Prostate Cancer Detection Rate Research Articles

Predictors of Prostate Cancer at Fusion Biopsy: The Role of Positive Family History, Hypertension, Diabetes, and Body Mass Index

PSA density and an elevated PI-RADS score are among the strongest predictors of prostate cancer (PCa) in a fusion biopsy. Positive family history, hypertension, diabetes, and obesity have also been associated with the risk of developing PCa. We aim to identify predictors of the prostate cancer detection rate (CDR) in a series of patients undergoing a fusion biopsy. We retrospectively evaluated 736 consecutive patients who underwent an elastic fusion biopsy from 2020 to 2022. Targeted biopsies (2-4 cores per MRI target) were followed by systematic mapping (10-12 cores). Clinically significant PCa (csPCa) was defined as ISUP score ≥ 2. Uni- and multi-variable logistic regression analyses were performed to identify predictors of CDR among age, body mass index (BMI), hypertension, diabetes, positive family history, PSA, a positive digital rectal examination (DRE), PSA density ≥ 0.15, previous negative biopsy status, PI-RADS score, and size of MRI lesion. The median patients' age was 71 years, and median PSA was 6.6 ng/mL. A total of 20% of patients had a positive digital rectal examination. Suspicious lesions in mpMRI were scored as 3, 4, and 5 in 14.9%, 55.0%, and 17.5% of cases, respectively. The CDR was 63.2% for all cancers and 58.7% for csPCa. Only age (OR 1.04, p < 0.001), a positive DRE (OR 1.75, p = 0.04), PSA density (OR 2.68, p < 0.001), and elevated PI-RADS score (OR 4.02, p = 0.003) were significant predictors of the CDR in the multivariable analysis for overall PCa. The same associations were found for csPCa. The size of an MRI lesion was associated with the CDR only in uni-variable analysis (OR 1.07, p < 0.001). BMI, hypertension, diabetes, and a positive family history were not predictors of PCa. In a series of patients selected for a fusion biopsy, positive family history, hypertension, diabetes, or BMI are not predictors of PCa detection. PSA-density and PI-RADS score are confirmed to be strong predictors of the CDR.

Incorporation of trans-rectal color doppler flow imaging and risk-stratification nomogram reduce unnecessary prostate biopsies in suspected prostate cancer patients: a bi-centered retrospective validation study

BackgroundTo explore the role of Trans-rectal Color Doppler Flow Imaging (TR-CDFI) and risk-stratification nomogram in a MRI-directed biopsy pathway and examine its clinical performance, via comparisons between existing four biopsy pathways.MethodsA Bi-centered retrospective cohort study on biopsy-naïve male population who received ultrasound-guided prostate biopsy from Jan. 2015 to Feb. 2022 was proposed. All enrolled patients should have undergone serum-PSA test, TR-CDFI and multiparametric MRI before biopsy, and subsequently opted for surgical intervention, enabling more accurate pathological grading. We then utilized univariate and multivariate logistic regression analysis to construct a predictive nomogram for risk-stratification. Outcome measurements were overall prostate cancer (PCA) detection rate, clinically significant PCA (csPCA) detection rate, clinically insignificant PCA (cisPCA) detection rate, biopsy avoidance rate and missed csPCA detection rate. Decision curve analysis was used to compare the performances between diagnostic pathways.ResultsUnder the criteria mentioned above, 752 patients from two centers were included. Reference pathway (biopsy for all) showed that overall PCA detection rate was 46.1%, csPCA and cisPCA detection rates were 32.3% and 13.8% respectively. Risk-based MRI-directed TR-CDFI pathway, which incorporated both TR-CDFI and risk stratification nomogram, exhibited PCA detection rate of 38.7%, csPCA detection rate of 28.7%, cisPCA detection rate of 7.0%, Biopsy avoidance rate of 42.4%, and missed csPCA detection rate of 3.6%. Decision curve analysis revealed that the risk-based pathway held the most net benefit, under the threshold probability level between 0.1 and 0.5.ConclusionsThe risk-based MRI-directed TR-CDFI pathway out-performed other strategies, balancing csPCA detection and biopsy avoidance. This suggested that incorporation of TR-CDFI and risk-stratification nomogram in the early PCA diagnostic procedures could reduce unnecessary biopsies.

Low cancer yield in PI-RADS 3 upgraded to 4 by dynamic contrast-enhanced MRI: is it time to reconsider scoring categorization?

