MP05-11 THE LEARNING CURVE OF MPMRI TARGETED BIOPSY FOR THE DETECTION OF CLINICALLY SIGNICANT PROSTATE CANCER IS RELATED TO THE CHARACTERISTICS OF THE INDEX LESION

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP05)1 Sep 2021MP05-11 THE LEARNING CURVE OF MPMRI TARGETED BIOPSY FOR THE DETECTION OF CLINICALLY SIGNICANT PROSTATE CANCER IS RELATED TO THE CHARACTERISTICS OF THE INDEX LESION Armando Stabile, Elio Mazzone, Francesco Barletta, Carlo Andrea Bravi, Giuseppe Rosiello, Francesco Pellegrino, Gabriele Sorce, Vito Cucchiara, Emanuele Zaffuto, Nicola Fossati, Giorgio Gandaglia, Giorgio Brembilla, Antonio Esposito, Francesco De Cobelli, Francesco Montorsi, and Alberto Briganti Armando StabileArmando Stabile More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Giorgio BrembillaGiorgio Brembilla More articles by this author , Antonio EspositoAntonio Esposito More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001972.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent data suggest that the characteristics of mpMRI index lesion (IL) do not influence the ability to perform an accurate targeted biopsy (TBx). However, none has tested the association between operator experience and the characteristics of the IL. We hypothesized that IL features can affect the learning curve of urologist in detecting csPCa during TBx. METHODS: 648 patients with positive mpMRI (PI-RADS≥3) receiving TBx plus systematic biopsy (SBx) at a single centre. Patients received a median of 4 TBx and 12 SBx cores. The outcome was the presence of csPCa defined as Gleason score ≥3+4 at TBx. Two multivariable logistic regression analysis (MVA) were used to assess the relationship between urologist experience (defined as the progressive number of procedures on a logarithmic scale for each performer) and the presence of csPCa at TBx according to IL volume (<3cc vs ≥3cc) and IL location (peripheral vs transitional zone) tested as interaction term. At MVA we accounted for the confounders: PSA, prostate volume, clinical stage, PI-RADS (<4 vs ≥4), number of TBx cores, and biopsy approach (transperineal vs transrectal). Non-parametric loess functions were used to graphically explore the interaction between urologist experience and IL volume and location. RESULTS: The median number of TBx cores was 4. Overall, 56% and 47% of men had PCa and csPCa found at TBx. Overall, 36%, 47% and 17% had PI-RADS 3, 4, and 5 at mpMRI. At MVA both the interactions between urologist experience vs IL volume (OR: 1.12) and vs IL location (OR: 0.91) were significantly correlated with the outcome (all p<0.01). In each MVA, PSA, prostate volume, PI-RADS score and biopsy approach were independent predictors of presence of csPCa at TBx. Figure 1a shows that learning curve is steeper for larger ILs with a plateau after 20 procedures. Conversely, roughly 150 procedures are needed to reach similar detection rate for smaller ILs. Similarly, figure 1b shows a slower learning curve for transitional ILs as compared to peripheral ILs. CONCLUSIONS: Smaller and transitional located ILs represent a more challenging scenario for urologists with low experience in performing TBx. To reach the same csPCa detection rates of larger and peripheral lesions, roughly 150 procedures are needed. Source of Funding:- © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e82-e82 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Armando Stabile More articles by this author Elio Mazzone More articles by this author Francesco Barletta More articles by this author Carlo Andrea Bravi More articles by this author Giuseppe Rosiello More articles by this author Francesco Pellegrino More articles by this author Gabriele Sorce More articles by this author Vito Cucchiara More articles by this author Emanuele Zaffuto More articles by this author Nicola Fossati More articles by this author Giorgio Gandaglia More articles by this author Giorgio Brembilla More articles by this author Antonio Esposito More articles by this author Francesco De Cobelli More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...