Combined T2 and diffusion-weighted MR imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies

Abstract

PurposeTransperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported.Materials and methodsA total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study.ResultsIn total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate.ConclusionsTransperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate.

Performance Characteristics of Transrectal Shear Wave Elastography Imaging in the Evaluation of Clinically Localized Prostate Cancer: A Prospective Study

“…Firstly, the present study is the largest cohort that has been used to analyse the utility of SWE in comparison to final histopathology reports from specimens using whole-mount radical prostatectomy specimens. Secondly, we confirmed that orientation involving what is observed on imaging is consistent with final histopathology slides via implementation of rapid prototyping and mold based technology [18].…”

“…All eligible participants' prostate specimens were sectioned according to our recently published method [18]. Briefly, we applied rapid prototyping methodology using prostate images.…”

“…Briefly, we applied rapid prototyping methodology using prostate images. Prostate specimens were placed in molds for sectioning to ensure orientation between histology and imaging slices [18,19] ( Figure 2-a). All prostate sections were analysed by an experienced uro-pathologist (more than 20 years of experience) without knowledge of SWE image findings.…”

Quantitative parameters in dynamic contrast-enhanced magnetic resonance imaging for the detection and characterization of prostate cancer

“…With this reference standard, the Gleason score obtained from TRUS-guided biopsy has sensitivity and specificity of 57.3% and 76.9% (p<0.001). This may be due to the fact that TRUS-guided biopsy has poor performance in sampling from anteriorly located tumors, as well as posteriorly located tumors in the peripheral zone [ 28 ]. The inhomogeneity of the tumor can also lead to a reduction in the biopsy’s accuracy.…”

“…Firstly, four different pharmacokinetic models from the same software were used and compared; the cut-off values of the ET and LD models were chosen due to their higher sensitivity and specificity and both of them have shown similarity with some other studies. Secondly, in a subgroup of the cohort, we used our recently published method of providing improved orientation between radiological data and histopathology slides using patient-specific prostate molds [ 28 ], which is believed to have a higher diagnostic accuracy. All men in this study had pre-biopsy 3T MRI scanning which avoids any potential artefacts due to biopsies.…”