Significant Prostate Cancer Detection Research Articles

Prospective analysis of clinically significant prostate cancer detection with [18F]DCFPyL PET/MRI compared to multiparametric MRI: a comparison with the histopathology in the radical prostatectomy specimen, the ProStaPET study

PurposeMultiparametric magnetic resonance imaging (mpMRI) is a well-established imaging method for localizing primary prostate cancer (PCa) and for guiding targeted prostate biopsies. [18F]DCFPyL positron emission tomography combined with MRI (PSMA-PET/MRI) might be of additional value to localize primary PCa. The aim of this study was to assess the diagnostic performance of [18F]DCFPyL-PET/MRI vs. mpMRI in tumour localization based on histopathology after robot-assisted radical-prostatectomy (RARP), also assessing biopsy advice for potential image-guided prostate biopsies.MethodsThirty prospectively included patients with intermediate to high-risk PCa underwent [18F]DCFPyL-PET/MRI and mpMRI prior to RARP. Two nuclear medicine physicians and two radiologists assessed tumour localization on [18F]DCFPyL-PET/MRI and on mpMRI respectively, and gave a prostate biopsy advice (2 segments) using a 14-segment model of the prostate. The uro-pathologist evaluated the RARP specimen for clinically significant PCa (csPCa) using the same model. csPCa was defined as any PCa with Grade Group (GG) ≥ 2. The biopsy advice based on imaging was correlated with the final histology in the RARP specimen for a total-agreement analysis. An additional near-agreement correlation was performed to approximate clinical reality.ResultsOverall, 142 of 420 (33.8%) segments contained csPCa after pathologic examination. The segments recommended for targeted biopsy contained the highest GG PCa segment in 27/30 patients (90.0%) both for [18F]DCFPyL-PET/MRI and mpMRI. Areas under the receiver operating characteristics curves (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the total-agreement detection of csPCa per segment using [18F]DCFPyL-PET/MRI were 0.70, 50.0%, 89.9%, 71.7%, and 77.9%, respectively. These results were 0.75, 54.2%, 94.2%, 82.8%, and 80.1%, respectively, for mpMRI only.ConclusionBoth [18F]DCFPyL-PET/MRI and mpMRI were only partly able to detect csPCa on a per-segment basis. An accurate detection (90.0%) of the highest GG lesion at patient-level was observed when comparing both [18F]DCFPyL-PET/MRI and mpMRI biopsy advice with the histopathology in the RARP specimen. So, despite the finding that [18F]DCFPyL-PET/MRI adequately detects csPCa, it does not outperform mpMRI.

Fusion US/MRI prostate biopsy using a computer aided diagnostic (CAD) system.

The aim of this study was to investigate the impact of computer aided diagnostic (CAD) system on the detection rate of prostate cancer (PCa) in a series of fusion prostate biopsy (FPB). Two prospective transperineal FPB series (with or without CAD assistance) were analyzed and PCa detection rates compared with per-patient and per-target analyses. The χ2 and Mann-Whitney test were used to compare categorical and continuous variables, respectively. Univariable and multivariable regression analyses were applied to identify predictors of any and clinically significant (cs) PCa detection. Subgroup analyses were performed after stratifying for PI-RADS Score and lesion location. Out of 183 FPB, 89 were performed with CAD assistance. At per-patient analysis the detection rate of any PCa and of cs PCa were 56.3% and 30.6%, respectively; the aid of CAD was negligible for either any PCa or csPCa detection rates (P=0.45 and P=0.99, respectively). Conversely in a per-target analysis, CAD-assisted biopsy had significantly higher positive predictive value (PPV) for any PCa versus MRI-only group (58% vs. 37.8%, P=0.001). PI-RADS Score was the only independent predictor of any and csPCa, either in per-patient or per-target multivariable regression analysis (all P<0.029). In a subgroup per-patient analysis of anterior/transitional zone lesions, csPCa detection rate was significantly higher in the CAD cohort (54.5%vs.11.1%, respectively; P=0.028), and CAD assistance was the only predictor of csPCa detection (P=0.013). CAD assistance for FPB seems to improve detection of csPCa located in anterior/transitional zone. Enhanced identification and improved contouring of lesions may justify higher diagnostic performance.

