Diagnosis Of Prostate Cancer In Patients With Persistently Elevated PSA And Tumor-Negative Biopsy in Ambulatory Care: Performance of MR Imaging in a Multi-Reader Environment

Scheidler, J.; Weöres, I; Brinkschmidt, Christian; Zeitler, H.; Panzer, Stephanie; Scharf, Michael; Heuck, A.; Siebels, M.

doi:10.1055/s-0031-1281974

Cited by 21 publications

(12 citation statements)

References 12 publications

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“…Because diagnostic MRI is necessary prior to MRI-guided biopsy, this study and others are limited by selection bias (33). All of the patients in our study had at least one suspicious lesion upon MRI.…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, the present study indicates that MRI-guided biopsy may be more suitable as a first line rebiopsy technique than a TRUS-guided saturation biopsy because it is less invasive and has a high detection rate. However, two issues need to be addressed in future studies: 1) determining the optimal and most cost-effective time point for referring patients for MRI-guided biopsy and 2) whether MRI-guided biopsy is indeed more expensive than TRUS when factoring in the differences in the detection rates as well as the avoidance of unnecessary TRUS-guided biopsies (33). Part of the solution may be to utilize MRI in routine, diagnostic imaging for patients with suspected prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

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MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Durmus¹,

Reichelt²,

Huppertz³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate prostate cancer detection rate of magnetic resonance imaging (MRI)-guided biopsy and to elucidate possible relations to the number of prior negative transrectal ultrasonography (TRUS)-guided biopsies. MATERIALS AND METHODSEighty-seven consecutive patients (mean age, 65.0 years; mean prostate-specific antigen, 13.3 ng/mL) with at least one prior negative TRUS-guided biopsy and persistent suspicion of prostate cancer were included in this study. All patients underwent MRI-guided biopsy after a diagnostic multiparametric MRI examination at 1.5 Tesla. Specimens were immediately fixated and subsequently evaluated by an experienced uropathologist. Prostate cancer detection rates were calculated. Prostate cancer-positive and -negative cores were compared. Correlation between number of prior biopsies and presence of prostate cancer was evaluated. RESULTSCancer detection rates for patients with one (n=24), two (n=25), three (n=18), and four or more (n=20) negative TRUS-guided biopsies were 29.2%, 40.0%, 66.7%, and 35.0%, respectively (P = 0.087). The median number of removed cores per patient was 3 (range, 1-8) without a significant difference between patients with and without cancer (P = 0.48). Thirty of 36 cancer patients were at intermediate or high risk according to the D´Amico clinical risk score. Eleven of 15 high risk cancers were localized in the transition zone (P = 0.002). CONCLUSIONSThis study demonstrates high cancer detection rates of MRI-guided biopsy independent of the number of previous TRUS-guided biopsies and the number of taken prostate cores. MRI-guided biopsy therefore represents a less invasive and effective diagnostic tool for patients with prostate cancer suspicion and previous negative TRUS-guided biopsies.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Durmus¹,

Reichelt²,

Huppertz³

et al. 2013

Diagn Interv Radiol

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“…Nebendiagnosen waren in 13/32 Fällen eine Prostatitis und in 5/32 Fällen eine High-Grade-PIN. [10,16]. Daher erscheint es sinnvoll, diese diagnostische Information während der TRUS-Biopsie zur Verfügung zu stellen und die Bilder beider Verfahren zu fusionieren [16].…”

Section: Us-fusionsbiopsieunclassified

Detektion des Prostatakarzinoms durch Echtzeit-MRT/US-Fusionsbiopsie: 3T MRT und moderne Ultraschalltechnik