ObjectivesTo evaluate MRI diagnostic performance in detecting clinically significant prostate cancer (csPCa) in peripheral-zone PI-RADS 4 lesions, comparing those with clearly restricted diffusion (DWI-score 4), and those with equivocal diffusion pattern (DWI-score 3) and positive dynamic contrast-enhanced (DCE) MRI.MethodsThis observational prospective study enrolled 389 men referred to MRI and, if positive (PI-RADS 3 with PSA-density [PSAD] ≥ 0.15 ng/mL/mL, 4 and 5), to MRI-directed biopsy. Lesions with DWI-score 3 and positive DCE were classified as “PI-RADS 3up,” instead of PI-RADS 4. Univariable and multivariable analyses were implemented to determine features correlated to csPCa detection.ResultsPrevalence of csPCa was 14.5% and 53.3% in PI-RADS categories 3up and 4, respectively (p < 0.001). MRI showed a sensitivity of 100.0%, specificity 40.9%, PPV 46.5%, NPV 100.0%, and accuracy 60.9% for csPCa detection. Modifying the threshold to consider MRI positive and to indicate biopsy (same as previously described, but PI-RADS 3up only when associated with elevated PSAD), the sensitivity changed to 93.9%, specificity 57.2%, PPV 53.0%, NPV 94.8%, and accuracy 69.7%. Age (p < 0.001), PSAD (p < 0.001), positive DWI (p < 0.001), and PI-RADS score (p = 0.04) resulted in independent predictors of csPCa.ConclusionsMost cases of PI-RADS 3up were false-positives, suggesting that upgrading peripheral lesions with DWI-score 3 to PI-RADS 4 because of positive DCE has a detrimental effect on MRI accuracy, decreasing the true prevalence of csPCa in the PI-RADS 4 category. PI-RADS 3up should not be upgraded and directed to biopsy only if associated with increased PSAD.Key Points• As per PI-RADS v2.1 recommendations, in case of a peripheral zone lesion with equivocal diffusion-weighted imaging (DWI score 3), but positive dynamic contrast-enhanced (DCE) MRI, the overall PI-RADS score should be upgraded to 4.• The current PI-RADS recommendation of upgrading PI-RADS 3 lesions of the peripheral zone to PI-RADS 4 because of positive DCE decreased clinically significant prostate cancer detection rate in our series.• According to our results, the most accurate threshold for setting indication to prostate biopsy is PI-RADS 3 or PI-RADS 3 with positive DCE both associated with increased PSA density.

Novel sampling scheme with reduced cores in men with multiparametric MRI-visible lesions undergoing prostate biopsy.

To investigate the effects of various prostate biopsy protocols with reduced cores on the detection of clinically significant prostate cancer (csPCa) in individuals with MRI-visible lesions (Prostate Imaging Reporting and Data System ≥ 3). A total of 464 patients with MRI-visible lesions were recruited. All patients underwent two or more targeted biopsies (TB) and systematic biopsies (SB). Several hypothetical biopsy schemes were set-up: TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+SB of the targeted sector (TB+t-SB), and TB+SB of the non-targeted sector (TB+n-SB). A subgroup analysis of patients with multiple MRI-visible lesions was performed. The standard of reference was defined as TB+SB. McNemar test was used to compare csPCa detection rates between various sampling schemes. The detection rates for prostate cancer and csPCa were 72.8% (338 of 464) and 62.1% (288 of 464), respectively. There were 8.0%, 0.3%, 6.3%, 1.0%, and 4.5% cases in which TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+t-SB, and TB+n-SB would have missed csPCa, respectively. All hypothetical schemes, with the exception of TB+contralateral SB (p = 0.063), significantly outperformed TB alone in terms of csPCa detection (p < 0.05). As for the multi-focus cohort, which included 48 cases, none of the non-index lesions had a higher Gleason grade than the index lesions within the same patients. TB+ipsilateral SB might be the optimal biopsy scheme for detecting csPCa. As for the multi-focus cohort, the biopsy of the non-index lesions provided limited pathological information.

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion

Prostate cancer is among the most frequently diagnosed cancers and a leading cause of cancer-related death in men. Currently, the most reliable and widely used imaging test for prostate cancer diagnosis is multiparametric pelvic magnetic resonance imaging (mpMRI). Modern biopsy techniques are based on the computerised merging of ultrasound and MRI images to provide better vision during the biopsy procedure (Fusion Biopsy). However, the method is expensive due to high equipment cost. Cognitive fusion of ultrasound and MRI images has recently emerged as a cheaper and easier alternative to computerised fusion. The aim of this prospective study is to perform an in-patient comparison of the systematic prostate biopsy procedure (SB) vs. cognitive fusion (CF) guided prostate biopsy method in terms of safety, ease of use, cancer detection rate and clinically significant cancer detection. We enrolled 103 patients with suspected prostate cancer that were biopsy naive, with PSA > 4 ng/dL and PIRADS score of 3, 4 or 5. All patients received a transperineal standard 12-18 cores systematic biopsy (SB) and a four-cores targeted cognitive fusion (CF) biopsy. Following the prostate biopsy, 68% of the patients were diagnosed with prostate cancer (70/103 patients). SB diagnosis rate was 62% while CF biopsy was slightly better with a 66% rate. There was a significant 20% increase in clinically significant prostate cancer detection rate for the CF compared to SB (p < 0.05) and a significant prostate cancer risk upgrade from the low to the intermediate risk category (13%, p = 0.041). Transperineal cognitive fusion targeted prostate biopsy is a straightforward biopsy method that is easy to perform and is a safe alternative to standard systematic biopsy with improved significant cancer detection accuracy. A combined targeted and systematic approach should be used for the best diagnostic results.