Outcome of 5-year follow-up in men with negative findings on initial biparametric MRI

BackgroundWe assessed the 5-year risk of being diagnosed with significant prostate cancer following a low-suspicion biparametric magnetic resonance imaging result. MethodsThe study population was derived from a prospective database used to assess the diagnostic accuracy of biparametric magnetic resonance imaging for significant prostate cancer detection in 1020 biopsy-naïve men. Significant prostate cancer was defined as any core with Gleason grade group ≥3 or a maximum cancerous core length greater than 50% of Gleason grade group 2. A secondary definition of significant prostate cancer was also included: any core with prostate cancer Gleason grade group ≥2. Of the 1020 men, 305 had a low-suspicion biparametric magnetic resonance imaging result (Prostate Imaging Reporting and Data System score of 1 or 2) but four men were excluded from follow-up. Thus, the final study population consisted of 301 men, who were clinically followed-up from inclusion (November 2015 to June 2017) until 1 June 2021. FindingsOverall, 1·7% (5/301) of the study population had significant prostate cancer diagnosed within 5 years (median 1480 days, Interquartile Range (1587–1382)) of their low-suspicion result and corresponding set of biopsies. When the secondary definition of significant prostate cancer was applied, this increased to 5% (15/301) of the study population. InterpretationThe 5-year risk of being diagnosed with significant prostate cancer after a prebiopsy low-suspicion prebiopsy biparametric magnetic resonance imaging result was 1·7%.

A Prospective Study and Single-Center Experience: Effectivity of Fusion Prostate Biopsy in Biopsy-Naïve Patients.

ObjectiveFusion prostate biopsy (FPB) has become a popular technique in biopsy-naïve patients, though not accepted as a standard approach (yet). In this study, we aimed to present the clinical outcomes of biopsy-naïve patients who underwent FPB.Material and methodsThe study included 400 biopsy-naïve patients aged 45-75 years who had a prostate-specific antigen (PSA) level of 2-10 ng/ml and were detected with a Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion on multiparametric prostate magnetic resonance imaging (mpMRI)-guided FPB. A combined biopsy (CB) was performed in each patient, in which 2-4 cores were obtained for suspicious lesions by targeted biopsy (TB) and then 12-core standard prostate biopsy (SPB) was conducted in the same session. Cancer detection rates, clinically significant prostate cancer (csPCa) detection rates, histological upgrading rates, and false negative rates were determined.ResultsThe 400 patients had a mean age of 62.01±7.00 years and a mean PSA value of 6.84±1.87 ng/ml. Overall PCa detection rate was 50% (200/400). The csPCa detection rates for TB, SPB, and CB were 25.0%, 31.8%, and 44.0%, respectively (p<0.001). In PIRADS 3, 4, and 5 lesions, CB had a csPCa detection rate of 29.2%, 54%, and 64.8%, respectively (p<0.001). The ratio of false negativity was significantly higher for TB compared to SPB (43.2% vs. 27.8%, p=0.003), whereas no significant difference was found between these two techniques with regard to upgrading rates although TB had a higher rate (19.6% vs. 13.7%, p=0.144).ConclusionFPB, a combined approach involving TB and SPB, was revealed as the most successful technique in biopsy-naïve patients with PSA<10 ng/ml due to its high cancer detection rates and low false negative rates.

Multiparametric Prostate MRI in Biopsy-Naïve Men: A Prospective Evaluation of Performance and Biopsy Strategies.

