Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting

Căta, Emanuel Darius; Andraș, Iulia; Ferro, Matteo; Kadula, Pierre; Leucuţa, Daniel; Musi, Gennaro; Matei, Deliu Victor; Cobelli, Ottavio De; Tamas-Szora, Attila; Caraiani, Cosmin; Lebovici, Andrei; Epure, Flavia; Bungardean, Maria; Coman, Radu Tudor; Crişan, Nicolae

doi:10.21037/tau-20-1001

Cited by 8 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in current clinical practice, the urologist performing the systematic biopsy is not blinded to the MRI, and frequently, the systematic targeting becomes cognitive-guided. As such, it may be considered almost a surrogate for saturation biopsy of the index lesion and a method to overcome errors of image registration or targeting [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Combined Systematic and MRI-US Fusion Prostate Biopsy Has the Highest Grading Accuracy When Compared to Final Pathology

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and objectives: Systematic prostate biopsy (SB) has a low Gleason group (GG) accuracy when compared to final pathology. This may negatively impact the inclusion of patients into specific risk groups and treatment choice. The aim of our study was to assess the GG accuracy of magnetic resonance imaging-ultrasound (MRI-US) fusion prostate biopsy. Materials and Methods: Of a cohort of minimally invasive radical prostatectomy (RP), we selected all patients who were diagnosed with prostate cancer (PCa) via MRI-US fusion biopsy (n = 115). Results: Combined biopsy had the highest rate for GG concordance (61.7% vs. 60.4% for SB vs. 45.3% for MRI-US fusion biopsy) and the lowest for upgrading (20.9% vs. 24.5% for SB vs. 34.9% for MRI-US fusion biopsy), p < 0.0001. No clinical data were predictive for upgrading or downgrading at final pathology. Locally advanced PCa was associated with a high Prostate Imaging-Reporting and Data System (PIRADS) score (p = 0.0014) and higher percentages of positive biopsy cores (PBC)/targeted (p = 0.0002) and PBC/total (p = 0.01). Positive surgical margins were correlated with higher percentages of PBC/systematic (p = 0.003) and PBC/total (p = 0.009). Conclusions: Pre-biopsy prostate MRI improves GG concordance between biopsy and RP. Combined biopsy provides the highest grading accuracy when compared to final pathology. Targeted and systematic biopsy data are predictive for adverse pathologic outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Combined Systematic and MRI-US Fusion Prostate Biopsy Has the Highest Grading Accuracy When Compared to Final Pathology

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Similarly, several technical issues of TB are also under investigation. For example, the number of targeted cores taken per lesion may impact csPC detection and Gleason score estimation [39]. In particular, obtaining three/four cores (current standard) from high-volume lesions, such as PIRADS 5, may not be sufficient to adequately estimate the Gleason score [40].…”

Section: Discussionmentioning

confidence: 99%

Prostate Biopsy in the Case of PIRADS 5—Is Systematic Biopsy Mandatory?

Malewski,

Milecki,

Szempliński

et al. 2023

JCM

View full text Add to dashboard Cite

Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically significant prostate cancer (csPC) detection in TB. Potentially, omitting SB in the case of PIRADS 5 may have a marginal impact on the csPC detection rate. The aim of this study was to determine whether SB can be avoided in the case of PIRADS 5 and to identify potential factors allowing for performing TB only. This cohort study involved n = 225 patients with PIRADS 5 on mpMRI (PIRADS 2.0/2.1) who underwent transperineal or transrectal combined biopsy (CB). CsPC was diagnosed in 51.6% (n = 116/225) of cases. TB and SB resulted in the detection of csPC in 48% (n = 108/225) and 20.4% (n = 46/225) of cases, respectively (TB vs. SB, p < 0.001). When the TB was positive, SB detected csPC in n = 38 of the cases (38/108 = 35%). SB added to TB significantly improved csPC detection in 6.9% of cases in absolute terms (n = 8/116) (TB vs. CB, p = 0.008). The multivariate regression model proved that the significant predictors of csPC detection via SB were the densities of the prostate-specific antigen—PSAD > 0.17 ng/mL2 (OR = 4.038, 95%CI: 1.568–10.398); primary biopsy setting (OR = 2.818, 95%CI: 1.334–5.952); and abnormal digital rectal examination (DRE) (OR = 2.746, 95%CI: 1.328–5.678). In a primary biopsy setting (n = 103), SB detected 10% (n = 6/60) of the additional cases of csPC (p = 0.031), while in a repeat biopsy setting (n = 122), SB detected 3.5% (n = 2/56) of the additional cases of csPC (p = 0.5). In the case of PSAD > 0.17 ng/mL2 (n = 151), SB detected 7.4% (n = 7/95) of additional cases of csPC (p = 0.016), while in the case of PSAD < 0.17 ng/mL2 (n = 74), SB detected 4.8% (n = 1/21) of the additional cases of csPC (p = 1.0). The omission of SB had an impact on the csPC diagnosis rate in patients with PIRADS 5 score lesions. Patients who have already undergone prostate biopsy and those with low PSAD are at a lower risk of missing csPC when SB is avoided. However, performing TB only may result in missing other csPC foci located outside the index lesion, which can alter treatment decisions.

show abstract

“…Several observational studies have shown a higher detection of GG2D prostate cancer when targeted and systematic biopsies are combined. 5,6 It has been hypothesized that systematic biopsies may improve detection of GG2D cancer by sampling the target when the targeted cores may have missed the target. 7,8 In contrast, Kim et al found little difference in detection between the combined approach and targeted cores.…”

Section: Guideline Statementsmentioning

confidence: 99%

Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy

et al. 2023

View full text Add to dashboard Cite

Purpose:The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part II of a two-part series focusing on initial and repeat biopsies, and biopsy technique. Please refer to Part I for discussion of initial prostate cancer screening recommendations.Materials and Methods:The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000–November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles.Results:The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsies, and biopsy technique.Conclusions:The evaluation of prostate cancer risk should be focused on the detection of clinically significant prostate cancer (Grade Group 2 or higher [GG2+]). The use of laboratory biomarkers, prostate MRI, and biopsy techniques described herein may improve detection and safety when a prostate biopsy is deemed necessary following prostate cancer screening.

show abstract

Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting

Cited by 8 publications

References 28 publications

Combined Systematic and MRI-US Fusion Prostate Biopsy Has the Highest Grading Accuracy When Compared to Final Pathology

Combined Systematic and MRI-US Fusion Prostate Biopsy Has the Highest Grading Accuracy When Compared to Final Pathology

Prostate Biopsy in the Case of PIRADS 5—Is Systematic Biopsy Mandatory?

Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy

Contact Info

Product

Resources

About