Is it time to consider a role for MRI before prostate biopsy?

Ahmed, Hashim U.; Kirkham, Alex; Arya, Manit; Illing, Rowland; Freeman, Alex; Allen, Clare; Emberton, Mark

doi:10.1038/nrclinonc.2009.18

Cited by 285 publications

(198 citation statements)

References 91 publications

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“…Studies using whole-mount histology as the reference standard have reported T2-weighted MRI scans with broad spectrums of sensitivity ranging between 37% and 96%. 22 The wide variation in results is a consequence of equipment, patient selection, experience and the accuracy of pathological correlation. 23 In addition, interobserver variability for the reference of each finding is also likely to affect the outcome.…”

Section: Discussionmentioning

confidence: 99%

The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score

Ko¹,

Sung²,

Kang³

et al. 2011

Asian J Androl

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To obtain improved accuracy in predicting extracapsular extension (ECE) and seminal vesicle invasion (SVI), we evaluated the variables affecting the predictability of staging magnetic resonance imaging (MRI, phased-array coil) and estimated their impact on accuracy between preoperative MRI staging and histological outcome. A total of 121 patients with localized or locally advanced prostate cancer who underwent robotic radical prostatectomy (RALP) were included. Following transrectal biopsy, all enrolled patients had undergone MRI for staging work-up. After RALP, only 43.8% (53/121) of the patients were matched with the MRI predicted stage. Compared to the matched group in the prediction of ECE, the unmatched group had significantly higher initial prostate-specific antigen (PSA, 12.8 ng ml 21 versus 8.1 ng ml 21 , P50.048). In the prediction of SVI, initial PSA (8.1 ng ml 21 versus 17.3 ng ml 21 , P50.009) and biopsy Gleason score (6.5 versus 7.6, P50.035) were significantly higher in the unmatched group. When applying clinical cutoffs of initial PSA of 10 and 20 ng ml 21 , the accuracy of MRI in the prediction of ECE was decreased in the group with PSA over 20 ng ml 21 (75.6, 64.5 and 37.5%, P50.01), and this group had significantly decreased accuracy of MRI in the prediction of SVI (91.5, 77.4 and 37.5%, P,0.01). Applying the clinical cutoff of a Gleason score of 7, the accuracy of MRI in the prediction of SVI was decreased in the higher Gleason score group (93.9, 82.1 and 62.9%, P50.01). Thus, for these patient groups, to obtain margin negativity during radical prostatectomy, operative findings, rather than post-biopsy MRI images, may provide substantial information, implying a clinical advantage in conducting MRI before prostate biopsy.

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Section: Discussionmentioning

confidence: 99%

The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score

Ko¹,

Sung²,

Kang³

et al. 2011

Asian J Androl

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“…This concept was advocated by Ahmed et al 108 Hambrock et al has shown that MRI-targeted biopsies can detect PCa in areas outside the peripheral zone or locations not biopsied in normal schemes, in particular the anterior part of the gland. 109 In that study, they utilized MRI to localize PCasuspicious areas followed by a median of four cores.…”

Section: Role Of Magnetic Resonance Imaging Targeted Biopsymentioning

confidence: 99%

Prostate cancer detection after a negative prostate biopsy: Lessons learnt in the Cleveland Clinic experience

Zaytoun

Jones

2011

Int J of Urology

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Abstract:Urologists are often faced with the dilemma of managing patients with a negative initial prostate biopsy in whom clinical or pathological risk for prostate cancer still exists. Such real-life challenging scenarios might raise questions such as: Who should undergo further biopsies? What are the optimal predictors for prostate cancer on subsequent biopsies? What is the optimal biopsy protocol that should be used? When to stop the biopsy cascade? The last decade has witnessed numerous studies that have analyzed factors conferring a significant risk for cancer discovered on repeat biopsies. We and others have developed predictive models to aid decision-making regarding pursuing further biopsies. For decades, high-grade prostatic intraepithelial neoplasia has been considered a strong risk indicator for subsequent cancer. However, it has been recently shown that only through segmentation of this heterogeneous population does the real risk profile emerge. Biopsy templates underwent modification regarding the number and location of cores with emergence of the transrectal or brachytherapy grid transperineal saturation biopsy. However, the best biopsy protocol remains controversial. We have refined the initial biopsy template to a 14 core initial biopsy template that optimizes cancer detection, and have shown that transrectal saturation biopsy significantly improves cancer detection for repeat biopsy. Another concern is the overdiagnosis of clinically insignificant cancer on repeat biopsies, so we explored ways to limit this, and to deal with its ramifications. Through carrying out a Medline literature search, we critically evaluated pertinent articles together with emphasis of our own journey in this arena to assist in the decision-making process for repeat biopsy population.

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“…[7][8][9] Results from the PROMIS study favour the use of upfront prostate mpMRI to triage biopsy-naive men when compared to systematic 10-12-core biopsy. 10 Other studies have shown the superiority of MRI-targeted biopsy compared to systematic 12-core biopsy, particularly in patients with previous negative biopsy.…”

Section: Introductionmentioning

confidence: 99%

Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted

Bladou

Fogaing

Levental

et al. 2017

CUAJ

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Introduction: Magnetic resonance imaging (MRI) is being more widely used in the detection of prostate cancer (PCa), particularly after an initial negative biopsy. In this study, we compared 12-core systematic biopsy (SYS), MRI-targeted biopsy (TAR), and the association of systematic and MRI-targeted (SYS+TAR) prostate biopsy in patients with previous biopsy and those who were biopsy-naive to evaluate the differences in terms of cancer detection and clinically significant cancer detection between the three modalities. Methods: Overall, 203 consecutive patients with suspicion of PCa were analyzed; 48.2% were biopsy-naive and 51.7% had at least one previous negative prostate biopsy. The median age was 66 years, median prostate-specific antigen (PSA) level was 7.9 ng/mL and median prostate volume was 46 mL. 38.9% had SYS, 19.2% TAR only, and 41.8% had SYS+TAR biopsy. Results: Overall, the PCa detection (PCaDR) was 63%. The SYS+TAR biopsy detected significantly more cancer than SYS and TAR only biopsies (72.9% vs. 56.9% and 53.8% respectively; p=0.03). Detection rate of clinically significant cancer (csPCaDR) was 50.7% overall; 65.8% in the SYS+TAR biopsy vs. 39.2% in the SYS and 48.7% in the TAR groups (p=0.002). In the biopsy-naive group, PCaDR and csPCaDR were significantly higher in the SYS+TAR group than in the SYS and TAR groups (p=0.01). In the repeat biopsy group, PCaDR and csPCaDR were equivalent in the TAR and SYS+TAR groups and higher than in the SYS group (p=0.001). Conclusions: TAR biopsy, when added to SYS biopsy, was associated with a higher detection rate of csPCa in biopsy-naive patients when compared to TAR and SYS only biopsies. In patients after previous negative biopsy, detection rates of csPCa were equivalent for SYS+TAR and TAR only biopsies, but higher than SYS.

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Is it time to consider a role for MRI before prostate biopsy?

Cited by 285 publications

References 91 publications

The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score

The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score

Prostate cancer detection after a negative prostate biopsy: Lessons learnt in the Cleveland Clinic experience

Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted

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