Prostate Cancer Detection Rate Research Articles

Prostate cancer detection rate of repeated biopsy in patients with positive mpMRI and negative initial target and random biopsy. An EAU-YAU Prostate Cancer Working Group multi-institutional study

Prostate cancer detection rate of repeated biopsy in patients with positive mpMRI and negative initial target and random biopsy. An EAU-YAU Prostate Cancer Working Group multi-institutional study

Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients

BackgroundTransrectal (TR) ultrasound guided prostate biopsy and transperineal (TP) ultrasound guided prostate biopsy are the two most commonly used methods to detect prostate cancer, the detection rate of the two biopsy approaches may differ in patients with different clinical characteristics. Here we aimed to compare the prostate cancer detection rate and positive rate of biopsy cores between TR and TP prostate biopsy in patients with different clinical characteristics.MethodsWe retrospectively analyzed and compared the clinical data of 452 patients underwent TR or TP prostate biopsy in our hospital from June 2017 to September 2021. And patients were stratified according to several clinical characteristic (serum PSA level, prostate volume, PSA density, T stage and ISUP grade), cancer detection rate and positive rate of biopsy cores were compared in different stratified groups.ResultsThere was no significant difference in age, PSA level, prostate volume, and PSA density between the TR and TP groups. TR group had a higher overall cancer detection rate and positive rate of biopsy cores than TP group. Further subgroup analysis showed that TR group had a higher cancer detection rate in patients with prostate volumes 30–80 mL, and that the TR group had a higher positive rate of biopsy cores among the patients with T3–T4 stages, while TP group had a higher positive rates of biopsy cores among the patients with T1–T2 stages. There were no significant differences between the TR and TP groups for each subgroup when stratified by PSA level, PSA density and ISUP grade.ConclusionsTR approach may have advantage in patients with prostate volumes 30–80 mL and T3–T4 stages, while TP approach may have advantage in patients with T1–T2 stages.

BpMRI and mpMRI for detecting prostate cancer: A retrospective cohort study.

We aimed to compare the detection rates of prostate cancer (PCa) and clinically significant prostate cancer(csPCa) by biparametric (bp-) and multiparameter magnetic resonance imaging (mpMRI). A total of 699 patients who underwent transperineal prostate biopsy in the Department of Urology, the Second Affiliated Hospital of Nantong University from January 2018 to December 2021 were retrospectively reviewed. Multivariate analysis was used to explore the influencing factors associated with the detection rates of PCa and csPCa. According to MRI examination before biopsy, the patients were divided into bpMRI group and mpMRI group. The detection rates of PCa and csPCa by bpMRI and mpMRI were compared. Furthermore, stratified analysis was performed for patients in these two groups to compare the detection rates of PCa and csPCa at different tPSA intervals, different prostate volume (PV) intervals and different PI-RADS V2 scores. A total of 571 patients were finally analyzed in this study after exclusion, and the overall detection rate of PCa was 54.5%. Multivariate analysis showed that patient age, tPSA level, prostate volume and PI-RADS V2 score were independent risk factors affecting the detection rates of PCa and csPCa. The detection rates of PCa and csPCa by bpMRI and mpMRI were comparable (51.3% vs. 57.9%, 44.0% vs. 48.0%, both P > 0.05), with no statistical significance. In the tPSA 10-20 ng/ml interval, the detection ratesof PCa (59.72% vs. 40.35%, P = 0.011) and csPCa (51.39% vs. 28.82%, P = 0.005) by mpMRI were significantly higher than those by bpMRI, while in other tPSA interval (tPSA < 4 ng/ml, 4-10 ng/ml, 20-100 ng/ml), different PVs (≤30 ml, 30-60 ml, >60 ml) and different PI-RADS V2 scores (3, 4, and 5), the detection rates of PCa and csPCa were comparable between the two groups. For detecting PCa and csPCa, bpMRI and mpMRI had similar diagnostic efficacies, whereas mpMRI detected more PCa and csPCa in the tPSA interval of 10-20 ng/ml.