A Matched-pair Analysis Comparing Systematic Prostate Biopsy by Conventional Transrectal Ultrasound-guidance Versus Software-based Predefined 3D-Guidance

To compare software-based three-dimensional-guided systematic prostate biopsy (3D-GSB) with conventional transrectal ultrasound-guided systematic biopsy (TGSB) regarding prostate cancer (PCa) detection rates (CDR). In total, 956 patients (200 TGSB patients and 756 3D-GSB patients) without prior positive biopsies and with a prostate-specific antigen value ≤20ng/ml were eligible for analysis. TGSB and 3D-GSB cases were matched in a 1:1 ratio using propensity score matching with age, prostate-specific antigen, prostate volume, previous biopsy status, and suspicious palpatory finding as confounders. 3D-GSB was conducted with the semi-robotic prostate fusion-biopsy system Artemis. For each patient in both groups, SB was conducted in a similar pattern with 12 cores. All cores in 3D-GSB were automatically planned and mapped on a 3D-model as well as on the real-time transrectal ultrasound imaging. Primary end points were the clinically significant (cs) and overall CDR. Secondary end point was the cancer-positive core rate. After matching, the csCDR was not significantly different between the 3D-GSB and the TGSB groups (33.3% vs28.8%, P=.385). Overall CDR was significantly higher for 3D-GSB compared to TGSB (55.6% vs39.9%, P=.002). 3D-GSB detected significantly more non-significant PCa than TGSB (22.2% vs11.1%, P=.004). In patients with PCa, the number of cancer-positive SB cores was significantly higher by TGSB (42% vs25%, P<.001). 3D-GSB was associated with a higher CDR than TGSB. However, no significant difference was shown in detection of csPCa between both techniques. Therefore, currently, 3D-GSB does not appear to add value to conventional TGSB.

MP66-03 LEARNING CURVE OF ROBOTIC-ASSISTED TRANSPERINEAL MRI/ULTRASOUND FUSION-GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP66-03 LEARNING CURVE OF ROBOTIC-ASSISTED TRANSPERINEAL MRI/ULTRASOUND FUSION-GUIDED PROSTATE BIOPSY Vitkor Alargkof Anagnostou, Christian Engesser, Pawel Trotsenko, Hanns-Christian Breit, David Winkel, Helge Seifert, and Christian Wetterauer Vitkor Alargkof AnagnostouVitkor Alargkof Anagnostou More articles by this author , Christian EngesserChristian Engesser More articles by this author , Pawel TrotsenkoPawel Trotsenko More articles by this author , Hanns-Christian BreitHanns-Christian Breit More articles by this author , David WinkelDavid Winkel More articles by this author , Helge SeifertHelge Seifert More articles by this author , and Christian WetterauerChristian Wetterauer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003329.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted fusion prostate biopsy platforms promise precision, while offering user-friendliness, short procedure times and low complication rates. To date, there is no study investigating the learning curve (LC) of robotic-assisted transperineal MRI/Ultrasound fusion-guided prostate biopsy (RA-TP-FBx). A LC is essential to facilitate efficient training, maintain institutional biopsy quality and assess potential for widespread use. Herein, we are the first to assess the learning curve of RA-TP-FBx using the iSR’obot MonaLisa device (Biobot). METHODS: We prospectively analyzed consecutive RA-TP-FBx performed at the University Hospital Basel from January to October 2022. Cases were randomly assigned to the urology chief resident, a first-year biopsy-naive resident and an expert in RA-TP-FBx senior consultant. All resident cases were supervised by the expert. We used multiple parameters to define the LC: 1) efficiency – measured by time for completion of individual procedure steps, 2) accuracy – defined as detection rate of prostate cancer (PCa) and clinically significant PCa (csPCa) stratified by PI-RADS score, 3) operator and supervisor performance evaluation – measured by entrustable professional activities (EPA) questionnaires, 4) workload assessment – measured by the NASA task load index and 5) complication rates. RESULTS: We collectively performed 75 procedures. Procedure time reduction is shown in Graphic 1. The major difference in procedure time between residents and expert stemmed from probe positioning and biopsy time. PCa was detected in 62% and csPCa in 44%. csPCA detection for PI-RADS 4 was 46%. PCa detection rate for PI-RADS 4 lesions was similar between operators and over time. 13 biopsies were necessary before stable independent completion of all procedure steps. The most difficult skill for residents was ultrasound probe positioning. A transition point for workload reduction was observed at 13 biopsies. Complications rates were similar among operators and over time. CONCLUSIONS: Urology residents can quickly acquire skills to independently perform RA-TP-FBx regardless of previous biopsy experience. RA-TP-FBx is a procedure with low workload stress. Safety and accuracy are ensured during the LC when supervised by an expert. Source of Funding: Department of Surgery, University Hospital Basel © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e932 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vitkor Alargkof Anagnostou More articles by this author Christian Engesser More articles by this author Pawel Trotsenko More articles by this author Hanns-Christian Breit More articles by this author David Winkel More articles by this author Helge Seifert More articles by this author Christian Wetterauer More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-01 TRENDS IN THE DIAGNOSTIC AND SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE UNITED STATES: ANNUAL CHANGES IN THE SELECTION OF TREATMENT OPTIONS AND AVERAGE COSTS DIFFERENTIAL FOR DIAGNOSTIC/SURGICAL TECHNIQUE