ObjectivesThis study aims to prospectively estimate the diagnostic performance of multiparametric prostate MRI (mpMRI) and compare the detection rates of prostate cancer using cognitive targeted transrectal ultrasound (TRUS) guided biopsies, targeted MR-guided in-bore biopsies (MRGB), or both methods combined in biopsy-naïve men.MethodsThe biopsy-naïve men referred for mpMRI (including T2-weighted, diffusion-weighted and dynamic contrast enhanced MRI) due to prostate cancer suspicion (elevated prostate-specific antigen or abnormal digital rectal examination) were eligible for inclusion. The images were scored according to Prostate Imaging Reporting and Data System (PI-RADS) v2, and men with PI-RADS 1–2 lesions were referred for routine systematic TRUS, while those with PI-RADS 3–5 lesions were randomized to MRGB or cognitive targeted TRUS. Men randomized to MRGB were referred to a secondary TRUS 2 weeks after MRGB. Gleason grade group ≥2 was defined as clinically significant prostate cancer. The performance of mpMRI was estimated using prostate cancer detected by any biopsy method as the reference test.ResultsA total of 210 men were included. There was no suspicion of prostate cancer after mpMRI (PI-RADS 1–2) in 48% of the men. Among these, significant and insignificant prostate cancer was diagnosed in five and 11 men, respectively. Thirty-five men who scored as PI-RADS 1–2 did not undergo biopsy and were therefore excluded from the calculation of diagnostic accuracy. The overall sensitivity, specificity, negative predictive value, and positive predictive value of mpMRI for the detection of significant prostate cancer were 0.94, 0.63, 0.92, and 0.67, respectively. In patients with PI-RADS 3–5 lesions, the detection rates for significant prostate cancer were not significantly different between cognitive targeted TRUS (68.4%), MRGB (57.7%), and the combination of the two biopsy methods (64.4%). The median numbers of biopsy cores taken per patient undergoing systematic TRUS, cognitive targeted TRUS, and MRGB were 14 [8-16], 12 [6-17], and 2 [1-4] respectively.ConclusionsmpMRI, in a cohort of biopsy-naïve men, has high negative predictive value, and our results support that it is safe to avoid biopsy after negative mpMRI. Furthermore, MRGB provides a similar diagnosis to the cognitive targeted TRUS but with fewer biopsies.

PD02-07 RESIDENT'S LEARNING CURVE OF MRI/TRUS TARGET PROSTATE FUSION BIOPSY AFTER MORE THAN 1000 PROCEDURES

You have accessJournal of UrologyEducation Research I (PD02)1 Sep 2021PD02-07 RESIDENT'S LEARNING CURVE OF MRI/TRUS TARGET PROSTATE FUSION BIOPSY AFTER MORE THAN 1000 PROCEDURES Enrico Checcucci, Federico Piramide, Sabrina De Cillis, Daniele Amparore, Gabriele Volpi, Alberto Piana, Stefano Granato, Angela Pecoraro, Paolo Alessio, Beatrice Carbonaro, Juliette Mézière, Giovanni Cattaneo, Francesca Ragni, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Enrico CheccucciEnrico Checcucci More articles by this author , Federico PiramideFederico Piramide More articles by this author , Sabrina De CillisSabrina De Cillis More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Alberto PianaAlberto Piana More articles by this author , Stefano GranatoStefano Granato More articles by this author , Angela PecoraroAngela Pecoraro More articles by this author , Paolo AlessioPaolo Alessio More articles by this author , Beatrice CarbonaroBeatrice Carbonaro More articles by this author , Juliette MézièreJuliette Mézière More articles by this author , Giovanni CattaneoGiovanni Cattaneo More articles by this author , Francesca RagniFrancesca Ragni More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001966.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During last years, prostate cancer (PCa) detection has been improved by the implementation of software allowing to perform MRI-transrectal ultrasonography fusion-guided prostate biopsy (MRI/TRUS fusion biopsy, FB). The aim of our study was to assess the learning curve (LC) of two urology residents in the execution of fusion biopsy (FB) considering overall prostate cancer (PCa) and clinically significant (cs) PCa detection rate (DR), based on different lesions’ characteristics at the MRI. METHODS: We extracted data from our prospectively maintained database from January 2015 to December 2019. FB was carried out with the BioJet fusion system (D&K Technologies, Barum, Germany) either by a transrectal or transperineal approach. An ANOVA test was used to assess the homogeneity of the cohort. Multivariable linear and logistic regression analysis were used to assess the correlation between operator experience and DR for PCa and csPCa. At last, the postprocedural complication rate trend was determined. RESULTS: 1005 men were enrolled in the study. During the five years of the study, the pre-biopsy characteristics of the patients enrolled did not change significantly except for the proportion of patients who previously underwent prostate biopsy (p<0.001) and the number of mpMRI performed at referral centers (p=0.002), both showing a decreasing trend over time. The overall DR of PCa was 61.2% (615/1005) [IC 0.58-0.64]; whilst DR for csPCA was 54.6% (549/1005) [IC 0.51–0.57]. Operator experience does not appear to impact the DR of overall PCa and csPCa. On the contrary, in case of lesions with diameter <8 mm, PCa and csPCa DR were significantly higher with operator experience (p=0.048 and p=0.038, respectively). Considering the suspicious tumours located in the more challenging areas of the prostate (transitional or posterolateral zone) were not significantly better diagnosed with experience improvement (p=0.34 and p=0.22 for PCa DR and csPCa DR respectively). The specific analysis focused on PI-RADS 5 lesions, mpMRI performed in referral centers, or for patients at repeated-biopsy did not reveal a significant relationship between operator experience and PCa or csPCa DR. Complication rate was stable during the whole study (p=0.75). CONCLUSIONS: A standardized FB approach demonstrated to be feasible, safe, and effective since the start of residents’ LC. PCa and csPCa DR was stable, after > 1000 biopsies. Nevertheless, in case of lesions < 8 mm, the execution of at least 100 FB is fundamental in order to correctly sample the area. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e40-e40 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Enrico Checcucci More articles by this author Federico Piramide More articles by this author Sabrina De Cillis More articles by this author Daniele Amparore More articles by this author Gabriele Volpi More articles by this author Alberto Piana More articles by this author Stefano Granato More articles by this author Angela Pecoraro More articles by this author Paolo Alessio More articles by this author Beatrice Carbonaro More articles by this author Juliette Mézière More articles by this author Giovanni Cattaneo More articles by this author Francesca Ragni More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement Loading ...