Nomograms Combining PHI and PI-RADS in Detecting Prostate Cancer: A Multicenter Prospective Study

(1) Background: The study aimed to construct nomograms to improve the detection rates of prostate cancer (PCa) and clinically significant prostate cancer (CSPCa) in the Asian population. (2) Methods: This multicenter prospective study included a group of 293 patients from three hospitals. Univariable and multivariable logistic regression analysis was performed to identify potential risk factors and construct nomograms. Discrimination, calibration, and clinical utility were used to assess the performance of the nomogram. The web-based dynamic nomograms were subsequently built based on multivariable logistic analysis. (3) Results: A total of 293 patients were included in our study with 201 negative and 92 positive results in PCa. Four independent predictive factors (age, prostate health index (PHI), prostate volume, and prostate imaging reporting and data system score (PI-RADS)) for PCa were included, and four factors (age, PHI, PI-RADS, and Log PSA Density) for CSPCa were included. The area under the ROC curve (AUC) for PCa was 0.902 in the training cohort and 0.869 in the validation cohort. The AUC for CSPCa was 0.896 in the training cohort and 0.890 in the validation cohort. (4) Conclusions: The combined diagnosis of PHI and PI-RADS can avoid more unnecessary biopsies and improve the detection rate of PCa and CSPCa. The nomogram with the combination of age, PHI, PV, and PI-RADS could improve the detection of PCa, and the nomogram with the combination of age, PHI, PI-RADS, and Log PSAD could improve the detection of CSPCa.

Can 18F-PSMA-7Q PET/CT replace prostate biopsy for the diagnosis of prostate cancer?-A single-center retrospective study.

Of the currently available prostate-specific membrane antigen (PSMA) positron emission tomography (PET) tracers, although 68Ga-PSMA-11 and 18F-DCFPyL have been approved by the US Food and Drug Administration (FDA), both tracers are excreted rapidly through the urinary tract, resulting in strong accumulation in the bladder and blurring the prostate.18F-PSMA-7Q is a novel quinoline-containing PSMA PET tracer developed by our team, which is primarily excreted through the liver. It can reduce the incidence of urine-induced false-positives in the prostate. We aimed to explore the diagnostic efficacy of 18F-PSMA-7Q PET/computed tomography (CT), and when 18F-PSMA-7Q PET/CT can be used instead of prostate biopsy to diagnose prostate cancer. Patients who underwent 18F-PSMA-7Q PET/CT for prostate cancer staging or prostate biopsy guidance at our institution between July 2020 and December 2021 were retrospectively enrolled. Molecular imaging PSMA (miPSMA) scores were assigned for intra-prostatic lesions according to the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria, and the diagnostic efficacy of 18F-PSMA-7Q PET/CT for different miPSMA scores was evaluated using pathological diagnosis as the gold standard. Of the 125 enrolled patients, 101 had prostate cancer, and 24 had prostatic hyperplasia or prostatitis. miPSMA ≥2 was the optimal diagnostic threshold, and area under curve (AUC) was 0.948, the sensitivity and specificity were 91.1% and 83.0%. The prostate cancer detection rates of 18F-PSMA-7Q PET/CT were 14.3% (3/21), 60.0% (6/10), 96.7% (58/60), and 100% (34/34) for patients with miPSMA scores of 0, 1, 2, and 3, respectively. There was no significant difference in the detection rate of prostate cancer between groups with miPSMA scores of 2 and 3, but there were significant differences between any other 2 groups. The prostate cancer detection rate of 18F-PSMA-7Q PET/CT was high for lesions with greater miPSMA scores of 2 and 3. For patients with a high miPSMA score, particularly those with a miPSMA score of 3, prostate biopsy can be omitted and prostate cancer-related treatment can be considered.

Application of Real-Time Ultrasound Elastography Combined with Prostate Calcification in Differential Diagnosis of Prostate Cancer.

