How Many Targeted Biopsy Cores are Needed for Clinically Significant Prostate Cancer Detection during Transperineal Magnetic Resonance Imaging Ultrasound Fusion Biopsy?

Gang, Song Woon; Ruan, Mingjian; Wang, He; Fan, Yu; He, Qun; Lin, Zhiyong; Li, Xueying; Wang, Xiaoying; He, Zhisong; Zhou, Liqun

doi:10.1097/ju.0000000000001302

Cited by 20 publications

(26 citation statements)

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“…In addition, all the patients had symptoms of dysuria. The mean age of the patients in this study was nearly 72 years old, which is older than that reported in other related studies (3,4,15). We found that the IIEF-5 scores were the worst at 3 months postoperatively, and while they recovered at 6 and 12 months postoperatively, the scores were still slightly worse than those before surgery.…”

Section: Discussioncontrasting

confidence: 56%

“…However, due to the non-specificity of prostate-specific antigen (PSA), the biopsy-positive rate of localized PCa is only 22.8-42.0% (2,3). With the development of magnetic resonance imaging -ultrasound fusion prostate biopsy, the accuracy of prostate biopsy has increased to approximately 60%, but missed diagnoses still occur (4,5). Radical prostatectomy (RP) is recommended as a curative method for localized PCa confirmed by needle biopsy.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety evaluation of complete intrafascial prostatectomy in suspected prostate cancer patients with dysuria: a retrospective cohort study

Zhou¹,

Xu²,

Shuan³

et al. 2023

Transl Androl Urol

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Background: Suspected localized prostate cancer (PCa) patients with dysuria Complete intrafascial prostatectomy (CIP) can remove the whole prostate gland with the maximal retain of adjacent normal tissues around the prostate, and can be applied in some suspected localized prostate cancer (PCa) patients with dysuria. However, precious few studies have assessed the efficacy and safety of CIP in these patients without preoperative needle biopsies. Methods:In this retrospective single-arm cohort study, all 22 suspected PCa patients with dysuria who underwent CIP at our hospital were enrolled. The clinical data including age, prostate-specific antigen (PSA), free-serum PSA, prostate volume, perioperative and postoperative complications were collected. The PSA level at 6 weeks after CIP and recoveries of urinary continence and erectile function were acquired in the follow-up procedures, and were used as the main measurements of efficacy and safety for CIP respectively. Results:The patients had an average age of 71.91±8.29 years and an average preoperative PSA level of 10.75±4.25 ng/mL. The operations for all 22 patients were successfully completed. The average operation time was 135.20±41.44 min (range, 40.0-215.0 min), and the average blood loss volume was 128.64±145.09 mL. In total, 17 patients (77.27%) had PCa confirmed by postoperative pathology, and 5 patients (22.73%) had benign prostatic hyperplasia. The PSA level dropped to 0.010±0.004 ng/mL at 6 weeks after surgery. According to the loose criteria to assess urinary incontinence, the patients achieved continence rates of 63.6% immediately after the operation, 95.5% at 1 month, and 100% at 3 months. According to the strict criteria, the continence rates immediately, and at 1, 3, 6, and 9 months after surgery were 27.3%, 63.6%, 90.9%, 95.5%, and 100%, respectively. None of the patients complained of urinary obstruction symptoms after surgery. Before CIP, all the patients had erectile dysfunction and an International Index of Erectile Function 5 (IIEF-5) score of 9.64±5.91.After surgery, the patients had IIEF-5 scores at 3, 6, and 12 months of 5.45±4.43, 6.95±5.30, and 7.57±5.69, respectively.Conclusions: Although the study had some limitations, CIP may be a prudent option for patients with suspected localized PCa who also present with dysuria.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety evaluation of complete intrafascial prostatectomy in suspected prostate cancer patients with dysuria: a retrospective cohort study

Zhou¹,

Xu²,

Shuan³

et al. 2023

Transl Androl Urol

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“…However, this approach is associated with the underdetection of clinically significant (higher‐grade) prostate cancers and the overdetection of clinically insignificant (low‐grade) cancers 15 . The advent of prostate mpMRI offers a new approach for this diagnosis 16 . TB using MRI‐ultrasound (US) fusion has been increasingly used recently in the diagnosis and characterization of PCa.…”

Section: Discussionmentioning

confidence: 99%

“…15 The advent of prostate mpMRI offers a new approach for this diagnosis. 16 TB using MRI-ultrasound (US) fusion has been increasingly used recently in the diagnosis and characterization of PCa. Previous studies indicate that MRI-targeted biopsies detect more intermediate/high-risk cancers using fewer biopsy needles and reduce the over-detection of low-risk cancer.…”

mentioning

confidence: 99%

Optimized grade group for reporting prostate cancer grade in systematic and MRI‐targeted biopsies