MP05-04 CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION RATES ON MRI GUIDED FUSION NEEDLE BIOPSY - EXPERIENCE FROM THE PENNSYLVANIA UROLOGIC REGIONAL COLLABORATIVE

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP05)1 Sep 2021MP05-04 CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION RATES ON MRI GUIDED FUSION NEEDLE BIOPSY - EXPERIENCE FROM THE PENNSYLVANIA UROLOGIC REGIONAL COLLABORATIVE Ako Adams Ako, Serge Ginzburg, Eric Singer, Bruce Jacobs, Claudette Fonshell, Adam Reese, Edouard Trabulsi, Jeffery Tomaszewski, John Danella, Laurence Belkoff, Thomas Guzzo, Robert Uzzo, and Jay Raman Ako Adams AkoAko Adams Ako More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Eric SingerEric Singer More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , Claudette FonshellClaudette Fonshell More articles by this author , Adam ReeseAdam Reese More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Jeffery TomaszewskiJeffery Tomaszewski More articles by this author , John DanellaJohn Danella More articles by this author , Laurence BelkoffLaurence Belkoff More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Jay RamanJay Raman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001972.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI) fusion needle biopsy has been shown to outperform systematic biopsy in detecting clinically significant prostate cancer. This study sought to: 1) Examine the variability of clinically significant prostate cancer detection rates in a large, regional quality improvement collaborative. 2) Examine the association between patient characteristics and clinically significant prostate cancer detection. METHODS: The Pennsylvania Urologic Regional Collaborative (PURC) is a physician-led data-sharing and quality improvement collaborative comprised of urology practices across Pennsylvania and New Jersey. We analyzed 857 first-time MRI fusion biopsy procedures performed at 5 PURC practices with a minimum of 30 procedures between January 2015 and June 2019. Chi-square tests and hierarchical logistic regression analyzed the variability in cancer detection rates by practice and the association between patient characteristics and Gleason ≥4+3 tumor detection. RESULTS: Median prostate specific antigen (PSA) was 6.8 ng/ml, 14.4% of men were ≤59 years old. Detection rates for Gleason ≥4+3 tumors by practice ranged from 14.3% to 28.3% (p=0.02). Age, digital rectal examination, PSA, gland volume and Prostate Imaging-Reporting and Data System version2 (PI-RADSv2) score were significantly associated with Gleason ≥4+3 tumors. Adjusting for patient characteristics demonstrated that there was no significant variation in Gleason ≥4+3 tumor detection by practice (Intercept variance = 0.04; p=0.26). PIRADSv2 ≥4 was associated with increased likelihood of detecting a Gleason ≥4+3 tumor (OR 2.67; 95% CI 1.76–4.07; p<0.0001). CONCLUSIONS: Variability in clinically significant prostate cancer detection between individual practice sites was predominantly due to variability in patient characteristics. Results highlight the importance of pre-biopsy MRI in the diagnosis of clinically significant prostate cancer. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e77-e78 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ako Adams Ako More articles by this author Serge Ginzburg More articles by this author Eric Singer More articles by this author Bruce Jacobs More articles by this author Claudette Fonshell More articles by this author Adam Reese More articles by this author Edouard Trabulsi More articles by this author Jeffery Tomaszewski More articles by this author John Danella More articles by this author Laurence Belkoff More articles by this author Thomas Guzzo More articles by this author Robert Uzzo More articles by this author Jay Raman More articles by this author Expand All Advertisement Loading ...