This study aimed to explore the clinical and differential diagnostic value of real-time ultrasound elastography combined with transabdominal prostate calcification in prostate cancer (PCa). This study retrospectively analysed the clinical pathological data of 97 patients with PCa and 105 patients with benign prostatic hyperplasia (BPH) diagnosed by postoperative pathology in our hospital from May 2020 to May 2021; Comparatively analysed the clinical data of the two groups, including the elastic strain ratio, elastic image compression index, types of prostate calcification and calcification diameter; And used logistic regression analysis to screen out the independent risk factors for identifying PCa and BPH. No significant difference in age, body weight, body mass index, location of calcification and calcification diameter was observed between the two groups (p > 0.05), and overt differences in elastic strain ratio, elastic image compression index, types of calcification, and testosterone were found between the PCa group and BPH group (p < 0.05). Logistic regression analysis showed that the elastic strain ratio, elastic image compression index and types of calcification were independent risk factors for identifying PCa (p < 0.05). The area under curve value of combined diagnosis under receiver operating characteristic curve was as high as 0.756 (95% CI: 0.691-0.813), with a sensitivity of 67.60% and a specificity of 76.30%. A certain correlation is observed amongst elastic strain ratio, elastic image compression index, types of prostate calcification and the occurrence and development of PCa. The application of real-time ultrasound elastography combined with the detection of transabdominal prostate calcification in clinical diagnosis can improve the detection rate of PCa, which has an important clinical application value.

Prostate cancer detection rate using MRI/ultrasound fusion-guided prostate biopsy in Siriraj Hospital

Objective: Systematic transrectal ultrasound (TRUS) guided biopsy has been considered a gold standard for prostate cancer diagnosis for many decades. The problem of this conventional method is the low detection rate especially in the case of repeat biopsy. This results from a limitation associated with ultrasound imaging inhibiting the visualization of cancerous lesions during the procedure. More recently, there has been increasing importance attributed to the use of multiparametric MRI for the identification of cancer inside the prostate gland. Targeted prostate biopsy, using multiparametric MRI/ultrasound (mpMRI/US) fusion-guided technology helps improve the detection of prostate cancer and has become a novel standard for tissue diagnosis. This study was conducted to investigate and report on the cancer detection rate of mpMRI/US fusion guided prostate biopsies at Siriraj Hospital. Materials and Methods: Data pertinent to patients who underwent mpMRI/US fusion guided biopsy at Siriraj Hospital between September 2017 and December 2019 was retrospectively reviewed. Results: A total of 499 men underwent mpMRI/US fusion guided biopsy, with the transperineal approach being used in the vast majority of cases (91.8%). Targeted biopsy provides a better cancer detection rate than systematic biopsy (55.3% vs 47.1%, p = 0.009). Combined targeted and systematic biopsies improved cancer detection rate compared to systematic biopsy alone (60.3% vs 47.1%, p &lt; 0.001). A subgroup analysis of men with positive biopsies showed that detection of clinically significant cancer (Gleason grade group ≥ 2) was no different between targeted and random biopsies (87.2% vs 80.8%, p = 0.11). The common complications from transperineal approach were urinary retention (5.4%) and hematuria (5.2%) while complications of infection were rare (0.2%). Conclusion: We found that targeted biopsy with mpMRI/US fusion guided technology provides a more effective option for prostate cancer diagnosis. A combination of targeted and systematic biopsy improve prostate cancer detection rate more effectively than systematic biopsy alone. The transperineal approach is a safe and effective technique with a rare incidence of infectious complications.

Prospective of 18-Core TRUS Biopsy and Detection Rate of Prostate Cancer

Background: A systematic 12-core transrectal ultrasound (TRUS)-guided prostate biopsy is currently recommended for prostate malignancy detection modalities. However, there is limited data about the diagnostic yield of increasing the core number to 18. Objective: To assess the effectiveness of cancer detection and clinical advantages between 12- and 18-core TRUS biopsies. Materials and Methods: The authors conducted a prospective, single-group trial of TRUS biopsies specifically for patients with prostate-specific antigen (PSA) levels between 4.0 and 20.0 ng/mL. Sixty-two consecutive patients were enrolled and received a 12- or an 18-core TRUS biopsy under local anaesthesia. The patients and prostate cancer characteristics, such as serum PSA, free PSA, prostate volume, PSA density, D’Amico risk classification, and Gleason grade group were recorded and analysed. Results: The prostate cancer detection rate using 12 cores for the initial TRUS biopsy was 22.6% (14 patients), while using 18 cores was 24.2% (15 patients). The results were not statistically different (p=0.83). Postoperative complications were two cases of gross haematuria and two case of acute urinary retention, which did not require admission. Infection occurred in two patients and no serious morbidities or mortalities. Conclusion: The present study did not find any significant benefit in increasing the number of biopsy cores from 12 to 18 for the diagnosis of prostate cancer in men with serum PSA levels between 4.0 and 20.0 ng/mL. Keywords: Transrectal prostate biopsy; 12-core; 18-core; Prostate cancer; Cancer detection

Should Transperineal Prostate Biopsy Be the Standard of Care?

