Targeted prostate biopsy: value of multiparametric magnetic resonance imaging in detection of localized cancer

Le, Jesse; Huang, Jiaoti; Marks, Leonard S.

doi:10.4103/1008-682x.122864

Cited by 20 publications

(10 citation statements)

References 78 publications

(117 reference statements)

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“…Several publications investigated the detection accuracy of targeted biopsy and standard biopsy alone or in combination [24,25,26,27]. Only a few studies have compared the detection rates of PCa between different targeting techniques.…”

Section: Discussionmentioning

confidence: 99%

Cognitive-Targeted versus Magnetic Resonance Imaging-Guided Prostate Biopsy in Prostate Cancer Detection

Osses¹,

Asten²,

Tijsterman³

2018

Current Urology

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Introduction: Purpose of this study is to evaluate the detection rates of prostate cancer (PCa) for cognitive-targeted biopsy (CTB) in comparison with magnetic resonance imaging (MRI)-guided biopsy (MRGB) related to prostate imaging reporting and data system (PI-RADS) score, lesion location and lesion volume. Furthermore, the addition of systematic transrectal ultrasound-guided biopsy (TRUS-GB) to CTB is evaluated. Materials and Methods: We included all patients with cancer-suspicious lesions on 3-Tesla multiparametric MRI who underwent either CTB and additional TRUS-GB or only MRGB (in-bore) in Haga Teaching Hospital between January 2013 and January 2015. Results: In total 219 patients were included: 64 CTB + TRUS-GB and 155 MRGB. In 32 (50%) men with CTB was positive for PCa. PI-RADS 3-, 4- and 5-lesions were in 17, 69 and 95% positive, respectively. In 100 men (65%) with MRGB was positive for PCa. Detection rates for PI-RADS 3-, 4- and 5-lesions were 10, 77 and 89%, respectively. CTB missed 4 (11%) low-grade tumors detected by TRUS-GB. In lesions between 0-1.5 ml PCa were significantly more often detected with MRGB than with CTB (69 vs. 39%). Conclusion: CTB has a high detection rate of PCa in men with cancer-suspicious lesions on MRI. Correction for lesion volume shows that in lesions < 1.5 ml MRGB is more accurate than CTB. The addition of TRUS-GB to CTB can safely be avoided without missing any high grade PCa.

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Section: Discussionmentioning

confidence: 99%

Cognitive-Targeted versus Magnetic Resonance Imaging-Guided Prostate Biopsy in Prostate Cancer Detection

Osses¹,

Asten²,

Tijsterman³

2018

Current Urology

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“…However, in fusion targeting, software is used to combine a pre-acquired MRI-derived target with real-time TRUS imaging to guide the biopsy. 43,44 In current NHS practice, MRI may be prohibited for 6-12 weeks, or more, after a biopsy because of bleeding, as this can lead to imaging artefacts. This has important time implications for the diagnostic testing strategies involving MRI after a negative or equivocal initial biopsy and any subsequent treatment, and may lead to delays in investigation and treatment.…”

Section: Clinical Assessment Plus Magnetic Resonance Imagingmentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of the PROGENSA® prostate cancer antigen 3 assay and the Prostate Health Index in the diagnosis of prostate cancer: a systematic review and economic evaluation

