MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis

Ahdoot, Michael; Wilbur, Andrew R; Reese, Sarah E.; Lebastchi, Amir H.; Mehralivand, Sherif; Gomella, Patrick T.; Bloom, Jonathan; Gurram, Sandeep; Siddiqui, M. Minhaj; Pinsky, Paul F.; Parnes, Howard L.; Linehan, W. Marston; Merino, María J.; Choyke, Peter L.; Shih, Joanna H.; Türkbey, Barış; Wood, Bradford J.; Pinto, Peter A.

doi:10.1056/nejmoa1910038

Cited by 649 publications

(582 citation statements)

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“…Unfortunately, most candidates for AS (90% in this study) have PI-RADS ≤4 lesions. We also note that in previous studies, lesions in patients with GG 1 PCa were reported to be largely invisible on mpMRI [ 16 17 18 ]. Therefore, although several studies have reported mpMRI to be useful for the selection of candidates appropriate for AS [ 19 20 ], mpMRI may, in fact, be reliable only for candidates with GG ≥2 lesions.…”

Section: Discussionsupporting

confidence: 50%

“…After a 2-year follow-up, however, baseline mpMRI, before confirmatory biopsy, yielded 50% fewer failures of surveillance and less progression to higher-grade cancer [ 25 ]. Ahdoot et al [ 18 ] reported on the diagnostic accuracy of targeted, systematic, and combined biopsy for lesions visible on MRI, with MRI-targeted biopsy providing a greater diagnostic yield than systematic biopsy. Specifically, 134 men with a diagnosis of GG 1 cancer by systematic biopsy were upgraded to a GG ≥2 cancer on MRI-targeted biopsy.…”

Section: Discussionmentioning

confidence: 99%

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Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

et al. 2020

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Purpose To evaluate the usefulness of multiparametric magnetic resonance imaging (mpMRI) to avoid misclassification of patients with clinically significant prostate cancer (PCa) into active surveillance (AS). Materials and Methods Patients with Gleason grade group (GG) 1 PCa on systematic biopsy who underwent mpMRI before radical prostatectomy (RP) were included. mpMRI and pathologic results were compared between the AS and NOT-AS candidates. Unfavorable disease was defined as the identification of T3-4 disease or GG upgrade in the RP specimen. We established an ideal cutoff Prostate Imaging Reporting and Data System (PI-RADS) score for predicting unfavorable disease, and analyzed the location of index lesions on mpMRI. Results PI-RADS scores were not significantly different between AS candidates (n=64) and NOT-AS candidates (n=136; p=0.629). Among 64 AS candidates, GG upgrading and unfavorable disease were diagnosed after RP in 24 (37.5%) and 25 (39.1%) patients, respectively. The rate of unfavorable disease was greater for patients with a PI-RADS score of 5 (83.3%) than in those with a score ≤4 (34.5%; p=0.030). Moreover, most PI-RADS 5 lesions in AS candidates were located in the anterior half of the prostate, with GG upgrading on targeted biopsy in 75.0% of cases. Conclusions Among the patients with GG 1 PCa, PI-RADS scores did not differ significantly between AS and NOT-AS candidates. Nonetheless, AS candidates with PI-RADS 5 lesions were diagnosed with unfavorable disease in >80% of RP specimens. Significant cancer located in the anterior half of the prostate including the transitional zone can be missed by systematic biopsy.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

et al. 2020

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“…The negative predictive value of non-suspicious mpMRI has proven to be excellent (90-95% in biopsy-naïve patients), and it is fascinating to see the initial results obtained by small retrospective studies confirmed in large, multicentre cohorts and randomised control trials [14,27,54]. Those who still doubt the ability of MRI to rule out clinically significant prostate cancer and put a higher confidence in systematic transrectal biopsy must remember that this biopsy scheme has been proven inferior to MRI in a randomised clinical trial [1].…”