We reviewed the advantages and disadvantages of transperineal prostate biopsy (TP-bx) to evaluate its potential role as the standard of care for prostate biopsy. Studies have suggested no difference in prostate cancer (PCa) detection rate between TP-bx and transrectal biopsy (TR-bx) but have suggested potentially increased detection of anterior prostate tumors. Advances in anesthetic technique have obviated the need for sedation thus allowing TP-bx to become an office-based procedure, which in turn can decrease the overall cost of TP-bx. Furthermore, given the low rate of infectious complications after TP-bx, some have foregone peri-procedural antibiotics without a change in the rate of infectious complications. Recent procedural advances have made TP-bx a tolerable, office-based procedure. Given the similar diagnostic performance and the benefits for the patient and community, TP-bx should become the standard of care for prostate biopsy for most patients. Future efforts should address the barriers for more universal adoption.

Freehand transperineal prostate biopsy with a coaxial needle under local anesthesia: Experience from a single institution in Malaysia

BackgroundFreehand transperineal prostate biopsy (TPPBx) using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer (PCa). It only requires the same equipment used for transrectal ultrasound-guided (TRUS) biopsy. Our study is the first in Malaysia to report this experience and its outcomes. We aim to determine PCa detection rate and pain tolerability of freehand TPPBx utilizing a coaxial needle under local anesthesia (LA). MethodsInstitutional review board approval was obtained from National Medical Research Register (NMRR ID-21-02052-VIL). We retrospectively reviewed the medical records of patients who underwent TPPBx between August 2020 and April 2022. Records were reviewed for patients’ characteristics, prostate volume, prostate-specific antigen (PSA) results, biopsy results and pain tolerability. Data was analyzed to determine PCa and clinically significant prostate cancer (csPCa) detection rate. LA was achieved using perineal skin infiltration and a periprostatic nerve block. The commonly used standard side-firing transrectal ultrasound with its Prostate Biplane Transducer was used as an imaging guide. The principles of the Ginsburg protocol were followed. Pain tolerability was assessed using a visual analog scale. ResultsA total of 55 patients with elevated PSA levels underwent freehand TPPBx under LA. The mean age was 67.3 years, the median PSA was 14.2 ng/mL, and the median PSA density (PSAD) was 0.33 ng/mL/cc. The optimal PSAD cutoff for predicting csPCa was 0.35 ng/mL/cc (area under the curve [AUC], 0.792; sensitivity, 87.5%; specificity, 69.2%). PCa was detected in 24 patients (43.6%), of whom 16 (29.1%) had csPCa. The median pain scores during LA infiltration and biopsy were four and two, respectively, which were significant different (P < 0.05). TPPBx exhibited an infection rate of zero. ConclusionThe PCa detection rate and patient tolerability of freehand TPPBx using a coaxial needle are similar to those of a contemporary published series. The use of existing equipment that is used for TRUS biopsy allows for widespread use and transition from TRUS biopsy.

Novel Technique in Performing Standard Transperineal Template Prostate Biopsies Under Local Anaesthetic.

Transperineal template prostate biopsies (TPTPB) are now increasingly commonly performed for the diagnosis of prostate cancer. TPTPB are traditionally performed under general anaesthetic. However, this poses a significant strain on hospital theatre capacity. As such, local anaesthetic (LA) TPTPB are becoming more popular. We describe a novel technique in performing the standard TPTPB under LA in the outpatient setting. Between February 2019- February 2021, 254 consecutive men (median age 69; range: 44-80 years) with a median PSA of 8.7 ng/ml (range: 2.2-76) underwent L/A TPTPB using our novel technique. This is whereby 50mls of 1% prilocaine was injected partially around the perineal skin and partially deep bilateral periprostatic areas. Multiple simultaneous prostate biopsies were then taken with the standard template grid and stepper. A total of 250/254 (98.4%) men underwent successful L/A TPTPB with a median visual analogue pain score of 4 (range: 2-8). The median prostate volume was 49cc (range: 14-240cc). The median number of cores taken were 18 (range: 14-24). A total of 163/250 men (65.2%) had a positive histology for prostate cancer with a median of 5 cores being involved with prostate cancer (range: 1-18). In addition, 101/163 men (62.0%) diagnosed with prostate cancer had either Gleason score 3+4=7 or greater. None experienced urosepsis and only 2/250 men (0.8%) had temporary urinary retention. Our novel LA technique in performing the standard TPTPB is safe, feasible and well tolerated and associated with a high rate of prostate cancer detection.

