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

Pepe, Pietro; Cimino, Silvia; Garufi, Antonio; Priolo, Giandomenico; Russo, Giorgio Ivan; Giardina, Raimondo; Reale, Giulio; Panella, P; Pennisi, Michele; Morgia, Giuseppe

doi:10.4081/aiua.2016.4.300

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…Studies on MRI and AS were excluded if MRI had previously been used (initial biopsies or previous negative biopsies) , if data on negative prostate MRI was excluded , if Gleason score 3 + 4 at initial TRUS biopsy was also included in the AS cohort , if sampled lesions with suspicion score of ‘2’ on MRI could not be excluded from the results , when MRI suspicion scores (Likert or PI‐RADS) were dichotomised as positive to a score ≥4 instead of a score ≥3 , if template biopsies (>20 cores) was used as the reference test , if data extraction to 2 × 2 contingency tables was not possible , if a transperineal biopsy approach , or unclear definition of index test was used . We excluded double publications .…”

Section: Methodsmentioning

confidence: 99%

Is magnetic resonance imaging‐targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low‐risk prostate cancer? A systematic review and meta‐analysis

et al. 2018

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Section: Methodsmentioning

confidence: 99%

Is magnetic resonance imaging‐targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low‐risk prostate cancer? A systematic review and meta‐analysis

et al. 2018

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“…While this approach may provide enhanced detection, it also subjects patients to the burden of increased tissue acquisition. Pepe et al proposed using a hybrid approach they referred to as “cognitive zonal fusion biopsy” ( 46 ). In this approach, all patients undergo mpMRI prior to a MRI–US fusion biopsy.…”

Section: Resultsmentioning

confidence: 99%

“…If during the biopsy there is a discrepancy between what was found on MRI and what is visualized on US, two to six cores are obtained from the MRI region of interest. In their prospective study of 58 individuals who were either biopsy naïve or on AS, this approach reliably detected significant PCa ( 46 ).…”

Section: Resultsmentioning

confidence: 99%

“…Recent evidence suggests that performing MRI-targeted biopsies may be just as reliable as saturation biopsies for detection of significant PCa ( 45 – 47 ). This would spare both patients and providers the burden of acquiring unnecessary cores, and may lessen the frequency of detecting insignificant disease ( 46 ). However, some studies suggest MRI–US fusion alone may not be adequate in the initial diagnostic setting, and standard template biopsy may be equally diagnostic in biopsy naïve men ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

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Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

et al. 2017

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BackgroundActive surveillance (AS) is a widely adopted strategy to monitor men with low-risk, localized prostate cancer (PCa). Current AS inclusion criteria may misclassify as many as one in four patients. The advent of multiparametric magnetic resonance imaging (mpMRI) and novel PCa biomarkers may offer improved risk stratification. We performed a review of recently published literature to characterize emerging evidence in support of these novel modalities.MethodsAn English literature search was conducted on PubMed for available original investigations on localized PCa, AS, imaging, and biomarkers published within the past 3 years. Our Boolean criteria included the following terms: PCa, AS, imaging, biomarker, genetic, genomic, prospective, retrospective, and comparative. The bibliographies and diagnostic modalities of the identified studies were used to expand our search.ResultsOur review identified 222 original studies. Our expanded search yielded 244 studies. Among these, 70 met our inclusion criteria. Evidence suggests mpMRI offers improved detection of clinically significant PCa, and MRI-fusion technology enhances the sensitivity of surveillance biopsies. Multiple studies demonstrate the promise of commercially available screening assays for prediction of AS failure, and several novel biomarkers show promise in this setting.ConclusionIn the era of AS for men with low-risk PCa, improved strategies for proper stratification are needed. mpMRI has dramatically enhanced the detection of clinically significant PCa. The advent of novel biomarkers for prediction of aggressive disease and AS failure has shown some initial promise, but further validation is warranted.

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“…Compared to saturation biopsies, recent evidence suggests that MRI-targeted biopsies may be just as reliable for csPCa detection with improved efficiency ( 58 - 60 , 69 ). This would spare patients, urologists and pathologists the task of acquiring and interpreting numerous cores obtained from a saturation biopsy approach and may decrease the frequency of finding insignificant disease ( 59 ). Furthermore, we identified two studies suggesting that in-bore MRI-guided biopsy may offer an even greater detection rate ( 55 , 56 ).…”

Section: Discussionmentioning

confidence: 99%

MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence

Glaser¹,

Porter²,

Thomas³

et al. 2018

Transl. Androl. Urol.

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Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.

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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

Abstract: 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.

Cited by 11 publications

References 22 publications

Is magnetic resonance imaging‐targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low‐risk prostate cancer? A systematic review and meta‐analysis

Is magnetic resonance imaging‐targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low‐risk prostate cancer? A systematic review and meta‐analysis

Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence

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