Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

Mannaerts, Christophe K.; Engelbrecht, Marc R.; Postema, Arnoud W.; Kollenburg, Rob A. A. van; Hoeks, Caroline; Savcı-Heijink, C. Dilara; Sloun, Ruud J. G. van; Wildeboer, Rogier R.; Reijke, Theo M. de; Mischi, Massimo; Wijkstra, Hessel

doi:10.1111/bju.15093

Cited by 22 publications

(15 citation statements)

References 42 publications

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“…Differently from the aforementioned study that included only patients with prior negative biopsy, in our series the majority of patients were biopsy‐naïve. Our result is in contrast with recent findings of Mannaerts et al, 7 who discovered in a series of 150 biopsy‐naïve patients that TBx are inferior to SBx (29% vs. 39%) for the detection of ISUP grade ≥2 PCa, despite reduced detection of insignificant cancers. In the present study the added value of SBx was scaled back as compared to our previous publication dating 2019, where we found in a multicentric series that SBx improved the CDR of 15% for all PCa and 12% for csPCa 17 .…”

Section: Discussioncontrasting

confidence: 99%

Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy

et al. 2022

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Introduction When performing targeted biopsy (TBx), the need to add systematic biopsies (SBx) is often debated. Aim of the study is to evaluate the added value of SBx in addition to TBx in terms of prostate cancer (PCa) detection rates (CDR), and to test the concordance between multiparametric magnetic resonance imaging (mpMRI) findings and fusion biopsy results in terms of cancer location. Methods We performed a retrospective, multicentric study that gathered data on 1992 consecutive patients who underwent elastic fusion biopsy between 2011 and 2020. A standardized approach was used, with TBx (2–4 cores per target) followed by SBx (12–14 cores). We assessed CDR of TBx, of SBx, and TBx+SBx for all cancers and clinically significant PCa (csPCa), defined as ISUP score ≥2. CDR was evaluated according to radiological and clinical parameters, with a particular focus on PI‐RADS 3 lesions. In a subgroup of 1254 patients we tested the discordance between mpMRI findings and fusion biopsy results in terms of cancer location. Uni‐ and multivariable logistic regression analyses were performed to identify predictors of CDR. Results CDR of TBx+SBx was 63.0% for all cancers and 38.8% of csPCa. Per‐patient analysis showed that SBx in addition to TBx improved CDR by 4.5% for all cancers and 3.4% for csPCa. Patients with lesions scored as PI‐RADS 3, 4, and 5 were diagnosed with PCa in 27.9%, 72.8%, and 92.3%, and csPCa in 10.7%, 43.6%, and 69.3%, respectively. When positive, PI‐RADS 3 lesions were ISUP grade 1 in 61.1% of cases. Per‐lesion analysis showed that discordance between mpMRI and biopsy was found in 56.6% of cases, with 710 patients having positive SBx outside mpMRI targets, of which 414 (58.0%) were clinically significant. PSA density ≥0.15 was a strong predictor of CDR. Conclusions The addition of systematic mapping to TBx contributes to a minority of per‐patient diagnoses but detects a high number of PCa foci outside mpMRI targets, increasing biopsy accuracy for the assessment of cancer burden within the prostate. High PSA‐density significantly increases the risk of PCa, both in the whole cohort and in PI‐RADS 3 cases.

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Section: Discussioncontrasting

confidence: 99%

Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy

et al. 2022

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“…Perfusion strength, strain pattern, with or without focal no-strain were assessed. PCa of mpUS was assessed according to the EFSUMB2017 guidelines, WFUMB2017 guidelines, and literature reports [10][11][12][13][14].…”

Section: Ceus and Tres Of The Target Areamentioning

confidence: 99%

The combined value of mpUS and mpMRI-TRUS fusion for the diagnosis of clinically significant prostate cancer

