Targeted Prostate Biopsy: Lessons Learned Midst the Evolution of a Disruptive Technology

Nassiri, Nima; Natarajan, Shyam; Margolis, Daniel; Marks, Leonard S.

doi:10.1016/j.urology.2015.07.001

Cited by 30 publications

(23 citation statements)

References 45 publications

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“…Complication rates are high for cystectomy and urinary diversion, especially in the frail elderly population with comorbidities [2]. Most studies are retrospective and the reported complication rates differ largely.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…In Figure 1 above, a falsely negative MRI from our institution is shown [2]. The MRI-invisible cancer is not a rarity.…”

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confidence: 92%

“…Thus, the data presented are striking because of the near-perfect findings, but not entirely convincing. Our work, involving >2 000 MRI/ultrasound-fusion biopsies, teaches that if biopsy is indicated on clinical grounds e.g., palpable abnormality, family or racial history, persistent PSA suspicion, a negative MRI should not preclude a systematic (template) biopsy [2]. Clinical information, especially increased PSA density, may help to select patients for biopsy beyond use of MRI data alone.…”

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confidence: 99%

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Some prostate cancers are invisible to magnetic resonance imaging!

Marks

2016

BJU International

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A test to exclude the presence of aggressive prostate cancer would be highly desirable. In the article by Wysock et al. [1], the authors examine pathological results in 75 men who underwent 12-core systematic biopsy using the Artemis device; all had a pre-biopsy MRI showing no suggestion of cancer. In 74 patients no cancer with Gleason score ≥7 was found on biopsy, which translates into a remarkable 98.7% negative predictive value (NPV) for potentially aggressive disease. The implication is that virtually all serious prostate cancers can be seen on MRI, and thus a negative MRI obviates the need for a biopsy. If this finding were to be confirmed, the majority of prostate biopsies could be avoided, a truly laudable goal.

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Section: Conflict Of Interestmentioning

confidence: 99%

“…In Figure 1 above, a falsely negative MRI from our institution is shown [2]. The MRI-invisible cancer is not a rarity.…”

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confidence: 92%

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confidence: 99%

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Some prostate cancers are invisible to magnetic resonance imaging!

Marks

2016

BJU International

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“…[43][44][45][46][47] Relatively recently, controlled trials have shown the relative value of in-bore versus systematic TRUS biopsies, and the success rates of image fusion targeted biopsies versus whole-mount histopathology and concomitant systematic biopsies. [48][49][50][51] The START protocol paper outlines the method by which these individual studies can be judged.…”

Section: Performance Metricsmentioning

confidence: 99%

MR-TRUS Fusion Biopsy

Margolis

2016

Topics in Magnetic Resonance Imaging

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The leading application of multiparametric magnetic resonance imaging (mpMRI) of the prostate is for lesion detection with the intention of tissue sampling (biopsy). Although direct in-bore magnetic resonance (MR)-guided biopsy allows for confirmation of the biopsy site, this can be expensive, time-consuming, and most importantly limited in availability. MR-transrectal ultrasound (MR-TRUS) image fusion targeted biopsy (TBx) allows for lesions identified on MRI to be targeted with the ease, efficiency, and availability of ultrasound.The learning objectives are optimized mpMRI protocol and reporting for image fusion targeted biopsy; methods of TRUS TBx; performance and limitations of MR-TRUS TBx; future improvements and applications.

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“…In the SEER database at prostatectomy, 9.7% of cases were up-staged and 44% up-graded when comparing postoperative specimens with preoperative biopsies and clinical assessment [181]. Hopefully, as improved technology and methods develop, new approaches will more accurately characterise the disease [182]. In the SERPCR cohort the tumour had a very indolent course during the first years after diagnosis, but showed a gradual progression into more lethal cancer over the 20-year period.…”

Section: Discussionmentioning

confidence: 99%

Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data

Klaff¹

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Introduction Prostate cancer (PCa) is the most common cancer among men in Sweden. The clinical course varies considerably, which makes it difficult to predict the prognosis in the individual case. In order to explore the early as well as the late course of the disease, large study groups and population-based cohorts are necessary. Aims To explore factors that influence the long-term outcome of men with low-risk tumours in a population-based register, to predict the long-term course, and to assess the mortality rate for men with prostate cancer (Paper I) To analyse long-term outcome and to investigate factors associated with long-term survival in patients with metastases to the skeleton (Paper II) To analyse early androgen deprivation treatment (ADT) failure and to define clinical predictors associated with short survival due to early ADT failure in prostate cancer patients with bone metastases (Paper III) To analyse the prognostic significance of the extent of bone metastases in relation to other pretreatment variables in prostate cancer patients, and to explore the impact of bone metastases on quality-of-life (Paper IV) Material and methods The study groups were assembled from The South East Region Prostate Cancer Register (SERPCR), and The Scandinavian Prostate Cancer Group (SPCG) Trial No. 5. In the first study, prognostic factors and long-term disease-specific mortality rates of low-risk prostate cancer patients from the early PSA era were analysed. In the second study, patient-related factors, quality-of-life (QoL) and long-term survival in 915 PCa patients with bone metastases (M1b) under ADT, were analysed. In Study III factors predicting primary failure to respond to ADT were identified. Study IV explored the impact of the extent of bone metastases on survival and QoL for these men. Result and conclusions The long-term disease-specific mortality of low-risk localised PCa is low, but the annual mortality rate gradually increases. This indicates that some tumours slowly develop into lethal cancer, particularly in men 70 years or older and with a PSA level ≥ 4 μg/L. From the SPCG Trial No. 5, a subgroup of patients with M1b disease and favourable set of predictive factors survived more than 10 years under ADT with an acceptable QoL. Independent predictors of long-term survival were identified as performance status (PS) < 2, limited extent of bone metastases, and a PSA level < 231 μg/L at the time of enrolment in the trial. However, four independent clinical predictors of early ADT failure could be defined. Men exhibiting these features should be considered for an alternative treatment. Patient grouping based on three categories of extent of bone metastases related to PS, haemoglobin, and QoL at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis

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Targeted Prostate Biopsy: Lessons Learned Midst the Evolution of a Disruptive Technology

Cited by 30 publications

References 45 publications

Some prostate cancers are invisible to magnetic resonance imaging!

Some prostate cancers are invisible to magnetic resonance imaging!

MR-TRUS Fusion Biopsy

Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data

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