The current recommendation for the management of isolated high-grade prostatic intraepithelial neoplasia.

To analyse the current predictive value of isolated high-grade prostatic intraepithelial neoplasia (HGPIN) for clinically significant prostate cancer (csPCa) detection in repeat biopsies. A cohort of 293 men with isolated HGPIN detected in previous biopsies performed without multiparametric magnetic resonance imaging (mpMRI), and who underwent repeat biopsy within 1 to 3 years, was analysed. Pre-repeat biopsy mpMRI and guided biopsies to suspicious lesions (Prostate Imaging - Reporting and Data System [PI-RADS] ≥3) and/or and systematic biopsies were performed. Persistent prostate cancer (PCa) suspicion, defined as sustained serum prostate-specific antigen level >4 ng/mL and/or abnormal digital rectal examination, was present in 248 men (84.6%), and was absent in 45 men (15.4%). A control group of 190 men who had no previous HGPIN, atypical small acinar proliferation or HGPIN with atypia who were scheduled to undergo repeat biopsy due to persistent PCa suspicion were also analysed. csPCa was defined as tumours of Grade Group ≥2. In the subset of 45 men with isolated HGPIN, in whom PCa suspicion disappeared, only one csPCa (2.2%) and one insignificant PCa (iPCa) were detected. csPCa was detected in 34.7% of men with persistent PCa suspicion and previous HGPIN, and in 28.4% of those without previous HGPIN (P =0.180). iPCa was detected in 12.1% and 6.3%, respectively (P =0.039). Logistic regression analysis showed that the risk of csPCa detection was not predicted by previous HGPIN: odds ratio (OR) 1.369 (95% confidence interval [CI] 0.894-2.095; P =0.149); however, previous HGPIN increased the risk of iPCa detection: OR 2.043 (95% CI 1.016-4.109; P =0.006). The risk of csPCa in men with isolated HGPIN, in whom PCa suspicion disappears, is extremely low. Moreover, in those men in whom PCa suspicion persists, the risk of csPCa is not influenced by the previous finding of HGPIN. However, previous HGPIN increases the risk of iPCa detection. Therefore, repeat prostate biopsy should not be recommended solely because of a previous HGPIN.

Outcome of 5-Year Follow-Up in Men with Negative Findings on Initial Biparametric MRI

Background: We assessed the 5-year risk of being diagnosed with significant prostate cancer following a low-suspicion biparametric magnetic resonance imaging result. Methods: The study population was derived from a prospective database used to assess the diagnostic accuracy of biparametric magnetic resonance imaging for significant prostate cancer detection in 1020 biopsy-naive men. Significant prostate cancer was defined as any core with Gleason grade group ≥ 3 or a maximum cancerous core length greater than 50% of Gleason grade group 2. A secondary definition of significant prostate cancer was also included: any core with prostate cancer Gleason grade group ≥ 2. Of the 1020 men, 305 had a low-suspicion biparametric magnetic resonance imaging result (Prostate Imaging Reporting and Data System score of 1 or 2) but four men were excluded from follow-up. Thus, the final study population consisted of 301 men, who were clinically followed-up from inclusion (November 2015 to June 2017) until 1 June 2021. Findings: Overall, 1·7% (5/301) of the study population had significant prostate cancer diagnosed within 5 years of their low-suspicion result and corresponding set of biopsies leading to a negative predictive value of 98·3%. When the secondary definition of significant prostate cancer was applied, this increased to 5% (15/301) of the study population, and a negative predictive value of 95·6%. Interpretation: The 5-year risk of being diagnosed with significant prostate cancer after a prebiopsy low-suspicion prebiopsy biparametric magnetic resonance imaging result was 1·7%. Funding Information: The authors received financial support from the Danish Cancer Society for this research. Declaration of Interests: The authors declare that they have no conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: The BIDOC study was approved by the Local Committee for Health Research Ethics and the Danish Data Protection Agency and participants provided written informed consent.

