Diagnostic Performance of Initial Transperineal Template-guided Mapping Biopsy of the Prostate Gland

Bittner, Nathan; Merrick, Gregory S.; Bennett, Abbey; Butler, Wayne M.; Andreini, Hugo; Taubenslag, Walter; Adamovich, Edward

doi:10.1097/coc.0b013e31829a2954

Cited by 20 publications

(22 citation statements)

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“…However, such a high prevalence has been seen by others when applying TTPM biopsies to this group of men (Bittner et al , 2015); thus, it is possible that existing thresholds for clinical significance might need to be raised (Bratt et al , 2015; Valerio et al , 2016). …”

Section: Discussionmentioning

confidence: 90%

The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy

et al. 2017

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Background:Transrectal prostate biopsy has limited diagnostic accuracy. Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE) was a paired-cohort confirmatory study designed to assess diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in men requiring a repeat biopsy.Methods:All underwent 3 T mpMRI and transperineal template prostate mapping biopsies (TTPM biopsies). Multiparametric MRI was reported using Likert scores and radiologists were blinded to initial biopsies. Men were blinded to mpMRI results. Clinically significant prostate cancer was defined as Gleason ⩾4+3 and/or cancer core length ⩾6 mm.Results:Two hundred and forty-nine had both tests with mean (s.d.) age was 62 (7) years, median (IQR) PSA 6.8 ng ml (4.98–9.50), median (IQR) number of previous biopsies 1 (1–2) and mean (s.d.) gland size 37 ml (15.5). On TTPM biopsies, 103 (41%) had clinically significant prostate cancer. Two hundred and fourteen (86%) had a positive prostate mpMRI using Likert score ⩾3; sensitivity was 97.1% (95% confidence interval (CI): 92–99), specificity 21.9% (15.5–29.5), negative predictive value (NPV) 91.4% (76.9–98.1) and positive predictive value (PPV) 46.7% (35.2–47.8). One hundred and twenty-nine (51.8%) had a positive mpMRI using Likert score ⩾4; sensitivity was 80.6% (71.6–87.7), specificity 68.5% (60.3–75.9), NPV 83.3% (75.4–89.5) and PPV 64.3% (55.4–72.6).Conclusions:In men advised to have a repeat prostate biopsy, prostate mpMRI could be used to safely avoid a repeat biopsy with high sensitivity for clinically significant cancers. However, such a strategy can miss some significant cancers and overdiagnose insignificant cancers depending on the mpMRI score threshold used to define which men should be biopsied.

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Section: Discussionmentioning

confidence: 90%

The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy

et al. 2017

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“…Using such a volume-adjusted stringent systematic saturation approach, the combination of the two biopsy methods did not have significant additional benefit. The detected overall cancer rates with 65% for all patients and 72, 45, and 81% for the primary biopsy cohort, the repeat biopsy cohort, and the surveillance cohort, respectively, are clearly compatible compared to other transperineal template-guided saturation (TTSB) or mapping biopsy studies (TTPM): for primary biopsy cohorts, detection rates of 54-76% have been reported using a mean amount of 19-54 cores [20][21][22][23] ; and for repeat biopsy cohorts, detection rates of 26-68% with a mean amount of 18-59 cores have been reported [21,22,[24][25][26][27][28][29] . In series in which TTPM biopsies was followed by RP, TTPM was highly accurate in detecting and excluding clinically significant disease [30,31] .…”

Section: Discussionmentioning

confidence: 68%

TOP: Prospective Evaluation of a Volume Based, Computer Assisted Method for Transperineal Optimized Prostate Biopsy

et al. 2017

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Objective: This study is a prospective evaluation of a volume-based, computer-assisted method for transperineal optimized prostate (TOP) biopsy. The TOP algorithm automates core planning for systematic prostate biopsies using the 3-dimensional organ contour and an alterable volume for tumors to be excluded. Subjects and Methods: MRI-transrectal ultrasound fusion biopsy with MRI-targeted biopsies (TBs) and systematic-TOP biopsies were performed on 172 men between October 2013 and March 2014. Systematic biopsies were placed according to TOP for detection of tumor volumes >0.5 mL with a minimum of 80% organ coverage in prostates up to 50 mL (70% in larger organs). Results: Median 24 TOP cores and 3 MRI-TBs have been placed. Prostate cancer (PCa) was detected in 112 of 172 (65%) of men; TOP detected 109 (97%) and TB 62 (55%). Significant cancer (Gleason score ≥7) was detected in 75 (44%) of men and of these TOP detected 73 of 75 (97%) and TB 51 of 75 (68%). Overall, systematic-TOP sampling significantly outperformed TB for the detection of both, all PCa as well as significant PCa (p < 0.0001, p = 0.0005). Conclusion: The TOP method is innovative by integrating the individual prostate volume and PCa volume detection thresholds. In the present cohort, it diagnosed more significant tumors than TB alone. However, at the same time, more low-risk tumors are detected.

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“…We used TTMB following a prior negative MRI-guided biopsy, as there was still a clinical indication of cancer. In published literature, cancer detection of TTMB in the primary setting and following a prior negative biopsy is 73% to 76% and 46% to 68%, respectively [14,15]. TTMB is rarely used as a primary biopsy technique but its high negative predictive value is often used to rule out significant cancer in patients with prior negative biopsy and prior to tissue-preservation management (AS and FT) [15].…”

Section: Discussionmentioning

confidence: 98%

Clinical utility of transperineal template-guided mapping biopsy of the prostate after negative magnetic resonance imaging−guided transrectal biopsy

Sivaraman

Sánchez-Salas

Ahmed

et al. 2015

Urologic Oncology: Seminars and Original Investigations

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Diagnostic Performance of Initial Transperineal Template-guided Mapping Biopsy of the Prostate Gland

Cited by 20 publications

References 20 publications

The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy

The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy

TOP: Prospective Evaluation of a Volume Based, Computer Assisted Method for Transperineal Optimized Prostate Biopsy

Clinical utility of transperineal template-guided mapping biopsy of the prostate after negative magnetic resonance imaging−guided transrectal biopsy

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