You have accessJournal of UrologyCME1 Apr 2023PD41-01 TRENDS IN THE DIAGNOSTIC AND SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE UNITED STATES: ANNUAL CHANGES IN THE SELECTION OF TREATMENT OPTIONS AND AVERAGE COSTS DIFFERENTIAL FOR DIAGNOSTIC/SURGICAL TECHNIQUE Jin-Kyu Oh, Francesco Del Giudice, Eugenio Bologna, Vincenzo Asero, Carlo Maria Scornajenghi, Ettore De Berardinis, Alessandro Sciarra, Satvir Basran, Shufeng Li, Federico Belladelli, and Benjamin I. Chung Jin-Kyu OhJin-Kyu Oh More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Eugenio BolognaEugenio Bologna More articles by this author , Vincenzo AseroVincenzo Asero More articles by this author , Carlo Maria ScornajenghiCarlo Maria Scornajenghi More articles by this author , Ettore De BerardinisEttore De Berardinis More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Satvir BasranSatvir Basran More articles by this author , Shufeng LiShufeng Li More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , and Benjamin I. ChungBenjamin I. Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). However, laser surgery techniques (e.g., photoselective vaporization of the prostate [PVP], holmium laser, thulium laser enucleation of the prostate [HoLEP or ThuLEP]), and minimally invasive treatment options (e.g., UroLift®) are increasingly replacing TURP. The aim of the study is to present the annual rates of BPH surgery and to analyze recent trends in the utilization of newer surgical modalities and any changes in medical costs related to these treatments over a 15-year period in the US. METHODS: Patient data was collected from the Optum Clinformatics® Data Mart Claims Database. Trends and distribution of surgical BPH techniques over the years of enrollment were analyzed across US regions. We then reviewed trends in adoption of diagnostic BPH methods including urodynamic studies, cystourethroscopy, transrectal ultrasound, prostatic biopsy, uroflowmetry, and the measurement of post-void residual urine volume (PVR). Finally, incidental diagnoses of prostate cancer (PCa) detected during BPH procedures were recorded over the years to depict the trends in PCa detection as well as median prostate specific antigen (PSA) values associated with BPH patients ultimately treated with a procedure. RESULTS: N=51,448 patients underwent BPH procedures from 2004 to 2017. There was a significant increase in the annual rate from 770 in 2004 to 6,571 in 2017. The mean patient age (±SD) increased from 67.6 years old (± 8.4) in 2004 to 73.4 years old (±8.4) in 2017. More than 60% of patients underwent cystourethroscopy and post-void residual urine check for workup prior to surgical management. TURP was the most common and PVP was the second most common BPH procedure. The total number of BPH diagnoses were 44,820 and the median cost for each procedure was $1459, $1875, $1419, and $3284 for TURP, PVP, HOLEP/ThULEP, Urolift, respectively. The median overall cost was $2471. With regard to the costs of treating BPH surgically, the diagnostic and treatment costs demonstrated annual increases while the detection rate of prostate cancer after BPH surgery gradually decreased from 19.87% in 2004 to 5.78% in 2017. CONCLUSIONS: We found recent trends in BPH management that demonstrates that alternative methods are starting to replace the traditional TURP technique, although TURP still remains the most common procedure. Future studies should assess whether these newer methods are both efficacious and cost effective over the long term. Of note, the cumulative incidence of PCa diagnosis was reduced over time, likely multifactorial in nature. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1058 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin-Kyu Oh More articles by this author Francesco Del Giudice More articles by this author Eugenio Bologna More articles by this author Vincenzo Asero More articles by this author Carlo Maria Scornajenghi More articles by this author Ettore De Berardinis More articles by this author Alessandro Sciarra More articles by this author Satvir Basran More articles by this author Shufeng Li More articles by this author Federico Belladelli More articles by this author Benjamin I. Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

MP44-07 INTER-INTRAREADER ASSESSMENTS WITH PI-RADS VERSION 2.1 FROM MRI/TRUS SOFTWARE FUSION PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP44-07 INTER-INTRAREADER ASSESSMENTS WITH PI-RADS VERSION 2.1 FROM MRI/TRUS SOFTWARE FUSION PROSTATE BIOPSY Won Hoon Song, Youn Ha Lee, Dan Bi Lee, Jae Yeon Kim, Seung Soo Lee, Jong Kil Nam, and Sung Woo Park Won Hoon SongWon Hoon Song More articles by this author , Youn Ha LeeYoun Ha Lee More articles by this author , Dan Bi LeeDan Bi Lee More articles by this author , Jae Yeon KimJae Yeon Kim More articles by this author , Seung Soo LeeSeung Soo Lee More articles by this author , Jong Kil NamJong Kil Nam More articles by this author , and Sung Woo ParkSung Woo Park More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In multiparametric MRI (mpMRI), there is an inter-intrareader variability according to Prostate Imaging Reporting and Data System (PI-RADS) Version 2.1. We have evaluated the inter-intrareader assessments with PI-RADS to improve the detection rate of prostate cancer from MRI/TRUS software fusion prostate biopsy METHODS: We evaluated 210 patients who underwent multiparametric MRI for MRI/TRUS software fusion prostate biopsy from October 2019 to February 2021. Examinations were interpreted by four readers including two radiologists and two urologists from our institution. The readers independently viewed all 210 examinations, and the 2.1 version of the PI-RADS grading scale was used to interpret MRI images. The interpretations were performed in two sessions. After the first session, a training intervention was conducted to improve inter-intrareader agreement with PI-RADS scores of the peripheral zone (PZ) and transitional zone (TZ). We used the Fleiss’s kappa coefficient (κ) to evaluate the inter-intrareader reliability. RESULTS: The κ between all readers were 0.427 (p<0.001) in the first session, and 0.466 (p<0.001) in the second session, which shows a moderate level of agreement. Higher agreement was observed among the two radiologists, with the κ of 0.563 (p<0.001) in the first session, and 0.708 (p<0.001) in the second session. Interreader agreement had a tendency to improve in the second session, after the training intervention took place. For all readers, the level of agreement was also stronger in the peripheral zone compared to the the transitional zone. Patients were categorized according to the PI-RADS score of 4 or more points and less than 3 points, and the two groups were compared. The κ between all readers for the peripheral zone was 0.761 (p<0.001) in the first session, and 0.599 (p<0.001) in the second session. This shows a higher agreement in the scoring of the peripheral zone. In the radiologists group, the level of agreement for PZ was 0.791 (p<0.001) and 0.733 (p<0.001), showing a substantial level of agreement. We evaluated the intrareader agreement of the two individual radiologists. The κ was higher when the PIRADS score was 4 or higher, achieving a substantial level of agreement, while interpretation became heterogeneous when PIRADS score was lower. CONCLUSIONS: Readers achieved moderate agreement for PI-RADS version 2.1 and benefitted from a training session. Scoring the PZ achieved better agreement than the TZ. Interreader agreement was stronger when PI-RADS score was 4 or higher. Interreader agreement can be improved with feedback and training. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e613 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Won Hoon Song More articles by this author Youn Ha Lee More articles by this author Dan Bi Lee More articles by this author Jae Yeon Kim More articles by this author Seung Soo Lee More articles by this author Jong Kil Nam More articles by this author Sung Woo Park More articles by this author Expand All Advertisement PDF downloadLoading ...

