Serial Biopsy Results in Prostate Cancer Screening Study

Roehl, Kimberly A.; Antenor, Jo Ann V.; Catàlona, William J.

doi:10.1097/00005392-200206000-00020

Cited by 83 publications

(96 citation statements)

References 19 publications

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“…[6][7]13,[16][17][18] Besides a statistically insignificant trend towards a lower detection rate for U2 residents compared to U1 residents, there were no statistically significant differences in prebiopsy variables and overall cancer detection rates between residents at any level of training. One possible explanation is that TRUS biopsy is an essentially random process.…”

Section: Discussionmentioning

confidence: 76%

Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy

Karam¹,

Shulman²,

Benaim

2004

Prostate Cancer Prostatic Dis

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The objective of this study is to evaluate the performance of urology residents at each training level in detecting prostate cancer with transrectal ultrasound-guided (TRUS) biopsy. The inclusion criteria were: (1) prostate-specific antigen (PSA) 4-10 ng/ml; and (2) 10-12 cores per biopsy session. Data from repeat biopsy sessions were excluded. Overall prostate cancer detection rate for 170 patients was 39.4%. PSA, digital rectal examination (DRE), and prostate volume were predictors of cancer detection. There were no significant differences in overall cancer detection rates, PSA, DRE, or prostate volume between resident levels. In conclusion, urology residents at all levels of training perform equally well at detecting cancer using TRUS prostate biopsy technology.

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Section: Discussionmentioning

confidence: 76%

Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy

Karam¹,

Shulman²,

Benaim

2004

Prostate Cancer Prostatic Dis

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“…2,87,88 This dilemma could be approached by determining both the rate and clinical behavior of the PCa that might be detected on repeated biopsies. The ERSPC showed PCa detection rates on first, second , third and fourth biopsies of 22%, 10%, 5% and 4%, respectively.…”

Section: Risk Of Detection Of Insignificant Cancer; How Many Sessionsmentioning

confidence: 99%

“…In this study, Zaytoun et al 2 recommended the following three additional measures to assist in the decision-making process for PBx patients, based on experience from the Cleveland Clinic and supported by a Medline literature search. 1 The 14-core PBx protocol including the critical area of the apex is recommended for use at the first PBx to maximally optimize the yield.…”

Section: Editorial Comment To Prostate Cancer Detection After a Negatmentioning

confidence: 99%

“…1 However, even with the widespread application of such extended prostate biopsy (ePBx) protocols, the false negative rate remains substantial. 2 It has been shown that 12 biopsy cores using an 18-gauge needle allow histological examination of just 0.04% of a prostate with a typical volume, with a high incidence of sampling errors. 3 With the inability of negative initial PBx to firmly exclude the presence of PCa, the need for repeat biopsies continues to rise.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Podría concluirse que el efecto adverso del screening es el sobrediagnóstico (detección de cáncer de próstata en pacientes que no hubieran sido diagnosticados de CaP si no se hubieran sometido a las pruebas de screening) y el sobretratamiento (pacientes que no deberían ser tratados si no se hubieran sometido al screening), con el consiguiente aumento del coste y el uso de procedimientos más invasivos. Además, estudios previos han demostrado que entre 20% y 30% de CaP detectados mediante el screening son pequeños (menos de 0,5 cm 3 ) y puede ser considerado "insignifi cante" 5 .…”

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Nuevos marcadores urinarios en pacientes con cáncer de próstata: Análisis de la problemática del screening

et al. 2012

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Nuevos marcadores urinarios en pacientes con cáncer de próstata. Análisis de la problemática del screening New urinary markers in patients with prostatic cancer. Analysis of the screening problem Sr. Editor: El cáncer de próstata (CaP) es el tumor maligno no cutáneo más frecuente en el hombre y la segunda causa de muerte por cáncer en hombres en Estados Unidos de Norteamérica, sólo superado por el cáncer de pulmón 1 . Constituye unos de los problemas sanitarios más importantes en nuestro medio (España), tanto en términos de morbimortalidad, como de impacto social, económico o sobre la calidad de vida.Algunas de las principales técnicas utilizadas en la evaluación del CaP en su etapa inicial son el examen digito-rectal (DRE), la determinación sérica del antígeno prostático específi co (PSA), y la ecografía transrectal de próstata. Sin embargo, se ha observado que el nivel sérico de PSA, como variable independiente, parece ser mejor predictor de cáncer que los hallazgos encontrados con el tacto rectal o los ultrasonidos 2 .El antígeno prostático específi co (PSA), descubierto en 1971, es considerado actualmente, el biomarcador más importante para la detección y monitorización del CaP. En 1986 fue aprobado por la USA Food and Drug Administration (FDA) para la monitorización del CaP. En 1994 el test fue aprobado para su uso en la detección del CaP en combinación con el tacto rectal 3 . Inicialmente se pensaba que era sintetizado exclusivamente por las células del epitelio prostático, de ahí que fuera utilizado como biomarcador para el diagnóstico y manejo del CaP. Sin embargo, el PSA se ha encontrado también en líneas celulares normales y tumorales, así como en fl uidos biológicos sintetizados por numerosas células, aunque principalmente por el epitelio prostático. La principal ventaja del PSA es su alta sensibilidad, siendo su principal desventaja su escasa especifi cidad. No existe una concentración de PSA en la que el riesgo de CaP sea inexistente. Esto da lugar a la realización de biopsias innecesarias por valores elevados de PSA, que en algunos casos refl ejan un gran volumen prostático en lugar de alto riesgo de CaP 4 .El diagnóstico de CaP se establece mediante la biopsia de próstata, la cual es una prueba inva-

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Serial Biopsy Results in Prostate Cancer Screening Study

Cited by 83 publications

References 19 publications

Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy

Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy

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

Nuevos marcadores urinarios en pacientes con cáncer de próstata: Análisis de la problemática del screening

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