Durmus

Stephan

Grigoryev

et al. 2013

Fortschr Röntgenstr

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Zusammenfassung Ziel: Die multiparametrische MRT der Prostata ist eine nicht invasive Methode mit hoher Sensitivit?t und Spezifit?t f?r das Prostatakarzinom. Ziel dieser Arbeit ist es, zu evaluieren, ob eine Bildfusion von modernen Ultraschalltechniken (CEUS, Elastografie) und MRT-Daten (T2w, DWI) die Detektionsrate der TRUS-Biopsie erh?hen kann. Material und Methoden: 32 konsekutive Patienten mit erh?hten PSA-Werten und mindestens einer negativen TRUS-gest?tzten Biopsie in der Anamnese mit klinischer Indikation f?r eine systematische Re-Biopsie der Prostata erhielten eine multiparametrische 3T MRT ohne Verwendung einer endorektalen Spule. Die MR-Daten (T2w) wurden auf ein modernes Sonografiesystem hochgeladen um eine Echtzeitfusion der Datens?tze w?hrend der Biopsien zu erm?glichen. B-Bild, Doppler, Elastografie und CEUS wurden zur Charakterisierung der MR-suspekten Herde angewendet. Gezielte Biopsien wurden entnommen. Hieran schloss sich eine systematische TRUS-gest?tzte Biopsie an. Die Detektionsraten beider Methoden wurden berechnet und mit dem Chi-Square-Test verglichen. Ergebnisse: Das mittlere Alter der Patienten mit und ohne einem Prostatakarzinom war nicht signifikant unterschiedlich (65,2???8,0 Jahre und 64,1???7,3 Jahre [p?=?0,93]). Der mittlere PSA-Wert war bei Patienten mit einem Karzinom signifikant h?her (15,5???9,3?ng/ml) als bei Patienten ohne Prostatakarzinom (PSA 10,4???9,6?ng/ml; p?=?0,02). Der Anteil histologisch nachgewiesener Karzinome in der Studienpopulation (n?=?32) war f?r die MR/US-Fusionsbiopsie (11/12; 34,4?%) signifikant h?her als f?r die systematische TRUS-gest?tzte (6/12; 18,8?%, p?=?0,01). Schlussfolgerung: Die MR/US-Bild-Fusion in Echtzeit kann die Prostatakarzinomdetektionsrate der TRUS-gest?tzten Biopsie erh?hen. Diese Methode sollte daher in gr??eren Folgestudien weiter untersucht werden.

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“…The implementation of multiparametric MRI and structured, standardized reporting could further increase interobserver agreement [22]. It must be noted, however, that all three readers were experienced in interpreting conventional endorectal prostate MRI, and experience has been found to be crucial for the diagnostic accuracy of prostate MRI [23]. It is also important to note that in a study population such as the one investigated here, it is essential to ensure an efficient workflow with prompt reporting of results to referring physicians to minimize any delay in diagnosis that might negatively impact a patient's prognosis in the screening situation.…”

Section: Figmentioning

confidence: 99%

Role of Endorectal Prostate MRI in Patients with Initial Suspicion of Prostate Cancer

Franiel

Vargas

Mazaheri

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate the role of conventional endorectal prostate MRI in patients with initial suspicion of prostate cancer. Materials and Methods: Ethics board approval was received for this retrospective study of 87?men who underwent 1.5-Tesla conventional prostate MRI with a combination of endorectal and body phased-array coils for suspected prostate cancer before their first systematic 12-core TRUS-guided biopsy. Three radiologists independently analyzed the images, dividing the prostate into 12 regions corresponding to the biopsy scheme and scoring each region for the presence of prostate cancer on a 5-point scale. Results were analyzed by prostate region. ROC analysis was done and descriptive statistics were calculated. The negative predictive value, specificity, sensitivity and positive predictive value were calculated using dichotomized scores (benign tissue?= scores of 1 and 2; malignant tissues?=?scores of 3, 4, and 5). Results: Biopsy revealed cancer in 47/87 patients (26 low-grade [Gleason score 6]; 21 high-grade [Gleason score ??3?+?4]), and 184/1044 cores (77?low-grade and 107 high-grade) with a median of 3 positive cores per cancer patient (range 1???12). The areas under ROC curves were 0.65???0.67 for cancer detection by region overall and 0.75???0.76 for the detection of high-grade cancer by region. Statistic figures for the detection of all cancers/high-grade cancers by region were as follows: negative predictive value, 87.4???88.2?%/92.6???93.1?%; specificity, 72.3???79.4?%/71.5???79.8?%; sensitivity, 49.5???54.8?%/62.6???69.2?%; and positive predictive value, 29.3???34.0?%/29.4???34.7?%. Conclusion: In patients with suspected prostate cancer, negative MRI findings indicate the absence of high-grade prostate cancer on subsequent TRUS-guided 12-core biopsy with high probability. However, agreement between conventional 1.5-T endorectal prostate MRI and systematic 12-core TRUS-guided biopsy for the detection of prostate cancer appears to be moderate. Citation Format:

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Diagnosis Of Prostate Cancer In Patients With Persistently Elevated PSA And Tumor-Negative Biopsy in Ambulatory Care: Performance of MR Imaging in a Multi-Reader Environment

Cited by 21 publications

References 12 publications

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Detektion des Prostatakarzinoms durch Echtzeit-MRT/US-Fusionsbiopsie: 3T MRT und moderne Ultraschalltechnik

Role of Endorectal Prostate MRI in Patients with Initial Suspicion of Prostate Cancer

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