The Role of Ipsilateral and Contralateral Transrectal Ultrasound-guided Systematic Prostate Biopsy in Men With Unilateral Magnetic Resonance Imaging Lesion Undergoing Magnetic Resonance Imaging-ultrasound Fusion-targeted Prostate Biopsy

Bryk, Darren J.; Llukani, Elton; Taneja, Samir S.; Rosenkrantz, Andrew B.; Huang, William C.; Lepor, Herbert

doi:10.1016/j.urology.2016.11.017

Cited by 72 publications

(63 citation statements)

References 28 publications

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“… using a four‐core transrectal TB approach (73% sensitivity for Gleason score ≥7) and Mischinger et al. for a four‐core robot‐assisted transperineal keyhole biopsy (80% sensitivity for Gleason score ≥7). Calio et al.…”

Section: Discussionmentioning

confidence: 99%

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

et al. 2019

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ObjectivesTo assess cancer detection rates of different target-dependent transperineal magnetic resonance (MR)/ultrasonography (US) fusion-guided biopsy templates with reduced number of systematic cores. Patients and MethodsSingle-centre outcome of transperineal MR/US fusionguided biopsies of 487 men with a single target MR imaging (MRI) lesion, prospectively collected between 2012 and 2016. All men underwent transperineal targeted biopsy (TB) with two cores, followed by 18-24 systematic sector biopsies (SB) using the Ginsburg protocol. Gleason score ≥7 prostate cancer detection rates for two-core TB, fourcore extended TB (eTB), 10-to 20-core saturation TB (sTB) including cores from sectors adjacent to the target, and 14 core ipsilateral TB (iTB) were compared to combined TB+SB. ResultsCancer was detected in 345 men and Gleason score 7-10 cancer in 211 men. TB alone detected 67%, eTB 76%, sTB 91% and iTB 91% of these Gleason score 7-10 cancers. In the subgroup of 33 men (7% of cohort) with an anterior >0.5 mL highly suspicious MRI lesion and a prostate volume ≤45 mL, four-core eTB detected 31 of 32 cancers (97%) and all 26 Gleason score 7-10 cancers.Conclusion sTB detected Gleason score 7-10 cancer in 25% more of the men than a two-core TB approach, and in almost as many men (91%) as the 20-26-core combined TB+SB, while needing only 10-20 cores. A four-core extended TB may suffice for large, highly suspicious anterior lesions in small or slightly enlarged prostates.

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Section: Discussionmentioning

confidence: 99%

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

et al. 2019

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“…For example, in the PRECISION (Prostate Evaluation for Clinically Important Disease: Sampling US-guided biopsy cores in 5% (95% CI: 3%, 8%) of biopsynaive men (8,37,53,58,66) (Fig 1). Recent data also show that most additional ISUP grade group 2 or higher tumors found at systematic biopsy are in sextants adjacent to MRI-identified lesions (8,35,(67)(68)(69), suggesting that targeting errors and tumor heterogeneity contribute substantially to nondetection and undergrading. These studies also document low yields of sampling normal-appearing nonadjacent sextants that do not alter overall risk stratification in the majority of patients with a cancer diagnosis (Fig 2) (8,35,67).…”