Nicholson

Mahon

Boland

et al. 2015

Health Technol Assess

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BackgroundThere is no single definitive test to identify prostate cancer in men. Biopsies are commonly used to obtain samples of prostate tissue for histopathological examination. However, this approach frequently misses cases of cancer, meaning that repeat biopsies may be necessary to obtain a diagnosis. The PROGENSA®prostate cancer antigen 3 (PCA3) assay (Hologic Gen-Probe, Marlborough, MA, USA) and the Prostate Health Index (phi; Beckman Coulter Inc., Brea, CA, USA) are two new tests (a urine test and a blood test, respectively) that are designed to be used to help clinicians decide whether or not to recommend a repeat biopsy.ObjectiveTo evaluate the clinical effectiveness and cost-effectiveness of the PCA3 assay and the phi in the diagnosis of prostate cancer.Data sourcesMultiple publication databases and trial registers were searched in May 2014 (from 2000 to May 2014), including MEDLINE, EMBASE, The Cochrane Library, ISI Web of Science, Medion, Aggressive Research Intelligence Facility database, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number Register and World Health Organization International Clinical Trials Registry Platform.Review methodsThe assessment of clinical effectiveness involved three separate systematic reviews, namely reviews of the analytical validity, the clinical validity of these tests and the clinical utility of these tests. The assessment of cost-effectiveness comprised a systematic review of full economic evaluations and the development of a de novo economic model.SettingThe perspective of the evaluation was the NHS in England and Wales.ParticipantsMen suspected of having prostate cancer for whom the results of an initial prostate biopsy were negative or equivocal.InterventionsThe use of the PCA3 score or phi in combination with existing tests (including histopathology results, prostate-specific antigen level and digital rectal examination), multiparametric magnetic resonance imaging and clinical judgement.ResultsIn addition to documents published by the manufacturers, six studies were identified for inclusion in the analytical validity review. The review identified issues concerning the precision of the PCA3 assay measurements. It also highlighted issues relating to the storage requirements and stability of samples intended for analysis using the phi assay. Fifteen studies met the inclusion criteria for the clinical validity review. These studies reported results for 10 different clinical comparisons. There was insufficient evidence to enable the identification of appropriate test threshold values for use in a clinical setting. In addition, the implications of adding either the PCA3 assay or the phi to clinical assessment were not clear. Furthermore, the addition of the PCA3 assay or the phi to clinical assessment plus magnetic resonance imaging was not found to improve discrimination. No published papers met the inclusion criteria for either the clinical utility review or the cost-effectiveness review. The results from the cost-effectiveness analyses indicated that using either the PCA3 assay or the phi in the NHS was not cost-effective.LimitationsThe main limitations of the systematic review of clinical validity are that the review conclusions are over-reliant on findings from one study, the descriptions of clinical assessment vary widely within reviewed studies and many of the reported results for the clinical validity outcomes do not include either standard errors or confidence intervals.ConclusionsThe clinical benefit of using the PCA3 assay or the phi in combination with existing tests, scans and clinical judgement has not yet been confirmed. The results from the cost-effectiveness analyses indicate that the use of these tests in the NHS would not be cost-effective.Study registrationThis study is registered as PROSPERO CRD42014009595.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…This method is blind to the location of suspicion within the prostate, and the false-negative rate has been reported to be as high as 50%. Saturation biopsy (≥24 cores) aimed at improving detection rates may not detect more significant cancer and are associated with higher morbidity [ 28 ]. This leads to repeated biopsies, especially in men in whom clinical suspicion is high.…”

Section: Histopathology From Prostate Biopsymentioning

confidence: 99%

Current role of multiparametric magnetic resonance imaging in the management of prostate cancer

et al. 2015

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The purpose of this review was to evaluate the current role of multiparametric magnetic resonance imaging (mp-MRI) in the management of prostate cancer (PC). The diagnosis of PC remains controversial owing to overdetection of indolent disease, which leads to overtreatment and subsequent patient harm. mp-MRI has the potential to equilibrate the imbalance between detection and treatment. The limitation of the data for analysis with this new technology is problematic, however. This issue has been compounded by a paradigm shift in clinical practice aimed at utilizing this modality, which has been rolled out in an ad hoc fashion often with commercial motivation. Despite a growing body of literature, pertinent clinical questions remain. For example, can mp-MRI be calibrated to reliably detect biologically significant disease? As with any new technology, objective evaluation of the clinical applications of mp-MRI is essential. The focus of this review was on the evaluation of mp-MRI of the prostate with respect to clinical utility.

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Targeted prostate biopsy: value of multiparametric magnetic resonance imaging in detection of localized cancer

Cited by 20 publications

References 78 publications

Cognitive-Targeted versus Magnetic Resonance Imaging-Guided Prostate Biopsy in Prostate Cancer Detection

Cognitive-Targeted versus Magnetic Resonance Imaging-Guided Prostate Biopsy in Prostate Cancer Detection

The clinical effectiveness and cost-effectiveness of the PROGENSA® prostate cancer antigen 3 assay and the Prostate Health Index in the diagnosis of prostate cancer: a systematic review and economic evaluation

Current role of multiparametric magnetic resonance imaging in the management of prostate cancer

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