PSMA-1007 Uptake in Ganglia of the Sympathetic Trunk and Its Intra-individual Reproducibility

Aim/Purpose18F-labeled PSMA ligands offer various advantages as PET tracers over 68Ga-labeled PSMA counterparts. Especially, an improved spatial resolution leads to improved detection rates of smaller prostate cancer (PCa) lesions. However, physiological PSMA uptake of ganglia of the sympathetic trunk can be quickly misinterpreted as possible PSMA-positive lymph node metastases. The aim of this retrospective study is to investigate [18F]PSMA-1007 uptake and its intra-individual reproducibility in ganglia of the sympathetic trunk.MethodsWe retrospectively included 28 consecutive patients (median age 69 ± 9 with a range of 49–90) with biochemical recurrence of PCa who underwent [18F]PSMA-1007 PET/CT scan and, accordingly, a follow-up examination between August 2018 and August 2021. Cervical, coeliac, and sacral ganglia were identified on the iterative PET reconstructions and correlated with CT component. Tracer uptake of ganglia was determined by measuring SUVmax and SUVmean values. Anatomical position of the ganglia in relation to adjacent vertebral bodies were noted. Statistical analyses were conducted using two-way repeated measures ANOVA and descriptive statistics.ResultsThe highest [18F]PSMA-1007 uptake was found in coeliac ganglia followed by cervical and sacral ganglia. The SUVmax in coeliac ganglia was 3.13 ± 0.85 (follow-up scan 3.11 ± 0.93), in cervical ganglia 2.73 ± 0.69 (follow-up scan 2.67 ± 0.74), and in sacral ganglia 1.67 ± 0.50 (follow-up scan 1.64 ± 0.52). The SUVmean in coeliac ganglia was 2.28 ± 0.64 (follow-up scan 2.28 ± 0.66), in cervical ganglia 1.62 ± 0.43 (follow-up scan 1.61 ± 0.43) and in sacral ganglia 1.15 ± 0.33 (follow-up scan 1.12 ± 0.34). In a given ganglion station, there was no statistically significant difference of SUVmax or SUVmean values between baseline and follow-up scans.ConclusionsThe first systematically described physiological [18F]PSMA-1007 uptake in ganglia of the sympathetic trunk showed a low variability of SUVmax or SUVmean and a good intra-individual reproducibility of [18F]PSMA-1007 uptake in follow-up scans. These findings might improve and guide the differentiation of ganglia from possible malignant lesions.

Patients With "Gray Zone" PSA Levels: Application of Prostate MRI and MRS in the Diagnosis of Prostate Cancer.

Improving the detection rates of prostate cancer (PCa) and avoiding unnecessary prostate biopsies in men with prostate-specific antigen (PSA) levels within the gray zone require urgent attention. In this context, rapid advances in MR technology in recent years may offer a promising possibility. A systematic review to evaluate the applications of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in detecting PCa and clinically significant PCa (csPCa) in men with PSA levels within the gray zone. The study type is defined as systematic review. In July 2022, out of 229 studies identified by the database search and from other sources, 23 articles related to the selected topic of interest were included in this review. No field strength or sequence restrictions. The data including the study population, study characteristics, as well as basic MRI characteristics, from the final studies included in this review, were extracted independently by two reviewers. The major results of the original study were summarized and no additional statistical analysis was performed. Among the 23 studies included in this review, 17 focused on the applications of MRS and MRI for the prebiopsy diagnosis of PCa. Nine of these 17 articles used Prostate Imaging Reporting and Data System (PI-RADS) score to interpret MRI results, thereby confirming the practicality of the PI-RADS score in predicting PCa and csPCa. The remaining six articles evaluated the applications of MRI and MRS in guiding prostate biopsy. Although there was a variation in the biopsy modalities used in these studies, both MRI- and MRS-guided prostate biopsies were observed to improve the detection rates of PCa and csPCa in patients with PSA levels within the gray zone. MRS and MRI showed good performance in the detection of PCa and csPCa before biopsy. In addition, MRS- or MRI-guided prostate-targeted biopsies were able to improve the detection rates of PCa and csPCa. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

