MRI Fusion-Targeted Transrectal Prostate Biopsy and the Role of Prostate-Specific Antigen Density and Prostate Health Index for the Detection of Clinically Significant Prostate Cancer in Southeast Asian Men

Tan, Teck Wei; Png, Keng Siang; Lee, Chau Hung; Yuwono, Arianto; Yeow, Yuyi; Chong, Kian Tai; Lee, Yee Mun; Tan, Cher Heng; Tan, York Kiat

doi:10.1089/end.2017.0485

Cited by 17 publications

(19 citation statements)

References 26 publications

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“…Values of PSA 2.87, PHI 40.7, and PSAD 0.1 were determined to be optimal cutoffs for the detection of CSPC. Similar to our study, Tan et al [ 16 ] suggested considering biopsy with PHI, PSAD, and PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesions on magnetic resonance imaging (MRI).…”

Section: Discussionsupporting

confidence: 81%

Correlation between Gleason score distribution and Prostate Health Index in patients with prostate-specific antigen values of 2.5–10 ng/mL

et al. 2020

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Purpose To determine the clinical significance and correlation between the Prostate Health Index (PHI) and Gleason score in patients with a prostate-specific antigen (PSA) value of 2.5–10 ng/mL. Materials and Methods This retrospective analysis included 114 patients who underwent biopsy after completion of the PHI from November 2018 to July 2019. Various parameters such as PSA, PHI, PSA density, free PSA, p2PSA, and %free PSA were collected, and correlations with biopsy Gleason score and cancer detection rates were investigated. Results Baseline characteristics were comparable between PHI groups (0–26.9 [n=11], 27.0–35.9 [n=17], 36.0–54.9 [n=50], and ≥55.0 [n=36]). A total of 37 patients (32.5%) were diagnosed with prostate cancer, and 28 (24.6%) were diagnosed with clinically significant prostate cancer (CSPC, Gleason score ≥7) after prostate biopsy. The cancer detection rate gradually increased with a corresponding increase in the PHI (18%, 24%, 30%, and 44%, respectively). The same pattern was observed with detecting CSPC (0%, 18%, 26%, and 33%, respectively). There was no CSPC in the groups with PHI <27.0, and Gleason score 7 began to appear in groups with PHI ≥27.0. In particular, patients with Gleason score 8 and 9 were distributed only in the groups with PHI ≥36.0. Conclusions The diagnostic accuracy of detection of CSPC could be increased when prostate biopsy is performed in patients with a PHI ≥36.0. In this study, there was a clear Gleason score difference when the PHI cutoff value was set to 27.0 or 36.0.

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Section: Discussionsupporting

confidence: 81%

Correlation between Gleason score distribution and Prostate Health Index in patients with prostate-specific antigen values of 2.5–10 ng/mL

et al. 2020

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“…Besides, 77 articles were eliminated due to insufficient data after carefully reading the full texts. Finally, 10 articles were included in this meta-analysis (18)(19)(20)(21)(22)(23)(24)(25)(26)(27); and all included articles were to assess the diagnostic value of MRI-TBx and TRUS-Bx for the detection of PCa. Among these, seven studies were about the influence of Gleason score for PCa diagnosis.…”

Section: Studies Characteristicsmentioning

confidence: 99%

Comparison of prostate cancer detection rates between magnetic resonance imaging-targeted biopsy and transrectal ultrasound-guided biopsy according to Prostate Imaging Reporting and Data System in patients with PSA ≥4 ng/mL: a systematic review and meta-analysis

et al. 2019

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Background: Previous studies have investigated magnetic resonance imaging-targeted biopsy (MRI-TBx) on the detection for prostate cancer (PCa). Prostate Imaging Reporting and Data System (PI-RADS), as a standardized MRI reporting system, has widely been used in the management of PCa. However, basing the PI-RADS score, the comparability between MRI-TBx and transrectal ultrasound-guided biopsy (TRUS-Bx) in diagnosing PCa remained inconsistent or even controversial. Thus, this systematic meta-analysis aimed to assess the value of PI-RADS in sifting better prostate biopsy method.Methods: A meta-analysis including 10 articles was performed. In these included studies, biopsy-naive subjects with concerning PSA levels and/or an abnormal digital rectal examination (DRE) were consecutively enrolled by referral from urologists. All subjects underwent multiparameter MRI (mpMRI) prostate and the results were scored independently by PI-RADS. Subjects with equivocal (PI-RADS 3) and intermediate/ high-risk (PI-RADS 4/5) lesions underwent MRI-TBx and followed by TRUS-Bx performed by a urologist.The online databases PubMed, Embase and Web of Science were searched to find all correlated articles until October 1 st , 2019. Data were pooled by odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of the associations. Subgroup analyses were conducted based on Gleason score.Results: Overall, 10 studies were included in this meta-analysis from January, 2015 to June, 2019. In the comparison of the detection of MRI-TBx and TRUS-Bx in PCa patients, TRUS-Bx had a significant advantage in overall PCa detection compared with MRI-TBx (OR =0.78, 95% CI: 0.62-0.98) in PI-RADS 3. Basing subgroup analysis of Gleason score (csPCa: Gleason score ≥7; non-csPCa: Gleason score <7) , a summary analysis of the detection rate of csPCa showed that no significant difference was found (OR =0.82, 95% CI: 0.58-1.16); Meanwhile, no significant difference in non-csPCa patients was also detected (OR =0.83, 95% CI: 0.53-1.28). In PI-RADS 4 or 5, no significant results were detected between MRI-TBx and TRUS-Bx (OR =0.96, 95% CI: 0.87-1.06) for overall PCa detection. The stratification analyses by Gleason score found that TRUS-Bx had an advantage over MRI-TBx in non-csPCa patients (OR =0.76, 95% CI: 0.60-0.98); However, there was no significant difference in the detection rate of csPCa (OR =1.05, 95% CI: 0.93-1.20). Zhu et al. Comparison of PCa detection rates between MRI-TBx and TRUS-Bx

