The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy

Mannaerts, Christophe K.; Kajtazovic, Amir; Lodeizen, Olivia; Gayet, Maudy; Engelbrecht, Marc R.; Jager, Gerrit J.; Wijkstra, Hessel; Reijke, Theo M. de; Beerlage, Harrie P.

doi:10.1016/j.urolonc.2019.01.005

Cited by 32 publications

(31 citation statements)

References 37 publications

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“…In our cohort, PI-RADS was correlated with a higher presence of PCa, csPCa, and a higher ISUP score. These findings were consistent with previous studies using either 1.5T 19 or 3T 20 .…”

Section: Conducting Mpmri Before Biopsy Significantly Improved the Pesupporting

confidence: 93%

“…Past studies have compared COG-TB and SB cores in a single cohort and reported that the combination of COG-TB and SB was superior to SB or COG-TB alone 18 . Several groups have also applied this to FUS-TB and found the combination of SB and FUS-TB to be superior, especially in the detection of csPCa [19][20][21] . In all studies except the PI-RADS score3 subgroup in Hansen et al 21 , TB alone showed a tendency to outperform SB alone.…”

Section: Conducting Mpmri Before Biopsy Significantly Improved the Pementioning

confidence: 99%

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Evaluating the efficacy of a low-cost, minimally-invasive cognitive MRI targeted biopsy protocol in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era.

Takeshima¹,

Tanaka²,

Takemura³

et al. 2019

Preprint

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Background: New MRI-guided targeting biopsy methods have increased cancer yield of prostate biopsies. However, cost and time constraints have made it difficult for many institutions to implement these newer methods. We evaluated the diagnostic performance of a low-cost, minimally-invasive, cognitive MRI-targeted biopsy protocol based on 1.5T multiparametric MRI graded with Prostate Imaging Reporting and Data System version 2 that is easily implemented in any low- to intermediate- volume center. Methods: Retrospective analysis of 255 patients who underwent prostate biopsy between December 2016 and March 2019 at a single facility. Indication for biopsy was based on clinical parameters including 1.5T multiparametric MRI. In addition to 10-core systematic biopsy, targeted cores were obtained with cognitive recognition under ultrasound. A control group of 198 patients biopsied without prior MRI from January to December 2015 was also analyzed. Results: Prostate biopsy preceded by MRI had a significantly higher probability of detecting both prostate cancer (68.1% vs. 43.6%) and clinically significant cancer (56.2% vs. 29.4%) (p values< 0.01). Combination of systematic biopsy and targeted biopsy outperformed either regimen alone for detection of prostate cancer. Multivariate analysis showed PSA density and prostate imaging reporting and data system score were independent risk factors of prostate cancer. A proposed diagnostic model showed sensitivity of 88.6%, specificity of 55%, PPV of 81.2%, NPV of 68.8%, and accuracy of 78%. Prostate imaging reporting and data system score was correlated with a higher presence of prostate cancer, clinically significant prostate cancer, and a higher pathological grade. Conclusions: Incorporation of pre-biopsy MRI imaging, scoring, and targeted biopsy improved cancer yield and achieved diagnostic performance comparable to newer methods of higher cost. Future alterations of possible benefit included increasing the number of target cores per lesion, and combining prostate imaging reporting and data system score and PSA density as indicators for biopsy.

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“…In our cohort, PI-RADS was correlated with a higher presence of PCa, csPCa, and a higher ISUP score. These findings were consistent with previous studies using either 1.5T 19 or 3T 20 .…”

Section: Conducting Mpmri Before Biopsy Significantly Improved the Pesupporting

confidence: 93%

Section: Conducting Mpmri Before Biopsy Significantly Improved the Pementioning

confidence: 99%

Evaluating the efficacy of a low-cost, minimally-invasive cognitive MRI targeted biopsy protocol in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era.

Takeshima¹,

Tanaka²,

Takemura³

et al. 2019

Preprint

View full text Add to dashboard Cite

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“…Recent studies showed that, in PIRADS score ≥3 men with SC on the combination of TB and SB, 5.5-27.7% of the SC were missed on TB. 4,[14][15][16] Our combination biopsy detected SC and GG ≥2 cancer in 191 and 183 men, respectively, whereas TB failed to detect SC and GG ≥2 cancer in 21 men for both (11.0% and 11.5%, respectively; data for GG ≥2 cancer is not shown), showing that the rate of our TB failure was within the range of the aforementioned data.…”