The value of MRI in the detection of prostate cancer in a peripheral center.

This study evaluated the value of pre-biopsy MRI and target biopsy in detection of significant prostate cancer in a peripheral center. A retrospective study included all patients of whom a MRI of the prostate was performed before biopsy, initial and repeated biopsy, between June 2016 and May 2017. Patients underwent transrectal ultrasound guided 8-12 cores prostate biopsy and cognitive fusion target biopsy was performed if a suspicious lesion was seen on MRI. The prostate cancer detection was compared between the MRI cognitive target biopsy and standard random biopsy. In a total of 265 patients a MRI was performed of whom 115 underwent prostate biopsy, 96 patients underwent MRI before initial biopsies and 19 patients had previous negative biopsies. In the initial biopsy group 83 MRI's were abnormal and only 7 (8.4%) target biopsies had an additional value in detecting or upstaging prostate cancer. Prostate cancer was found in 4 of 13 (30.8%) normal MRI's. In the prior negative biopsy group, 4 of 18 abnormal MRI's had an additional value in upstaging or detecting prostate cancer. In this study the pre-biopsy MRI had a limited additional value compared to standard biopsy in detecting or upstaging prostate cancer.

Beyond the Learning Curve of Prostate MRI/TRUS Target Fusion Biopsy after More than 1000 Procedures

ObjectiveTo evaluate the learning curve (LC) of two urology residents in the execution of fusion biopsy (FB) in terms of overall prostate cancer (PCa) and clinically significant (cs) PCa detection rate (DR) and according to different characteristics of the lesions on MRI Material and MethodsWe analyzed data from our prospective maintained FB database between January 2015 and December 2019. FB was performed using the BioJet fusion system (D&K Technologies, Barum, Germany) with a transrectal or transperineal approach. An ANOVA test was used to evaluate the homogeneity of our cohort. Multivariable linear and logistic regression analysis were used to evaluate the relationship between operator experience and DR for PCa and csPCa. Then, the postprocedural complication rate trend was evaluated. Results1005 patients were included. The overall DR of PCa was 61.2% (615/1005) [IC 0.58 – 0.64]; whilst DR for csPCA was 54.6% (549/1005) [IC 0.51 – 0.57]. Operator experience does not seem to influence the DR of overall PCa and csPCa; whilst for lesions <8 mm in diameter, PCa and csPCa DR increased significantly with operator experience (P = 0.048 and P = 0.038, respectively). Postprocedural complications remained stable during the whole study period (P = 0.75). ConclusionA standardized FB approach turned out to be feasible, safe, and effective since the beginning of the residents’ LC. PCa and csPCa DR remained stable, at 60% and 55% respectively, after more than 1,000 biopsies. However, for lesions smaller than 8 mm, at least 100 FB of experience is needed to correctly sample the area.

Optimal PSA Threshold for Obtaining MRI-Fusion Biopsy in Biopsy-Naïve Patients.

