1634 TRANSPERINEAL MAPPING TEMPLATE PROSTATE BIOPSY ADDRESSES UNDER SAMPLING FOR MEN CONSIDERING ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111634 TRANSPERINEAL MAPPING TEMPLATE PROSTATE BIOPSY ADDRESSES UNDER SAMPLING FOR MEN CONSIDERING ACTIVE SURVEILLANCE Michael Rowley, Chang He, Rabia Siddiqui, Stephanie Meyers, John Wei, David Wood, and Priya Kunju Michael RowleyMichael Rowley Ann Arbor, MI More articles by this author , Chang HeChang He Ann Arbor, MI More articles by this author , Rabia SiddiquiRabia Siddiqui Ann Arbor, MI More articles by this author , Stephanie MeyersStephanie Meyers Ann Arbor, MI More articles by this author , John WeiJohn Wei Ann Arbor, MI More articles by this author , David WoodDavid Wood Ann Arbor, MI More articles by this author , and Priya KunjuPriya Kunju Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Appropriate patient selection for active surveillance (AS) is crucial given the goal to select for a low risk population. We present our institutional experience with transperineal mapping template prostate biopsy (TMTPB) as an entrance criteria for AS and its effect on management. METHODS 78 patients underwent TMTPB as an entrance criteria for AS. Pathologic institutional AS criteria in men ≤ 70 years include Gleason (Gl) score < 7, ≤ 1/3 of all cores involved and ≤ 50% of any individual core involved. Inclusion criteria for men > 70 years include Gl 6 or 3+4 = 7 disease with no restriction on number or percent of cores positive. Using a transperineal approach, the prostate was systematically biopsied in 26 unique regions guided by a brachytherapy template. Prostate size determined total number of cores. Clinical and biopsy parameters were evaluated as predictors for whether entrance TMTPB changed the decision to go on to definitive therapy. RESULTS A mean of 62.8 cores were taken on TMTPB. 61 of 78 (78.2%) TMTPBs were positive for cancer. Highest Gl in patients were as follows: 34 of 78 (43.6%) Gl 6, 20 (25.6%) Gl 3+4, 4 (5.1%) Gl 4+3, and 3 (3.8%) Gl 8 or 9. Gl score was upgraded on TMTPB in 11 of 41 (26.8%) cases where the previous biopsy was available for pathologic review. Only 50 of 78 (64.1%) patients met institutional criteria for AS following TMTPB. Of the 28 cases that did not meet institutional criteria, 26 (92.9%) cases were because of Gl score and 2 (7.1%) cases were because the greatest % positive core was > 50%. 20 of 78 (25.6%) patients switched from AS to definitive therapy based on the result of the TMTPB. These patients had a higher PSA (p=0.02), higher PSA density (0.01) and higher greatest % positive core (p=0.0006) on previous biopsy. Predictors for change in management on multivariate regression included PSA density (p=0.03). Complications were limited in 10 patients (12.8%): urinary retention (5) and hematuria (5). CONCLUSIONS TMTPB leads to a change in management strategy from AS to definitive therapy in a significant percentage of patients. A significant proportion of biopsies lead to an upgrading of Gleason score. Therefore, patients contemplating AS should undergo a TMTPB for more accurate risk assessment and staging. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e655-e656 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rowley Ann Arbor, MI More articles by this author Chang He Ann Arbor, MI More articles by this author Rabia Siddiqui Ann Arbor, MI More articles by this author Stephanie Meyers Ann Arbor, MI More articles by this author John Wei Ann Arbor, MI More articles by this author David Wood Ann Arbor, MI More articles by this author Priya Kunju Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...