Section: Patient Implications After Intermediate-or High-likelihood Mmentioning

confidence: 99%

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Padhani¹,

Barentsz²,

Villeirs³

et al. 2019

Radiology

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he current version of the Prostate Imaging Reporting and Data System (PI-RADS) was formulated on experience gained from PI-RADS version 1, accumulated scientific evidence, and expert consensus (1). The release of PI-RADS version 2.1 is expected to further improve observer variability (2). A recent publication evaluated multiple clinical studies, systematic analyses, and professional guidelines on their use of multiparametric MRI in prostate cancer detection (3). It showed that the test performance of multiparametric MRI-directed biopsy in the detection of prostate cancer is superior to that of systematic transrectal US-guided biopsy. High-level evidence has now established multiple benefits of MRI-directed biopsy over systematic transrectal US-guided biopsy of the prostate (4). These benefits include (a) a reduction in the number of men who need to undergo biopsy (5-9); (b) a reduction in the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm (4,10), with the potential to reduce overtreatment, treatment-related complications, and active surveillance rates (6); (c) improved detection of clinically significant prostate cancers, particularly in patients with prior negative transrectal US-guided biopsy findings (4,10); and (d) improved risk stratification of diagnosed cancers owing to greater precision in tumor grade and volume determinations, which helps direct disease management. All these advantages can be achieved with fewer targeted biopsy cores per patient, potentially reducing biopsy-related morbidity (6,8,11). The purpose of this article is to focus on how multiparametric MRI results can positively impact the health of men suspected of having clinically significant prostate cancer. Who Should Undergo MRI before Biopsy? Patients chosen for MRI before biopsy include biopsynaive men with elevated serum prostate-specific antigen (PSA) levels, abnormal digital rectal examination findings, or both, and men who are deemed to have persistent elevated risk of harboring clinically significant cancers despite prior negative or nonexplanatory systematic transrectal US biopsy findings. Indications for MRI should be based on the recommendations for screening and early diagnosis of the National Comprehensive Cancer Network and the European Association of Urology (12,13). Accordingly, biopsy-naive men with lower than average risk of prostate cancer should not undergo prostate biopsy or MRI. However, limiting the options to prespecified PSA thresholds is not recommended, as there are many factors (eg, symptoms, age, race, family history, PSA kinetics, digital rectal examination findings) that in

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“…In order to decrease the diagnosis of indolent PCa, the role of contralateral prostate lobe biopsy has been investigated. Lepor et al [15] showed that avoidance of con- tralateral biopsy associates a rate of 18.6% of less indolent PCa diagnosed and 4% missed csPCa, so in selected cases targeted plus ipsilateral systematic biopsy might be sufficient for an accurate diagnosis. Our results confirm that for lesions with PIRADS score of 5, contralateral biopsy could be safely avoided both in the initial and repeat biopsy setting.…”

Section: Discussionmentioning

confidence: 99%

“…Given the high accuracy of mpMRI and MRI-TRUS fusion guided prostate biopsy for the detection of csPCa, the importance of concurrent systematic biopsy has been questioned, as it may increase the diagnosis rate of indolent PCa, as well as the morbidity of the procedure [15].…”

Section: Introductionmentioning

confidence: 99%

MRI-TRUS fusion guided prostate biopsy – initial experience and assessment of the role of contralateral lobe systematic biopsy

Andraș

Crişan

Căta³

et al. 2019

Med Ultrason

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Aims: To present our initial experience and results of MRI-TRUS fusion guided prostate biopsy and assess the role of contralateral lobe systematic biopsy.Material and method: A number of 119 patients with clinical or biochemical suspicion for prostate cancer (PCa) were included. All patients harbored at least one PIRADS score ≥ 3 lesion and underwent MRI-TRUS fusion guided biopsy, as well as a concurrent systematic biopsy. The biopsy was performed by the same operator, using a rigidregistration software system.Results: The mean age of the patients was 62.2 years. The mean pre-biopsy PSA was 9.15 ng/dl. The diagnosis rate of MRI-TRUS fusion guided biopsy was 47% for overall PCa and 29.4% for clinically significant (cs) PCa. A higher PIRADS score was significantly associated with the presence of overall and csPCa. MRI-TRUS fusion guided biopsy had a higher percentage of positive biopsy cores (51% vs 29%), higher likelihood of csPCa (OR 5.36, p=0.008) and upgrading (14.8%) in comparison with systematic biopsy but missed 6.7% csPCa. The contralateral lobe systematic biopsy could have been avoided without losing the PCa diagnosis all patients with PIRADS score 5, both in initial and repeat biopsy setting. Anterior and transitional lesions were more likely to be diagnosed only by targeted cores.Conclusion: MRI-TRUS guided prostate biopsy improves the detection of PCa, but systematic biopsy is still essential. In selected cases (PIRADS 5), contralateral lobe systematic biopsy can safely be avoided. Pre-biopsy mpMRI might reduce the number of biopsy sessions in patients with anterior and transitional lesions.

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The Role of Ipsilateral and Contralateral Transrectal Ultrasound-guided Systematic Prostate Biopsy in Men With Unilateral Magnetic Resonance Imaging Lesion Undergoing Magnetic Resonance Imaging-ultrasound Fusion-targeted Prostate Biopsy

Cited by 72 publications

References 28 publications

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

Optimising the number of cores for magnetic resonance imaging‐guided targeted and systematic transperineal prostate biopsy

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

MRI-TRUS fusion guided prostate biopsy – initial experience and assessment of the role of contralateral lobe systematic biopsy

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