EDITORIAL COMMENT: (re: Minimally Invasive Management of Rectourethral Fistulae)

Although rare, rectourethral fistula (RUF) is a morbid pathology most commonly presenting as an iatrogenic defect in patients treated for prostate or rectal cancer. Increasing rates of prostate cancer detection and concurrent use of energy therapies for pelvic malignancies have led to an increased incidence of RUF. An estimated 0.1%-3% of patients undergoing external beam radiation therapy, brachytherapy, and/or cryotherapy for prostate or rectal cancer present with RUF. 1 Hechenbleikner E.M. Buckley J.C. Wick E.C. Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes. Dis Colon Rectum. 2013; 56: 374-383https://doi.org/10.1097/DCR.0b013e318274dc87 Google Scholar Decreasing repair failures and complications of intervention are important when considering treatment approaches.

EP007 - Our prostate cancer detection rate in patients with reported PIRADS-3 lesions

EP007 - Our prostate cancer detection rate in patients with reported PIRADS-3 lesions

Transrectal ultrasound examination of prostate cancer guided by fusion imaging of multiparametric MRI and TRUS: avoiding unnecessary mpMRI-guided targeted biopsy.

The purpose of this study was to explore transrectal ultrasound (TRUS) findings of prostate cancer (PCa) guided by multiparametric magnetic resonance imaging (mpMRI) and to improve the Prostate Imaging Reporting and Data System (PI-RADS) system for avoiding unnecessary mpMRI-guided targeted biopsy (TB). From January 2018 to October 2019, fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients. The study included 188 suspicious lesions on mpMRI in 156 patients, all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy (SB). Univariate analyses were performed to investigate the relationship between TRUS features and PCa. Then, logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa. The detection rates of PCa based on TB alone, SB alone, and combined SB and TB were 55.9% (105 of 188), 52.6% (82 of 156), and 62.8% (98 of 156), respectively. The significant predictors of PCa on TRUS were hypoechogenicity (odds ratio [OR]: 9.595, P = 0.002), taller-than-wide shape (OR: 3.539, P = 0.022), asymmetric vascular structures (OR: 3.728, P = 0.031), close proximity to capsule (OR: 3.473, P = 0.040), and irregular margins (OR: 3.843, P = 0.041). We propose subgrouping PI-RADS score 3 into categories 3a, 3b, 3c, and 3d based on different numbers of TRUS predictors, as the creation of PI-RADS 3a (no suspicious ultrasound features) could avoid 16.7% of mpMRI-guided TBs. Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.

Prostate MRI versus PSA screening for prostate cancer detection (the MVP Study): a randomised clinical trial

ObjectivesOur objective was to compare prostate cancer detection rates between patients undergoing serum prostate-specific antigen (PSA) vs magnetic resonance imaging (MRI) for prostate cancer screening.DesignPhase III open-label randomised controlled trial.SettingSingle...

MRI-based analysis of different clinically significant prostate cancer detection rate of prostate imaging reporting and data system score 4 in the peripheral zone.

To compare the clinically significant prostate cancer (csPCa) detection rate between diffusion-weighted imaging (DWI) 4 and DWI 3 with positive dynamic contrast-enhanced (DCE) (hereinafter called 'DWI 3/DCE+') lesions in the peripheral zone (PZ) and to explore the diagnostic performance of targeted biopsy (TB) or systematic biopsy (SB) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions. We retrospectively enrolled 206 patients who underwent multiparametric magnetic resonance imaging and had at least one PI-RADS 4 lesion in the PZ. All patients subsequently underwent combined magnetic resonance imaging/ultrasound fusion-guided TB and ultrasound-guided 12-core SB. The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions. Based on the TB + SB results as a standard reference, we analyzed the sensitivity, negative predictive value, and diagnostic accuracy of TB alone or SB alone. Patients with DWI 4 lesions had higher csPCa detection rate than those with DWI 3/DCE+ lesions when using TB + SB, TB, and SB, and the differences were significant for TB + SB (72.22 vs. 54.84%, p = 0.015) or SB (65.97 vs. 46.77%, p = 0.010). For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10ng/mL, TB alone showed the highest negative predictive value (95% Cl 78.12-100). DWI 4 tends to have worse results than DWI 3/DCE+. TB has great diagnostic performances in DWI 3/DCE+ patients, especially for those prostate-specific antigen ranging from 4 to 10ng/mL.