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“…These findings suggested that in patients with PI-RADS 3 index lesions, which is a gray zone for PI-RADS v2, PHI may help to identify high-risk groups for csPCa and may enable several patients to avoid unnecessary biopsy. Accordingly, in a previous report, Tan et al showed that a PHI cutoff value of ≥ 27 would have allowed 34% of the patients with PI-RADS 3 lesions ( n = 35) to avoid a targeted biopsy, with both sensitivity and NPV of 100% [ 23 ]. In a study published by Stejskal et al [ 30 ] including 395 men, the authors performed a head-to-head comparison between PHI and mpMRI (using the PI-RADS version 1, 1.5 T endorectal coil and 3 T machines), reporting that PHI achieved more accurate prediction for csPCa both in the first ( n = 249) and repeated ( n = 144) biopsy subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports indicated that the use of PHI in clinical routine, when compared with total and free PSA, produced a significant decrease in unnecessary biopsies and a reduction in the percentage of low-risk diagnosed PCa [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. However, only few authors investigated the predictive performance of PHI combined and compared with mpMRI [ 19 , 20 ] and how PHI performs in patients stratified by PI-RADS score [ 21 , 22 , 23 ]. Interestingly, some authors analyzed the ability of the combination of PHI density (the ratio between PHI value and prostate volume) and mpMRI to identify high-grade PCa [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

Ferro

Crocetto

Bruzzese

et al. 2021

Cancers

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Widespread use of PSA as the standard tool for prostate cancer (PCa) diagnosis led to a high rate of overdiagnosis and overtreatment. In this study, we evaluated the performance of the prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the prediction of positive biopsy and of high-grade PCa at radical prostatectomy (RP). To this end, we prospectively enrolled 196 biopsy-naïve patients who underwent mpMRI. A subgroup of 116 subjects with biopsy-proven PCa underwent surgery. We found that PHI significantly outperformed both PI-RADS score (difference in AUC: 0.14; p < 0.001) and PHI density (difference in AUC: 0.08; p = 0.002) in the ability to predict positive biopsy with a cut-off value of 42.7 as the best threshold. Conversely, comparing the performance in the identification of clinically significant prostate cancer (csPCa) at RP, we found that PHI ≥61.68 and PI-RADS score ≥4 were able to identify csPCa (Gleason score ≥7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. In conclusion, PHI had a better ability than PI-RADS score to predict positive biopsy, whereas it had a comparable performance in the identification of pathological csPCa.

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MRI Fusion-Targeted Transrectal Prostate Biopsy and the Role of Prostate-Specific Antigen Density and Prostate Health Index for the Detection of Clinically Significant Prostate Cancer in Southeast Asian Men

Abstract: Targeted prostate biopsies were found to be significantly superior to systematic biopsies for the detection of csPCa, while detecting less Gleason 6 cancer. Usage of PSAD and PHI cutoff levels in patients with PI-RADS 3 lesions may enable a number of patients to avoid unnecessary biopsy.

Cited by 17 publications

References 26 publications

Correlation between Gleason score distribution and Prostate Health Index in patients with prostate-specific antigen values of 2.5–10 ng/mL

Correlation between Gleason score distribution and Prostate Health Index in patients with prostate-specific antigen values of 2.5–10 ng/mL

Comparison of prostate cancer detection rates between magnetic resonance imaging-targeted biopsy and transrectal ultrasound-guided biopsy according to Prostate Imaging Reporting and Data System in patients with PSA ≥4 ng/mL: a systematic review and meta-analysis

Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

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