whitson

Porten

Cowan

et al. 2013

Urologic Oncology: Seminars and Original Investigations

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“…Although it is difficult to compare various biopsy methods in terms of positive biopsy rate among previous studies because of differences in patient clinical backgrounds even in the same PSA range and possible differences in compliance of candidates for prostate biopsies at institutions (that is, selection bias during institutional decision-making on biopsy indications), the positive biopsy rates shown in the present study were comparable to or greater than those of previous studies from other institutes. [5][6][7][8][9][10][11][12][13][14]19,20 Previous studies have demonstrated that the use of additional lateral cores to the original sextant biopsy cores increased the detection rate of prostate cancer. Eskew et al 19 reported the usefulness of 13-18-core biopsies using the five-region anatomical approach.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14] Even in internally or externally validated nomograms, the feasibility of logistic regressionbased nomograms in actual individual urological clinics should be evaluated from the viewpoints of the acceptability of clinical factors taken into account in the nomogram and homogeneity of biopsy schemes between clinics and the institutions providing the nomograms. The life expectancy-and PV-adjusted biopsy may be unique, and could be difficult to adjust to any previously published nomogram.…”

Section: Introductionmentioning

confidence: 99%

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Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy- and prostate volume-adjusted biopsy scheme

Nomura

Ito

Miyakubo

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND:We previously reported the diagnostic efficacy of the age-and prostate volume-adjusted prostate biopsy method (the adjusted biopsy method). Here, we developed a new nomogram for predicting cancer probability at initial biopsy using the adjusted method. METHODS:Between 2002 and 2010, 1059 Japanese men with PSA levels between 1.1 and 40 ng ml À1 and biopsied for the first time using the adjusted method at Gunma University Hospital were enrolled. All subjects underwent digital rectal examination (DRE) and transrectal ultrasonography (TRUS). Data from the initial 849 subjects were used for development of the nomogram and those from the final 210 subjects were used for internal validation. External validation was conducted using data from two affiliated hospitals where the same adjusted biopsy method was used. The nomogram was developed through logistic regression analysis, and predictive accuracy and performance characteristics were assessed using the area under the curve (AUC) of the receiver operating characteristics and calibration plots. Furthermore, we compared the predictive accuracy of the newly developed nomogram with the 'Prostate Risk Indicator' using the development data set, as well as the two external data sets. RESULTS:The AUC of the logistic regression-based nomogram was significantly higher than those of any single clinical parameter. External validation showed significant correlations with the present model. The AUC-receiver operating characteristic of the 'Prostate Risk Indicator' was the second largest following the new nomogram using the development data set and one external data set and almost equal to the new nomogram using the other external data set.CONCLUSIONS: Nevertheless the present model does not include somewhat subjective findings on TRUS abnormality, which is necessary for the estimation by 'Prostate Risk Indicator', the predictive accuracy of the present simple nomogram could be excellent enough to contribute to accurate shared decision-making between doctors and men who are candidates for the adjusted biopsy scheme.

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“…107 However, based on its simplicity, tolerability and reproducibility, we continue to use the 20-core template in our institute with variable prostate volumes.…”

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confidence: 99%

Prostate cancer detection after a negative prostate biopsy: Lessons learnt in the Cleveland Clinic experience

Zaytoun

Jones

2011

Int J of Urology

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Abstract:Urologists are often faced with the dilemma of managing patients with a negative initial prostate biopsy in whom clinical or pathological risk for prostate cancer still exists. Such real-life challenging scenarios might raise questions such as: Who should undergo further biopsies? What are the optimal predictors for prostate cancer on subsequent biopsies? What is the optimal biopsy protocol that should be used? When to stop the biopsy cascade? The last decade has witnessed numerous studies that have analyzed factors conferring a significant risk for cancer discovered on repeat biopsies. We and others have developed predictive models to aid decision-making regarding pursuing further biopsies. For decades, high-grade prostatic intraepithelial neoplasia has been considered a strong risk indicator for subsequent cancer. However, it has been recently shown that only through segmentation of this heterogeneous population does the real risk profile emerge. Biopsy templates underwent modification regarding the number and location of cores with emergence of the transrectal or brachytherapy grid transperineal saturation biopsy. However, the best biopsy protocol remains controversial. We have refined the initial biopsy template to a 14 core initial biopsy template that optimizes cancer detection, and have shown that transrectal saturation biopsy significantly improves cancer detection for repeat biopsy. Another concern is the overdiagnosis of clinically insignificant cancer on repeat biopsies, so we explored ways to limit this, and to deal with its ramifications. Through carrying out a Medline literature search, we critically evaluated pertinent articles together with emphasis of our own journey in this arena to assist in the decision-making process for repeat biopsy population.

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Biopsy Schemes with the Fewest Cores for Detecting 95% of the Prostate Cancers Detected by a 24-Core Biopsy

Cited by 96 publications

References 24 publications

Factors associated with downgrading in patients with high grade prostate cancer

Factors associated with downgrading in patients with high grade prostate cancer

Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy- and prostate volume-adjusted biopsy scheme

Prostate cancer detection after a negative prostate biopsy: Lessons learnt in the Cleveland Clinic experience

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