Shen

et al. 2022

The Prostate

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Purpose: To explore an optimized grade group (oGG) criterion from systematic biopsies (SB) and targeted biopsies (TB) and offer a better prediction of radical prostatectomy (RP) grade group (GG).Methods: Positive needles were collected from 146 patients who underwent SB + TB followed by RP. The grade was assigned for two different kinds of biopsies with five GG criteria: (1) global GG (gGG); (2) most common GG (most common GG from SB + TB, mGG); (3) highest GG (highest numerical GG from SB + TB, hGG); (4) largest volume/linear length cancer GG (defined as GG from the SB + TB with the largest length of cancer in a needle, lGG). These biopsy grades were compared (equivalence, upgrade, or downgrade) with the final grade of the RP lesion, using weighted κ coefficients; (5) Then the best agreement of the (2) (3) (4) grading scores from SB or TB was combined to introduce an oGG.Results: In this study, gGG showed generally poor agreement (47.2%) with RP GG (weighted κ: 0.43). Using the three criteria (mGG, hGG, and lGG) of SB, mGG had the best agreement (55.5%, weighted κ: 0.46), while hGG and lGG had a lower agreement (48.6% and 48.6%, weighted κ: 0.42 and 0.38). Using the three criteria (mGG, hGG and lGG) of TB: lGG had the best agreement (56.8%, weighted κ: 0.43), while mGG and hGG had lower agreement (50.0% and 49.3%, weighted κ: 0.40 and 0.40); Then oGG was generated (higher GG between mGG of SB and lGG of TB) and the agreement of oGG increased to 59.6% and weighted κ was 0.49. Additionally, oGG had a lower upgrade rate than gGG, while the downgrade rate remained unchanged.Conclusions: oGG showed better agreement with RP GG than gGG. oGG had a lower upgrade rate than gGG, while downgrade rate remained unchanged.

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“…positive samples, divided by the number of needles fired. Five needles are chosen to represent the maximum number typically used in targeted biopsy [23]. CCL is the total length (in mm) overlapping the target, i.e.…”

Section: Methodsmentioning

confidence: 99%

Strategising template-guided needle placement for MR-targeted prostate biopsy

Gayo¹,

Saeed²,

Barratt³

et al. 2022

Preprint

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Clinically significant prostate cancer has a better chance to be sampled during ultrasound-guided biopsy procedures, if suspected lesions found in pre-operative magnetic resonance (MR) images are used as targets. However, the diagnostic accuracy of the biopsy procedure is limited by the operator-dependent skills and experience in sampling the targets, a sequential decision making process that involves navigating an ultrasound probe and placing a series of sampling needles for potentially multiple targets. This work aims to learn a reinforcement learning (RL) policy that optimises the actions of continuous positioning of 2D ultrasound views and biopsy needles with respect to a guiding template, such that the MR targets can be sampled efficiently and sufficiently. We first formulate the task as a Markov decision process (MDP) and construct an environment that allows the targeting actions to be performed virtually for individual patients, based on their anatomy and lesions derived from MR images. A patient-specific policy can thus be optimised, before each biopsy procedure, by rewarding positive sampling in the MDP environment. Experiment results from fifty four prostate cancer patients show that the proposed RL-learned policies obtained a mean hit rate of 93% and an average cancer core length of 11 mm, which compared favourably to two alternative baseline strategies designed by humans, without hand-engineered rewards that directly maximise these clinically relevant metrics. Perhaps more interestingly, it is found that the RL agents learned strategies that were adaptive to the lesion size, where spread of the needles was prioritised for smaller lesions. Such a strategy has not been previously reported or commonly adopted in clinical practice, but led to an overall superior targeting performance, achieving higher hit rates (93% vs 76%) and measured cancer core lengths (11.0mm vs 9.8mm) when compared with intuitively designed strategies.

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How Many Targeted Biopsy Cores are Needed for Clinically Significant Prostate Cancer Detection during Transperineal Magnetic Resonance Imaging Ultrasound Fusion Biopsy?

Cited by 20 publications

References 0 publications

Efficacy and safety evaluation of complete intrafascial prostatectomy in suspected prostate cancer patients with dysuria: a retrospective cohort study

Efficacy and safety evaluation of complete intrafascial prostatectomy in suspected prostate cancer patients with dysuria: a retrospective cohort study

Optimized grade group for reporting prostate cancer grade in systematic and MRI‐targeted biopsies

Strategising template-guided needle placement for MR-targeted prostate biopsy

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