Section: Discussionmentioning

confidence: 99%

What to expect from a non-suspicious prostate MRI? A review

Fiard

Norris

Nguyen

et al. 2020

Progrès en Urologie

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Abbreviations mpMRI Multiparametric Magnetic Resonance Imaging NPV Negative Predictive Value Résumé Contexte : La réalisation d'une IRM multiparamétrique (IRMmp) est désormais recommandée avant la réalisation de biopsies prostatiques. En revanche, la conduite à tenir en présence d'une IRMmp non-suspecte (Score Likert ou PIRADS 1-2) est toujours débattue. Objectifs : Faire une synthèse de la littérature récente pour répondre à trois questions. 1) Faut-il réaliser des biopsies systématisées en présence d'une IRMmp non suspecte ? 2) Quels facteurs prédictifs permettent de définir les patients candidats à une biopsie systématisée ? 3) Le manque de visibilité de certains cancers peut-elle être expliquée et quelles en sont les conséquences cliniques ? Sources : Une revue narrative de la littérature a été réalisée à partir des bases de données Medline utilisant deux recherches avec les termes "MRI" AND "prostate cancer" AND ("diagnosis" OR "biopsy") AND ("non-suspicious" OR "negative" OR "invisible") ; "prostate cancer MRI visible". Les références des articles sélectionnés ont été analysées à la recherche d'articles supplémentaires. Sélection des études : Les études publiées dans les 5 dernières années en anglais ont été analysées et retenues si les données disponibles permettaient de répondre à l'une des 3 questions posées. Résultats : Considérant les cancers de grade ISUP ³ 2 cliniquement significatifs, la valeur prédictive négative (VPN) de l'IRMmp était comprise entre 76% et 99%, dépendante de la prévalence du cancer et du type de test de référence utilisé. La VPN était plus élevée chez les patients aux antécédents de biopsie négative (88-96%), et plus faible chez les patients en surveillance active (85-90%). La densité de PSA (PSAd) avec un seuil de PSAd<0.15ng/ml/ml était le facteur prédictif le plus étudié et le plus pertinent associé à l'IRMmp pour éliminer un cancer significatif. Enfin, les tumeurs non visibles à l'IRMmp présentaient des différences au niveau histopathologique et génétique, conférant un intérêt clinique à la visibilité IRM. Limites du travail : La plupart des données proviennent de centres experts et les résultats peuvent ne pas être reproductibles en dehors. Conclusion : L'IRMmp fait preuve de performances diagnostiques élevées pour éliminer un cancer cliniquement significatif. La densité de PSA peut être utilisée pour sélectionner patients devant avoir une biopsie. Une meilleure connaissance des mécanismes à l'origine de la visibilité du cancer devrait aider le développement de nomogrammes et biomarqueurs plus précis.

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“… 12 However, mpMRI-targeted biopsy may not be insufficient alone to estimate risk of disease progression. 13 As the ability of mpMRI to detect tumours is influenced by additional histopathological features, it is pertinent to now draw together this expanding radiopathological literature to address this important clinical challenge.…”

Section: Introductionmentioning

confidence: 99%

Histopathological features of prostate cancer conspicuity on multiparametric MRI: protocol for a systematic review and meta-analysis

et al. 2020

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IntroductionMultiparametric MRI (mpMRI) has improved risk stratification for men with suspected prostate cancer. Indeed, mpMRI-visible tumours tend to be larger and of higher pathological grade than mpMRI-invisible tumours; however, concern remains around significant cancer that is undetected by mpMRI. There has been considerable recent interest to investigate whether tumour conspicuity on mpMRI is associated with additional histopathological features (including cellular density, microvessel density and unusual prostate cancer subtypes), which may have important clinical implications in both diagnosis and prognosis. Furthermore, analysis of these features may help reveal the radiobiology that underpins the actual mechanisms of mpMRI visibility (and invisibility) of prostate tumours. Here, we describe a protocol for a systematic review of the histopathological basis of prostate cancer conspicuity on mpMRI.Methods and analysisA systematic search of the MEDLINE, PubMed, Embase and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to guide screening, thematic reporting and conclusions drawn from all eligible studies. Included papers will be full-text, English-language articles, comparing the histopathological characteristics of mpMRI-visible lesions and mpMRI-invisible tumours. All studies published between January 1950 and January 2020 will be eligible for inclusion. Studies using confirmatory immunohistochemistry for the identification of immune subsets or structural components will be included. Study bias and quality will be assessed using a modified Newcastle-Ottawa scale. To ensure methodological rigour, this protocol is written in accordance with the PRISMA Protocol 2015 checklist. If appropriate, a meta-analysis will be conducted comparing histopathological feature frequency between mpMRI-visible and mpMRI-invisible disease.Ethics and disseminationNo ethical approval will be required as this is an academic review of published literature. Findings will be disseminated through publications in peer-reviewed journals and presentations at national and international conferences.PROSPERO registration numberCRD42020176049

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MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis

Cited by 649 publications

References 39 publications

Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

What to expect from a non-suspicious prostate MRI? A review

Histopathological features of prostate cancer conspicuity on multiparametric MRI: protocol for a systematic review and meta-analysis

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