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

The Detection of Prostate Cancer With Magnetic Resonance Imaging-targeted Prostate Biopsies Is Superior With the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study. Letter.

MP12-04 THE EFFECT OF THE USPTSF PSA GUIDELINES ON PROSTATE CANCER DETECTION AND MORTALITY IN TWO UNDERSERVED CITIES IN NEW JERSEY

You have accessJournal of UrologyCME1 Apr 2023MP12-04 THE EFFECT OF THE USPTSF PSA GUIDELINES ON PROSTATE CANCER DETECTION AND MORTALITY IN TWO UNDERSERVED CITIES IN NEW JERSEY Thomas Hwang, David Ali, Gabriel Fernandez, Courtney Berg, Evan Kovac, Amjad Alwaal, and Robert Weiss Thomas HwangThomas Hwang More articles by this author , David AliDavid Ali More articles by this author , Gabriel FernandezGabriel Fernandez More articles by this author , Courtney BergCourtney Berg More articles by this author , Evan KovacEvan Kovac More articles by this author , Amjad AlwaalAmjad Alwaal More articles by this author , and Robert WeissRobert Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: NJ has one of the most ethically and racially diverse populations in the United States. There are nine million people in NJ – 56% White, 20% Hispanic, 13% African American (AA) and 9% Asian. Despite this diversity, the discriminatory practice of “redlining” which withheld services and investment from specific neighborhoods has resulted in significant segregation in several NJ cities. Two urban centers in NJ – Newark and Trenton are examples of this segregation. Newark has a population of 318,431 with 50.8% AA, 34.8% Hispanic, 11.1% White and 1.8% Asian. Trenton has a population 92,063 with 50.9% AA, 34% Hispanic, 13.8% White and 1.1% Asian. Both cities have significant poverty and are in the lowest 3% of the states annual per capita income. We investigated the effect of the change by the USPTSF PSA guidelines in 2012 on the detection and mortality of prostate cancer in these two underserved urban centers. METHODS: NJ State Cancer Registry was used to compare prostate cancer detection and mortality rates in from 2008- 2019. We specifically compared annual rates in Newark/ Essex County and Trenton/ Mercer County. The cohort of patients from 2008-2012 was compared to the cohort from 2013-2019 to determine if there was a change due to PSA screening RESULTS: The incidence of prostate cancer in Trenton was 1667 and Newark 3161 from 2008-2012. Age adjusted rate of prostate cancer was 166.2 whites and 303.7 AA in Trenton. The age adjusted rate of prostate cancer was 161.5 for whites and 221.5 for AA in Newark. The prostate cancer specific mortality was 21.1 for whites and 57.6 for AA in Trenton from 2008-2012. The prostate cancer specific mortality was 16.6 for whites and 48.3 for AA in Newark. CONCLUSIONS: Statewide rate of prostate cancer deaths in both white and AA has decreased in New Jersey since the initiation of the USPTSF guideline change in 2012. This decrease in mortality has been observed in both underserved Trenton and Newark. Better access to healthcare via Medicaid expansion and opportunities for earlier or more effective treatment may be areas that have improved outcomes and warrant further study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e134 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Hwang More articles by this author David Ali More articles by this author Gabriel Fernandez More articles by this author Courtney Berg More articles by this author Evan Kovac More articles by this author Amjad Alwaal More articles by this author Robert Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

PD38-06 WHAT IS THE IDEAL NUMBER OF CORES TO COLLECT PER REGION OF INTEREST DURING TARGETED PROSTATE BIOPSY?

