Does prostate HistoScanning™ play a role in detecting prostate cancer in routine clinical practice? Results from three independent studies

Abstract

ObjectivesTo evaluate the ability of prostate HistoScanning™ (PHS; Advanced Medical Diagnostics, Waterloo, Belgium) to detect, characterize and locally stage prostate cancer, by comparing it with transrectal ultrasonography (TRUS)-guided prostate biopsies, transperineal template prostate biopsies (TTBs) and whole-mount radical prostatectomy specimens. Subjects and MethodsStudy 1. We recruited 24 patients awaiting standard 12-core TRUS-guided biopsies of the prostate to undergo PHS immediately beforehand. We compared PHS with the TRUS-guided biopsy results in terms of their ability to detect cancer within the whole prostate and to localize it to the correct side and to the correct region of the prostate. Lesions that were suspicious on PHS were biopsied separately.Study 2. We recruited 57 patients awaiting TTB to have PHS beforehand. We compared PHS with the TTB pathology results in terms of their ability to detect prostate cancer within the whole gland and to localize it to the correct side and to the correct sextant of the prostate. Study 3. We recruited 24 patients awaiting radical prostatectomy for localized prostate cancer to undergo preoperative PHS. We compared PHS with standardized pathological analysis of the whole-mount prostatectomy specimens in terms of their measurement of total tumour volume within the prostate, tumour volume within prostate sextants and volume of index lesions identified by PHS. ResultsThe PHS-targeted biopsies had an overall cancer detection rate of 38.1%, compared with 62.5% with standard TRUS-guided biopsies. The sensitivity and specificity of PHS for localizing tumour to the correct prostate sextant, compared with standard TRUS-guided biopsies, were 100 and 5.9%, respectively.The PHS-targeted biopsies had an overall cancer detection rate of 13.4% compared with 54.4% for standard TTB. PHS had a sensitivity and specificity for cancer detection in the posterior gland of 100 and 13%, respectively, and for the anterior gland, 6 and 82%, respectively.We found no correlation between total tumour volume estimates from PHS and radical prostatectomy pathology (Pearson correlation coefficient −0.096). Sensitivity and specificity of PHS for detecting tumour foci ≥0.2 mL in volume were 63 and 53%. ConclusionsThese three independent studies in 105 patients suggest that PHS does not reliably identify and characterize prostate cancer in the routine clinical setting.

Prostate Imaging – An Update

“…With regard to the detection of prostate cancer, it was able to be shown in a current study that systematic biopsy detected more prostate cancers compared to HistoScanning TM . Prostate cancer was found in 63 % of the examined patients with systematic biopsy while this was the case in only 38 % of patients with HistoScanning TM [15]. The comparison of the detection rate of HistoScanning TM with the results of systematic perineal biopsy yielded comparable results.…”

“…This insufficient detection accuracy is in agreement with a suboptimal localization accuracy of tumors ≥ 0.2 cm 3 . Therefore, this method does not seem suitable for staging [15]. The cancer volume determined with HistoScanning TM did not coincide with the actual volume in the prostatectomy specimen [17].…”

“…The comparison of the detection rate of HistoScanning TM with the results of systematic perineal biopsy yielded comparable results. A prostate cancer could be detected in only 13 % of patients with HistoScanning TM in one study while systematic transperineal biopsy detected prostate cancer in 54 % of patients [15]. A further study with 198 evaluated patients used HistoScanning TM for prediction accuracy of a subsequent sextant biopsy.…”

Sextant-Specific Analysis of Detection and Tumor Volume by HistoScanning™

“…In contrast, the Hamburg group from the Martini Clinic reported that the total cancer volumes by HS in tumors up to 10 ml did not correlate with those by histology [15]. Javed et al [16] reported similar results about the correlation of the HS and RP specimen. In our cohort, the systematic underestimation of volume estimates by HS compared to pathology becomes apparent for tumors >8 ml.…”

Using imaging biomarkers to improve the planning of radical prostatectomies

“…Its sensitivity and specificity compared with combined TRUS and transperineal biopsy were shown to be 93.5% and 79.5%, respectively [13]. However, a more recent study has found lower specificities and sensitivities of cancer detection compared with RP specimens and found that in certain clinical settings, it did not reliably detect PCas when compared with TRUS or transperineal US guided biopsies [14]. mpMRI and an application of this CAD (prostate HistoScanning) are currently being assessed as diagnostic tests in a prospective validating cohort study [15].…”