The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer

Fourcade, Alexandre; Payrard, C.; Tissot, V.; Perrouin‐Verbe, Marie‐Aimée; Demany, N; Serey-Effeil, S.; Callerot, P.; Coquet, J.; Doucet, Laurent; Deruelle, C.; Joulin, V.; Nonent, Michel; Fournier, Georges; Valéri, Antoine

doi:10.1080/21681805.2018.1438509

Cited by 27 publications

(16 citation statements)

References 33 publications

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“…Many groups reported mpMRI had excellent negative predictive value for ruling out csPCa [10] . Yet, analysis of several prospective monocenter trials showed that combined systematic and targeted biopsy performed substantially better than targeted biopsy alone [52] , [56] , [57] , [58] , [59] , which is in line with the MRI-FIRST results. Interestingly, one retrospective study of 211 patients with unilateral MRI lesions reported that systematic biopsy was useful in addition to targeted biopsy in the lobe containing the MRI lesion; in contrast, the added value of the systematic biopsy of the contralateral lobe was marginal [60] .…”

Section: The Role Of Mpmri In the Management Of Clinically Localized supporting

confidence: 71%

The current role of prostate multiparametric magnetic resonance imaging

Rouvière

Moldovan

2019

Asian Journal of Urology

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Prostate multi-parametric magnetic resonance imaging (mpMRI) has shown excellent sensitivity for Gleason ≥7 cancers, especially when their volume is ≥0.5 mL. As a result, performing an mpMRI before prostate biopsy could improve the detection of clinically significant prostate cancer (csPCa) by adding targeted biopsies to systematic biopsies. Currently, there is a consensus that targeted biopsies improve the detection of csPCa in the repeat biopsy setting and at confirmatory biopsy in patients considering active surveillance. Several prospective multicentric controlled trials recently showed that targeted biopsy also improved csPCa detection in biopsy-naïve patients. The role of mpMRI and targeted biopsy during the follow-up of active surveillance remains unclear. Whether systematic biopsy could be omitted in case of negative mpMRI is also a matter of controversy. mpMRI did show excellent negative predictive values (NPV) in the literature, however, since NPV depends on the prevalence of the disease, negative mpMRI findings should be interpreted in the light of a priori risk for csPCa of the patient. Nomograms combining mpMRI findings and classical risk predictors (age, prostate-specific antigen density, digital rectal examination, etc. ) will probably be developed in the future to decide whether a prostate biopsy should be obtained. mpMRI has a good specificity for detecting T3 stage cancers, but its sensitivity is low. It should therefore not be used routinely for staging purposes in low-risk patients. Nomograms combining mpMRI findings and other clinical and biochemical data will also probably be used in the future to better assess the risk of T3 stage disease.

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Section: The Role Of Mpmri In the Management Of Clinically Localized supporting

confidence: 71%

The current role of prostate multiparametric magnetic resonance imaging

Rouvière

Moldovan

2019

Asian Journal of Urology

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“…A recent systematic review indicated that the overall cancer detection rate was 26.3%-56.6% in SPB as opposed to 33.7%-79.5% in FPB (10). Similarly, Fourcade et al reported that the overall cancer detection rate was higher in FPB compared to SPB (45% vs. 33.5%, p=0.02) (24). In our study, we found that the malignancy detection rate was significantly higher in FPB compared to SPB (44% vs. 25.8%, p=0.004).…”

Section: Discussionmentioning

confidence: 97%

Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy

et al. 2020

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Objectives: Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. Materials and Methods: Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS <3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. Results: 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p <0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). Conclusion: FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.

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“… 15 On the other hand, two recent studies reported that the overall sPCa detection rate in their patients who underwent TB was 38%. 3 , 16 However, these two studies, unlike our study, included not only patients with PSA levels <10 ng/ml but also patients with higher serum PSA levels, which could be the reason for the difference between the sPCa detection rates in our study and in those two studies.…”

Section: Discussionmentioning

confidence: 61%

“…FPB is typically performed as targeted biopsy (TB) or in combination with TB or standard prostate biopsy (SPB). 3 The literature recommends the use of 2–4 cores per suspicious lesion in TB. 4 , 5 However, the ideal number of biopsy cores to be obtained from each lesion with regard to the type and characteristics of the lesion remains controversial, and there is no consensus in the literature regarding this controversy, which is a major concern in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

What is the ideal number of biopsy cores per lesion in targeted prostate biopsy?

Sönmez

Demirtaş

Tombul

et al. 2020

Prostate International

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Background The number of cores to be obtained in targeted biopsy (TB) is important. This study aimed to evaluate the TB outcomes in suspicious prostate lesions classified according to the Prostate Imaging Reporting and Data System (PI-RADS) and to determine the ideal number of biopsy cores per lesion. Methods This retrospective study included patients who underwent multiparametric magnetic resonance imaging–guided fusion prostate biopsy owing to increased serum prostate-specific antigen (PSA) levels and suspicious digital rectal examination outcomes in our institute. Patients with PI-RADS <3 lesions, PSA levels >10 ng/ml, and a prior diagnosis of prostate cancer (PCa) (active surveillance) were excluded from the study. The number of biopsy cores to be obtained from each lesion was determined by the clinician. Results The study included a total of 418 patients and 684 lesions. Among PI-RADS 3 lesions, clinically significant PCa (sPCa) detection rate was similar in the lesions from which 2 and 3 cores were obtained (9.1% and 10.0%, respectively), whereas it was relatively higher in the lesions from which 4 biopsy cores were obtained (18.5%). Among PI-RADS 4 lesions, sPCa detection rate was similar in the lesions from which 3 and 4 cores were obtained (35.6% and 32.3%, respectively), whereas it was relatively lower in the lesions from which 2 biopsy cores were obtained (17.9%). Among PI-RADS 5 lesions, however, sPCa detection rate was similar in the lesions from which 2, 3, or 4 cores were obtained (47.6%, 46.0%, 48.9%, respectively). Conclusion The results indicated that the ideal number of cores to be obtained from each suspicious lesion in TB depends on the characteristics of the lesions. Accordingly, while obtaining 2–3 biopsy cores could be adequate in PI-RADS 4 and 5 lesions, which have a serious risk of cancer, a minimum of 4 biopsy cores should be obtained from PI-RADS 3 lesions to ensure accurate histopathological results. Clinical trial number ( ClinicalTrials.gov ) NCT03936296 .

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The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer

Abstract: The combination of TBx and SBx achieved the best results for the detection and prognosis of PCa-s. The use of SBx alone would have missed the detection of PCa-s in 12% of patients.

Cited by 27 publications

References 33 publications

The current role of prostate multiparametric magnetic resonance imaging

The current role of prostate multiparametric magnetic resonance imaging

Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy

What is the ideal number of biopsy cores per lesion in targeted prostate biopsy?

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