You have accessJournal of UrologyCME1 Apr 2023PD38-06 WHAT IS THE IDEAL NUMBER OF CORES TO COLLECT PER REGION OF INTEREST DURING TARGETED PROSTATE BIOPSY? Casey Brodsky, Ji Qi, Kathryn Marchetti, and John Wei Casey BrodskyCasey Brodsky More articles by this author , Ji QiJi Qi More articles by this author , Kathryn MarchettiKathryn Marchetti More articles by this author , and John WeiJohn Wei More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past decade, magnetic resonance imaging (MRI)-guided targeted prostate biopsy has been gaining favor over 12-core systematic biopsy for more accurate detection of clinically significant prostate cancers; however, no guidelines exist regarding the optimal number of biopsy cores that should be taken per region of interest (ROI) identified on MRI. An ideal number of cores balances maximizing cancer detection while minimizing patient discomfort, procedure time, and infection risk. In this project, we analyze the prostate cancer detection rate depending on core number for a large patient cohort. METHODS: Patients receiving targeted prostate cancer biopsy at the University of Michigan between January 2017 and June 2022 were identified. For each biopsy, 12 systematic cores were taken, as well as 4 cores per ROI. Statistical simulation was performed in SAS, using 500 iterations randomizing the order of cores taken, to assess cancer detection rate (CDR) and clinically significant cancer detection rate (CSCDR, defined as Gleason grade group ≥2) if 1, 2, or 3 versus 4 cores were taken per ROI. Chi-square tests were used to compare CDR and CSCDR between different scenarios. RESULTS: We identified 1022 patients, with 1095 total ROIs biopsied. Median age at time of biopsy was 65 (IQR 60-71), and median pre-biopsy PSA was 6.7 ng/mL (IQR 4.9-9.5). On systematic 12-core biopsy, CDR and CSCDR were 60% and 31%, respectively. On targeted biopsy considering all 4 cores, CDR and CSCDR were 59% and 39%, respectively. Combined biopsy considering systematic 12-core plus 4-core targeted biopsy showed CDR and CSCDR of 70% and 44%, respectively. Compared to taking 4 cores per ROI, taking fewer than 4 cores resulted in a decrease in both CDR and CSCDR, with statistically significant decreases seen for 1 and 2 versus 4 cores (Figure 1). This effect is mitigated when both targeted and systematic biopsy were combined. CONCLUSIONS: These analyses indicate that relative to 4 cores per ROI, cancer detection was inferior when only 1 or 2 cores are taken, but that 3 cores was not clinically nor statistically different than 4 cores. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e995 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Casey Brodsky More articles by this author Ji Qi More articles by this author Kathryn Marchetti More articles by this author John Wei More articles by this author Expand All Advertisement PDF downloadLoading ...

Robotically controlled three-dimensional micro-ultrasound for prostate biopsy guidance.

Prostate imaging to guide biopsy remains unsatisfactory, with current solutions suffering from high complexity and poor accuracy and reliability. One novel entrant into this field is micro-ultrasound (microUS), which uses a high-frequency imaging probe to achieve very high spatial resolution, and achieves prostate cancer detection rates equivalent to multiparametric magnetic resonance imaging (mpMRI). However, the ExactVu transrectal microUS probe has a unique geometry that makes it challenging to acquire controlled, repeatable three-dimensional (3D) transrectal ultrasound (TRUS) volumes. We describe the design, fabrication, and validation of a 3D acquisition system that allows for the accurate use of the ExactVu microUS device for volumetric prostate imaging. The design uses a motorized, computer-controlled brachytherapy stepper to rotate the ExactVu transducer about its axis. We perform geometric validation using a phantom with known dimensions and compare performance with magnetic resonance imaging (MRI) using a commercial quality assurance anthropomorphic prostate phantom. Our geometric validation shows accuracy of 1mm or less in all three directions, and images of an anthropomorphic phantom qualitatively match those acquired using MRI and show good agreement quantitatively. We describe the first system to acquire robotically controlled 3D microUS images using the ExactVu microUS system. The reconstructed 3D microUS images are accurate, which will allow for future applications of the ExactVu microUS system in prostate specimen and in vivo imaging.

Промежностная фьюжн-биопсия предстательной железы. Диагностическая ценность в сравнении со стандартной биопсией.

Introduction. A significant improvement in the quality of prostate imaging by magnetic resonance (MRI), as well as the possibility of combining MRI and ultrasound images (fusion technology) for biopsy, open up new possibilities for the diagnosis of prostate cancer. The arsenal of methods of treating prostate cancer includes active surveillance and focal therapy for patients with low risk disease. That raises the question of improving the accuracy of diagnosis of tumor volume, stage and differentiation, which will largely determine the tactics of patient management. The aim of our work was to determine the diagnostic effectiveness of targeted MRI-assisted fusion biopsy of the prostate in comparison with standard biopsy. Materials and methods. We analyzed data of 356 patients who underwent tranperineal fusion biopsy. The age of the patients ranged from 48 to 72 years with an average value of 68.2 ± 2.1 years. The selection criteria for the study were an increase in the level of PSA (345 patients) – the range from 4 to 44.5 ng/ml (on average 6.02±0.21) or the detection of tumor-suspicious areas during finger rectal examination or transrectal ultrasound examination (TRUS) of the prostate gland (41 patients). Further methods of examination included multiparametric magnetic resonance imaging (MRI) and subsequent transperineal fusion biopsy in combination with standart biopsy. Results. In our study, the detection rate of prostate cancer was (82.6%) – the diagnosis was confirmed in 294 out of 356 examined patients. At the same time, with an increase in the PI-RADS gradation, the frequency of histological confirmation of cancer increased: 62.4% for PI-RADS 3 lesions, 89.6% for 4 and 96.7% for PI-RADS 5. Targeted biopsies confirmed the presence of prostate cancer in 246 cases out of 356 patients (69.1%). In relation to all cases of cancer detection, the proportion of positive targeted biopsies was 83.7%. Conclusion. Targeted MRI-assisted fusion biopsy allows detecting prostate cancer in 69.1%, but when supplemented with a polyfocal biopsy at standard points, the diagnostic accuracy increases to 82.6%. Thus, the data obtained allow us to conclude that based on the examination of patients with suspected prostate cancer using mpMRI with targeted fusion biopsy, supplemented by polyfocal biopsies at standard points, it is possible to determine the localization, extent and degree of malignancy of the tumor with a high degree of certainty.