Objective The study investigates the prostate-specific antigen threshold for adding targeted, software-based, magnetic resonance imaging-ultrasound fusion biopsy during a standard 12-core biopsy in biopsy-naïve patients. It secondarily explores whether the targeted biopsy is necessary in setting of abnormal digital rectal examination. Methods 260 patients with suspected localized prostate cancer with no prior biopsy underwent prostate magnetic resonance imaging and were found to have Prostate Imaging Reporting and Data System score ≥ 3 lesion(s). All 260 patients underwent standard 12-core biopsy and targeted biopsy during the same session. Clinically significant cancer was Gleason ≥3 + 4. Results Percentages of patients with prostate-specific antigen 0–1.99, 2–3.99, 4–4.99, 5–5.99, 6–9.99, and ≥10 were 3.0%, 4.7%, 20.8%, 16.9%, 37.7%, and 16.9%, respectively. Cumulative frequency of clinically significant prostate cancer increased with the addition of targeted biopsy compared with standard biopsy alone across all prostate-specific antigen ranges. The difference in clinically significant cancer detection between targeted plus standard biopsy compared to standard biopsy alone becomes statistically significant at prostate-specific antigen >4.3 (p=0.031). At this threshold, combination biopsy detected 20 clinically significant prostate cancers, while standard detected 14 with 88% sensitivity and 20% specificity. Excluding targeted biopsy in setting of a positive digital rectal exam would save 12.3% magnetic resonance imaging and miss 1.8% clinically significant cancers in our cohort. Conclusions In biopsy-naïve patients, at prostate-specific antigen >4.3, there is a significant increase in clinically significant prostate cancer detection when targeted biopsy is added to standard biopsy. Obtaining standard biopsy alone in patients with abnormal digital rectal examinations would miss 1.8% clinically significant cancers in our cohort.

Prostat Görüntüleme Raporlama ve Veri Sistemi-3 lezyonlarında prostat kanserini öngören temel faktörler

Objective: We aimed to investigate the role of the digital rectal examination, PSA density, regional location of the lesion and prostate size in predicting prostate cancer in Prostate Imaging and Data Reporting System (PI-RADS)-3 lesions. Material and Methods: A total of 236 patients with multiparametric MRI performed for clinical suspicion of prostate cancer and reported PI-RADS-3 enrolled between January 2016 and July 2019 in this retrospective study. The datas were extracted from the hospital’s electronic records, patient files and outpatient clinic records. Multiparametric MRI was performed patients to whom have elevated PSA level and/or suspicious digital rectal examination. Patients diagnosed with and without prostate cancer were compared in terms of age, PSA, PSA density, prostate size, pathological results, lesion localization and DRE findings. Results: One hundred thirty- independent predictor seven patients with an initial score of PI-RADS-3 were subjected to further analysis. Prostat cancer detection rate in overall and clinically significant prostate cancer detection rate was 26.2% and 4.3%, respectively. There was a significant difference regarding DRE findings (p=0.001) and PZ location of the lesion (p=0.005) between PCa and no PCa groups. Digital rectal examination (p=0.001) was an independent predictor of prostate cancer in multivariate logistic regression analysis. Conclusion: Digital rectal examination is a practical and important parameter in clarifying the suspicion of prostate cancer in PI-RADS-3 lesions. Keywords: prostatic neoplasms, digital rectal examination, multiparametric magnetic resonance imaging, image guided biopsy

Naive patients with suspicious prostate cancer and positive multiparametric magnetic resonance imaging (mp-MRI): is it time for fusion target biopsy alone?

Objectives: To determine if standard biopsy still has a role in the detection of prostate cancer or clinically significant prostate cancer in biopsy-naive patients with positive multiparametric magnetic resonance imaging. Materials and methods: We extracted, from our prospective maintained fusion biopsy database, patients from March 2014 to December 2018. The detection rate of prostate cancer and clinically significant prostate cancer and complication rate were analysed in a cohort of patients who underwent fusion biopsy alone (group A) or fusion biopsy plus standard biopsy (group B). The International Society of Urological Pathology grade group determined on prostate biopsy with the grade group determined on final pathology among patients who underwent radical prostatectomy were compared. Results: Prostate cancer was found in 249/389 (64.01%) and 215/337 (63.8%) patients in groups A and B, respectively ( P=0.98), while the clinically significant prostate cancer detection rate was 57.8% and 55.1% ( P=0.52). No significant differences in complications were found. No differences in the upgrading rate between biopsy and final pathology finding after radical prostatectomy were recorded. Conclusions: In biopsy-naive patients, with suspected prostate cancer and positive multiparametric magnetic resonance imaging the addition of standard biopsy to fusion biopsy did not increase significantly the detection rate of prostate cancer or clinically significant prostate cancer. Moreover, the rate of upgrading of the cancer grade group between biopsy and final pathology was not affected by the addition of standard biopsy. Level of evidence: Not applicable for this multicentre audit.