2022

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Objective To evaluate the combined efficacy of multiparametric ultrasonography (mpUS) and multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI-TRUS) fusion for detecting clinically significant prostate cancer (csPCa). Methods From November 2019 to September 2021, biopsy-naïve patients underwent mpMRI-TRUS fusion imaging combined with mpUS-guided targeted biopsies (TB) and systematic biopsies (SB). To further evaluate the additional diagnostic value of mpUS, the imaging features of 202 focus obtained from fusion imaging were assessed. The diagnostic accuracies of mpMRI-TRUS fusion imaging and the combination of mpMRI-TRUS fusion imaging with mpUS for csPCa were comparatively evaluated. Results A total of 202 prostate lesions (160 patients) were included in the final analysis, of which 105 were csPCa, 16 were ciPCa, and 81 were noncancerous. The median patient age was 69 (65–73) years and the median tPSA was 22.07 (11.22–62.80) ng/mL. For csPCa, the detection rate of TB was higher than that of SB (50.0% vs. 45.5%, p < 0.05). The imaging characteristics of mpUS in the PCa and non-PCa groups were significantly different (p < 0.001). When compared with mpMRI-TRUS fusion imaging, the positive predictive value, false positive rate, and area under the curve (AUC) of csPCa diagnosis by mpMRI-TRUS fusion imaging combined with mpUS increased by 11.30%, decreased by 19.58%, and increased from 0.719 to 0.770 (p < 0.05), respectively. Conclusion TB can improve the detection rate of csPCa and hence can be effectively used in the diagnosis and risk assessment of csPCa. The mpUS-enriched valuable diagnostic information for mpMRI-TRUS fusion imaging and their combination showed a higher diagnostic value for csPCa, which can guide subsequent clinical treatment.

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“…However, the disappointing results might be affected by the observers' considerable amount of prior CEUS experience, and lack of it with the interpretation of CUDI maps. Recently, Mannaerts et al prospectively enrolled 142 men suspected of PCa to compare the effectiveness of targeted biopsy based on CUDI software-analyzed parametric maps (CUDI-Bx) and FBx [82]. Overall, 62/142 (43%) patients were diagnosed with csPCa, of which CUDI-Bx identified 40/62 cases (65% sensitivity) and FBx identified 41/62 cases (66% sensitivity).…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

Alternatives for MRI in Prostate Cancer Diagnostics—Review of Current Ultrasound-Based Techniques

Gurwin

Kowalczyk

Knecht-Gurwin

et al. 2022

Cancers

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The purpose of this review is to present the current role of ultrasound-based techniques in the diagnostic pathway of prostate cancer (PCa). With overdiagnosis and overtreatment of a clinically insignificant PCa over the past years, multiparametric magnetic resonance imaging (mpMRI) started to be recommended for every patient suspected of PCa before performing a biopsy. It enabled targeted sampling of the suspicious prostate regions, improving the accuracy of the traditional systematic biopsy. However, mpMRI is associated with high costs, relatively low availability, long and separate procedure, or exposure to the contrast agent. The novel ultrasound modalities, such as shear wave elastography (SWE), contrast-enhanced ultrasound (CEUS), or high frequency micro-ultrasound (MicroUS), may be capable of maintaining the performance of mpMRI without its limitations. Moreover, the real-time lesion visualization during biopsy would significantly simplify the diagnostic process. Another value of these new techniques is the ability to enhance the performance of mpMRI by creating the image fusion of multiple modalities. Such models might be further analyzed by artificial intelligence to mark the regions of interest for investigators and help to decide about the biopsy indications. The dynamic development and promising results of new ultrasound-based techniques should encourage researchers to thoroughly study their utilization in prostate imaging.

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Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

Cited by 22 publications

References 42 publications

Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy

Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy

The combined value of mpUS and mpMRI-TRUS fusion for the diagnosis of clinically significant prostate cancer

Alternatives for MRI in Prostate Cancer Diagnostics—Review of Current Ultrasound-Based Techniques

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