Clinical value of minimum apparent diffusion coefficient for prediction of clinically significant prostate cancer in the transition zone

BackgroundThis study investigated the association between apparent diffusion coefficients in Prostate Imaging Reporting and Data System 4/5 lesions and clinically significant prostate cancer in the transition zone.MethodsWe included 102 patients who underwent transperineal cognitive fusion targeted biopsy for Prostate Imaging Reporting and Data System 4/5 lesions in the transition zone between 2016 and 2020. The association between apparent diffusion coefficients and prostate cancers in the transition zone was analyzed.ResultsThe detection rate of prostate cancer was 49% (50/102), including clinically significant prostate cancer in 37.3% (38/102) of patients. The minimum apparent diffusion coefficients in patients with clinically significant prostate cancer were 494.5 ± 133.6 µm2/s, which was significantly lower than 653.8 ± 172.5 µm2/s in patients with benign histology or clinically insignificant prostate cancer. Age, prostate volume, transition zone volume, and mean and minimum apparent diffusion coefficients were associated with clinically significant prostate cancer. Multivariate analysis demonstrated that only the minimum apparent diffusion coefficient value (odds ratio: 0.994; p < 0.001) was an independent predictor of clinically significant prostate cancer. When the cutoff value of the minimum apparent diffusion coefficient was less than 595 µm2/s, indicating the presence of prostate cancer in the transition zone, the detection rate increased to 59.2% (29/49) in this cohort.ConclusionThe minimum apparent diffusion coefficient provided additional value to indicate the presence of clinically significant prostate cancer in the transition zone. It may help consider the need for subsequent biopsies in patients with Prostate Imaging Reporting and Data System 4/5 lesions and an initial negative targeted biopsy.

Impact of changing PI-RADS cutoff on prostate cancer detection by MRI cognitive fusion biopsy in biopsy-naïve patients

BackgroundMulti-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3–5 and PI-RADS 4–5 as a threshold for targeted prostatic biopsy.MethodsThis is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3–4 versus PI-RADS 4–5 lesion by mpMRI for prostate cancer detection in biopsy-naive men.ResultsThe overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3–5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4–5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value < 0.0001 and P value = 0.004, respectively).ConclusionsLimiting the TBs to PI-RADS 4–5 lesions improves the performance of mp-MRI in the detection of prostate cancer especially aggressive tumors.

(18F)-PSMA-1007PET/CT in patients with biochemical recurrence after radical prostatectomy: Diagnostic performance and impact on treatment management.

To evaluate the diagnostic performance of (18F)-PSMA-1007 PET/CT in prostate cancer patients with biochemical recurrence (BCR) after radical prostatectomy and the effect of (18F)-PSMA-1007 PET/CT on treatment strategy. A total of 114 patients with BCR after radical prostatectomy who performed (18F)-PSMA-1007 PET/CT were retrospectively analyzed. The Gleason scores (GS), maximum standardized uptake values (SUVmax) and the diagnostic performance were compared according to different prostate-specific antigen (PSA) groups. To evaluate the impact of (18F)-PSMA-1007 PET/CT on treatment management, we also collected subjects' therapy before and after PET/CT. The PSA value was monitored to evaluate the biochemical response. (18F)-PSMA-1007PET/CT was positive in 92/114 patients (80.7%). The detection rates were 20/34 (58.8%), 13/17 (76.5%), 15/17 (88.2%) and 44/46 (95.7%) for PSA levels of 0.2-<0.5, 0.5-<1, 1-<2, ≥2ng/ml. The positive lesions on PET/CT revealed local recurrence in 24/114 (21.1%) patients, lymph nodes metastases in 54/114 (47.4%) and metastatic sites in bone, lung, and others in 75/114 (65.8%). A significant positive correlation was observed between the GS/ SUVmax and PSA level (r1=0.375, r2=0.336, P<0.001). As a result of the (18F)-PSMA-1007 PET/CT, therapeutic decision-making changed in 60/114 (52.6%) patients. With a follow-up of 11.0±6.4 months, 81/114 PSA were collected after treatment guided by (18F)-PSMA-1007 PET/CT, and in 42/81 (51.9%) of patients, serum PSA levels decreased of more than 60%. (18F)-PSMA-1007 PET/CT has a high lesion detection rate for recurrent prostate cancer (PCa) and could have significant implications in decision-making treatment plan for the majority of PCa patients.