Sistematik ve kognitif hedefe yönelik biyopsi: klinik olarak anlamlı prostat kanseri ile ilgili parametrelerinin değerlendirilmesi ve tespit oranlarının karşılaştırılması

Objective: This study aims to compare the clinically significant prostate cancer (csPCa) detection rates of cognitive targeted biopsy (CTB) and systematic biopsy (SB) and to reveal the factors affecting csPCa detection rates. Material and Methods: Patients diagnosed with localized prostate cancer between 2016-2019 were evaluated retrospectively. Patients who underwent SB and concomitant CTB were recorded. The number of cores taken from the index lesion in CTB, age, prostate-specific antigen (PSA) level, Gleason score, International Society of Urological Pathology (ISUP) grade, Prostate Imaging and Data Reporting System (PIRADS) score, the diameter of index lesion, and digital rectal examination (DRE) findings was recorded. We also studied whether there was a concordance between the localization of the lesion on MRI (magnetic resonance imaging) and the localization of the nodule detected on DRE. Results: Eighty patients were included in the study. csPCa was detected in 55 (68.7%) patients with SB, whereas CTB alone detected csPCa in 35 (43.7%) patients (p&lt;0,01). SB missed 2 patients with csPCa, but 35% of the men with csPCa would be missed by CTB. Detection rates of csPCa in SB and CTB were significantly higher in patients with a concordance between DRE and mpMRI (p= 0.012 and p&lt;0.01, respectively). In patients who had csPCa in CTB, significant differences were detected in the mean age, prostate volume, PSA, lesion diameter, number of cores, and PIRADS score (p=0.005, p=0.02, p=0.005, p=0.003, p=0.017, and p=0.002, respectively) Conclusion: SB maintains its importance in the diagnosis of csPCa. CTB can be preferred in patients with larger lesions. Keywords: Prostate cancer, prostate biopsy, magnetic resonance imaging, targeted biopsy

Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy.

When performing targeted biopsy (TBx), the need to add systematic biopsies (SBx) is often debated. Aim of the study is to evaluate the added value of SBx in addition to TBx in terms of prostate cancer (PCa) detection rates (CDR), and to test the concordance between multiparametric magnetic resonance imaging (mpMRI) findings and fusion biopsy results in terms of cancer location. We performed a retrospective, multicentric study that gathered data on 1992 consecutive patients who underwent elastic fusion biopsy between 2011 and 2020. A standardized approach was used, with TBx (2-4 cores per target) followed by SBx (12-14 cores). We assessed CDR of TBx, of SBx, and TBx+SBx for all cancers and clinically significant PCa (csPCa), defined as ISUP score ≥2. CDR was evaluated according to radiological and clinical parameters, with a particular focus on PI-RADS 3 lesions. In a subgroup of 1254 patients we tested the discordance between mpMRI findings and fusion biopsy results in terms of cancer location. Uni- and multivariable logistic regression analyses were performed to identify predictors of CDR. CDR of TBx+SBx was 63.0% for all cancers and 38.8% of csPCa. Per-patient analysis showed that SBx in addition to TBx improved CDR by 4.5% for all cancers and 3.4% for csPCa. Patients with lesions scored as PI-RADS 3, 4, and 5 were diagnosed with PCa in 27.9%, 72.8%, and 92.3%, and csPCa in 10.7%, 43.6%, and 69.3%, respectively. When positive, PI-RADS 3 lesions were ISUP grade 1 in 61.1% of cases. Per-lesion analysis showed that discordance between mpMRI and biopsy was found in 56.6% of cases, with 710 patients having positive SBx outside mpMRI targets, of which 414 (58.0%) were clinically significant. PSA density ≥0.15 was a strong predictor of CDR. The addition of systematic mapping to TBx contributes to a minority of per-patient diagnoses but detects a high number of PCa foci outside mpMRI targets, increasing biopsy accuracy for the assessment of cancer burden within the prostate. High PSA-density significantly increases the risk of PCa, both in the whole cohort and in PI-RADS 3 cases.