Section: Discussionsupporting

confidence: 69%

Value of extra‐target prostate biopsy for the detection of magnetic resonance imaging‐missed adverse pathology according to the Prostate Imaging Reporting and Data System scores: Spatial analysis using magnetic resonance–ultrasound fusion images

et al. 2020

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Objectives To clarify who benefits from extra‐target sampling of systematic prostate biopsy to detect magnetic resonance imaging‐missed significant cancer and upgrading, when concurrently carried out with magnetic resonance imaging–ultrasound fusion targeted biopsy. Methods Targeted biopsy and systematic biopsy were carried out in 301 men with Prostate Imaging Reporting and Data System scores ≥3. All score ≥3 regions were designated as targets. According to patients’ highest Prostate Imaging Reporting and Data System scores, spatial relations between targets and biopsy‐proven cancer were investigated to identify magnetic resonance imaging‐missed pathology. Results Overall, targeted biopsy and systematic biopsy detected significant cancer in 56.5% and 46.5%, respectively (P < 0.001). Significant cancer was detected only by systematic biopsy in 7.0%, and only outside targets in 5.0%. Upgrading by systematic biopsy was observed in 16.3%, and occurred outside targets in 11.0%. On multivariate analysis, the highest Prostate Imaging Reporting and Data System 4 was predictive for significant cancer only outside targets (odds ratio 5.81, P = 0.002) and for upgrading derived from outside targets (odds ratio 2.64, P = 0.012). According to the scores of 3, 4 and 5, significant cancer was identified only outside targets in 1.0%, 11.2% and 2.9%, respectively (P = 0.003 for Prostate Imaging Reporting and Data System 3 vs 4; P = 0.019 for Prostate Imaging Reporting and Data System 4 vs 5), and upgrading occurred in 6.1%, 18.4% and 8.6%, respectively (P = 0.009 and 0.040). Conclusions Men with the highest Prostate Imaging Reporting and Data System score 4 receive the largest benefit from extra‐target biopsy for magnetic resonance imaging‐missed significant cancer detection and upgrading. In men with a score of 3, less adverse pathology is missed without extra‐target biopsy. These findings suggest prostate biopsy strategy could be tailored according to Prostate Imaging Reporting and Data System scores.

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“…Follow-up data are presented in Table S6. None of the 62 men with a benign biopsy session had a GG ≥2 PCa at follow-up [median (interquartile range): 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)…”

Section: Follow-up and Mpmri Re-readingmentioning

confidence: 99%

Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

et al. 2020

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To compare and evaluate a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) strategy, contrast-ultrasound-dispersion imaging (CUDI)-TBx strategy and systematic biopsy (SBx) strategy for the detection of clinically significant prostate cancer (csPCa) in biopsy-na€ ıve men. Patients and Methods A prospective, single-centre paired diagnostic study included 150 biopsy-na€ ıve men, from November 2015 to November 2018. All men underwent pre-biopsy mpMRI and CUDI followed by a 12-core SBx taken by an operator blinded from the imaging results. Men with suspicious lesions on mpMRI and/or CUDI also underwent MRI-TRUS fusion-TBx and/ or cognitive CUDI-TBx after SBx by a second operator. A non-inferiority analysis of the mpMRI-and CUDI-TBx strategies in comparison with SBx for International Society of Urological Pathology Grade Group [GG] ≥2 PCa in any core with a non-inferiority margin of 1 percentage point was performed. Additional analyses for GG ≥2 PCa with cribriform growth pattern and/or intraductal carcinoma (CR/IDC), and GG ≥3 PCa were performed. Differences in detection rates were tested using McNemar's test with adjusted Wald confidence intervals. Results After enrolment of 150 men, an interim analysis was performed. Both the mpMRI-and CUDI-TBx strategies were inferior to SBx for GG ≥2 PCa detection and the study was stopped. SBx found significantly more GG ≥2 PCa: 39% (56/142), as compared with 29% (41/142) and 28% (40/142) for mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). SBx found significantly more GG = 1 PCa: 14% (20/142) compared to 1% (two of 142) and 3% (four of 142) with mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). Detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa did not differ significantly between the strategies. The mpMRI-and CUDI-TBx strategies were comparable in detection but the mpMRI-TBx strategy had less false-positive findings (18% vs 53%). Conclusions In our study in biopsy-na€ ıve men, the mpMRI-and CUDI-TBx strategies had comparable PCa detection rates, but the mpMRI-TBX strategy had the least false-positive findings. Both strategies were inferior to SBx for the detection of GG ≥2 PCa, despite reduced detection of insignificant GG = 1 PCa. Both strategies did not significantly differ from SBx for the detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa.

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The added value of systematic biopsy in men with suspicion of prostate cancer undergoing multiparametric MRI-targeted biopsy

Cited by 32 publications

References 37 publications

Evaluating the efficacy of a low-cost, minimally-invasive cognitive MRI targeted biopsy protocol in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era.

Evaluating the efficacy of a low-cost, minimally-invasive cognitive MRI targeted biopsy protocol in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era.

Value of extra‐target prostate biopsy for the detection of magnetic resonance imaging‐missed adverse pathology according to the Prostate Imaging Reporting and Data System scores: Spatial analysis using magnetic resonance–ultrasound fusion images

Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

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