Prospective study of prostate cancer detection using multiparametric magnetic resonance imaging ultrasound-guided fusion, standard, and saturation biopsy

Background. Currently, about 80 % of men with low-grade prostate cancer (per ISUP 1 (International Society of Urological Pathology)) have indications for radical treatment. Overdiagnosis of low-grade cancer is associated with the use of systematic biopsy methods (standard transrectal, saturation) under ultrasound control for diagnosis verification. To improve prostate cancer diagnosis, the European Association of Urology (2019) recommended multiparametric magnetic resonance imaging before biopsy, and in case of detection of a suspicious lesion magnetic resonance imaging (MRI)-targeted biopsy. In clinical practice, the most common method of MRI-targeted biopsy is multiparametric MRI ultrasound-guided (mpMRI/US) fusion biopsy. However, some studies show contradictory results in detection of prostate cancer using systematic and MRI-targeted biopsy techniques.Aim. To compare detection of clinically significant prostate cancer (ISUP ≥2) using mpMRI/US fusion, standard, and saturation biopsy.Materials and methods. The study included 96 patients. The following inclusion criteria were applied: prostate-specific antigen &gt;2 ng/mL and/or detection of a suspicious lesion during digital rectal and/or transrectal ultrasound examination, and PI-RADS (Prostate Imaging Reporting and Data System) v.2.1 score ≥3. At the first stage, “unblinded” urologist performed a transperineal mpMRI/US fusion and saturation biopsies. At the second stage, “blinded” urologist performed standard transrectal biopsy. Clinically significant cancer was defined as ISUP ≥2.Results. Median age was 63 years, prostate volume – 47 cm3, prostate-specific antigen – 6.82 ng/mL. MpMRI/US fusion, standard, and saturation biopsies were comparable in regard to the rate of detection of clinically significant (29, 24, 28 %; p = 0.81) and clinically insignificant (25, 26, 35 %; p = 0.43) cancer. Overall prostate cancer detection rates were also similar: 54, 50, 63 %, respectively (p = 0.59). The percentages of positive cores in mpMRI/US fusion, standard, and saturation biopsies were 33, 10 and 13 %, respectively (p &lt;0.01). The maximal core length in mpMRI/US was 6.4 mm, in standard biopsy – 6.35 mm, in saturation biopsy – 5.1 mm (p = 0.7).Conclusion. Detection rates of clinically significant, clinically insignificant prostate cancer and overall detection rate are comparable between systematic biopsy techniques and mpMRI/US fusion biopsy.

Learning Curve of Transperineal MRI/US Fusion Prostate Biopsy: 4-Year Experience

This study aimed to evaluate the learning curve of transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy in a team composed of a single surgeon, a single radiologist, and a single pathologist. We prospectively enrolled 206 patients undergoing MRI/US fusion prostate biopsy and divided them into four cohorts by the year of biopsy. We analyzed temporal changes in clinically significant prostate cancer (csPC) detection rate, percentage of positive cores on biopsy, and Gleason upgrading rate after radical prostatectomy. The csPC detection rate by MRI/US fusion targeted biopsy (TB) increased significantly (from 35.3% to 60.0%, p = 0.01). With increased experience, the csPC detection rates for small (≤1 cm) and anterior target lesions gradually increased (from 41.2% to 51.6%, p = 0.5; from 54.5% to 88.2%, p = 0.8, respectively). The percentage of positive cores on TB increased significantly (from 18.4% to 44.2%, p = 0.001). The Gleason upgrading rate gradually decreased (from 22.2% to 11.1%, p = 0.4). In conclusion, with accumulated experience and teamwork, the csPC detection rate by TB significantly increased. Multidisciplinary team meetings and a free-hand biopsy technique were the key factors for overcoming the learning curve.

Robot-Assisted Magnetic Resonance Imaging-Targeted versus Systematic Prostate Biopsy; Systematic Review and Meta-Analysis

Robot-assisted devices have been recently developed for use in prostate biopsy. However, it is possible advantages over standard biopsy remain unclear. We aimed to assess the diagnostic performance and safety of robot-assisted targeted (RA-TB) and systematic prostate biopsies (RA-SB). A systematic literature search was performed in MEDLINE and Scopus databases. The detailed search strategy is available at Prospero (CRD42021269290). The primary outcome was the clinically significant prostate cancer (PCa) detection rate. The secondary outcomes included the overall detection rate of PCa, cancer detection rate per core, and complications. The clinically significant cancer detection rate, overall cancer detection rate, and "per patient" did not significantly differ between RA-TB and RA-SB [OR = 1.02 (95% CI 0.83; 1.26), p = 0.05, I2 = 62% and OR = 0.95 (95% CI 0.78; 1.17), p = 0.17, I2 = 40%, respectively]. There were no differences in the clinically insignificant cancer detection rate "per patient" between RA-TB and RA-SB [OR = 0.81 (95% CI 0.54; 1.21), p = 0.31, I2 = 0%]. RA-TB had a significantly higher cancer detection rate "per core" [OR = 3.01 (95% CI 2.77; 3.27), p < 0.0001, I2 = 96%]. RA-TB and RA-SB are both technically feasible and have comparable clinical significance and overall PCa detection rates.