Trends in the Uptake of Diagnostic Multi-Parametric MRI of the Prostate With Federal Funding: Australia Population Data

In recent years, there has been an expanding role for multi-parametric Magnetic Resonance Imaging (mpMRI) in the workup of prostate cancer. There is growing evidence suggesting the utilization of mpMRI increases clinically significant prostate cancer detection and reduces prostate biopsy rates.1 Furthermore, there are suggestions that mpMRI may help guide the management of patients with prostate cancer.2,3 In keeping with this, the European Association of Urology prostate cancer guidelines now strongly recommend that mpMRI should be performed prior to biopsy.

Magnetic resonance/ultrasound fusion targeted biopsy of the prostate can be improved by adding systematic biopsy.

Magnetic resonance/ ultrasound fusion targeted biopsy (Tbs) is widely used for diagnosing prostate cancer (PCa).The aim of our study was to compare the cancer detection rate (CDR) and the clinically significant prostate cancer detectionrate (csPCa) of the magnetic resonance/ultrasound fusion targeted biopsy with those of the standard systematic biopsy (Sbs)and of the combination of both techniques. A total of 182 patients underwent magnetic resonance/ultrasound fusion Tbs on the prostate for PCa suspicion based on multiparametric magnetic resonance imaging (mMRI)detection of lesions with PI-RADSv2 score ≥3. A total of 78 patients had prior negative biopsies. Tb was performed by taking2-4 cores from each suspected lesion, followed by Sb with 12 cores. We evaluated the overall detection rate of PCa andclinically significant prostate cancer, defined as any PCa with Gleason score ≥3+4. Median prostate specific antigen(PSA) level pre-biopsy was 7.4 ng/ml and median free-PSA/PSA ratio was 10.2%. Patient median age was 62 years old. PIRADSv2score was 3 in 54 cases, 4 in 96 cases and 5 in 32 cases. PI-RADS-dependent detection rate of Tbs for scores 3, 4 and5 was 25.9%, 65.6% and 84.4%, respectively, with csPCa detection rates of 24.1%, 54.2%, and 71.9%. Overall detection ratewas 57.1% for Tbs, which increased to 60.4% by adding Sbs results. Detection rate for clinically significant prostate cancer(csPCa) was 48.4% and increased to 51.1% by adding Sbs. Overall detection rate for repeated biopsy was 50% and 68.3%for biopsy in naïve patients. Sbs detection rate was 55.5%, 8 patients having a negative biopsy on Tbs. WhenTbs is considered due to a PI-RADS ≥3 lesion on mMRI, combined Tbs + Sbs increases the overall CDR and csPCa detectionrates.

P0942 - Comparative analysis of a novel target saturation biopsy approach in Magnetic Resonance Imaging (MRI) TransrRectal UltraSound (TRUS) fusion biopsy versus transperineal template saturation biopsy for the detection of significant prostate cancer

P0942 - Comparative analysis of a novel target saturation biopsy approach in Magnetic Resonance Imaging (MRI) TransrRectal UltraSound (TRUS) fusion biopsy versus transperineal template saturation biopsy for the detection of significant prostate cancer

P0907 - Detection of significant prostate cancer using target saturation in transperineal magnetic resonance imaging/transrectal ultrasonography–fusion biopsy: A prospective, randomized comparison to conventional target biopsy

P0907 - Detection of significant prostate cancer using target saturation in transperineal magnetic resonance imaging/transrectal ultrasonography–fusion biopsy: A prospective, randomized comparison to conventional target biopsy

P0927 - Diagnostic accuracy of mpMRI-US fusion and micro-ultrasound guided biopsies for clinically significant prostate cancer detection

P0927 - Diagnostic accuracy of mpMRI-US fusion and micro-ultrasound guided biopsies for clinically significant prostate cancer detection

P0906 - A predictive tool for clinically significant prostate cancer detection in men with prostate cancer suspicion

P0906 - A predictive tool for clinically significant prostate cancer detection in men with prostate cancer suspicion