Fusion Prostate Biopsy Research Articles

Fusion prostate biopsy: tips and tricks to improve rigid registration

Background: We introduced tips and tricks to improve the rate of correct rigid registration during fusion prostate biopsy: (1) creation of similar anatomical condition during multiparametric magnetic resonance of the prostate (mpMRI) and trans rectal ultrasound (TRUS) (bladder and rectum should be empty and the use of MRI trans rectal probe avoided), (2) revision of mpMRI performed outside our institution by our radiologist, (3) the use of the boundary between transitional/central and peripheral zone of the prostate as the main anatomical landmark (less prone than the peripheral shape to deformation) at the level of the target, (4) repeating the registration at the level of every target or after unintended movement of the patients. Methods: We reviewed our internal database to assess the impact of our tips and tricks. Patients submitted to radical prostatectomy after fusion biopsy in our centre over the last two years were selected. Biopsy positivity in a sextant with cancer at the radical prostatectomy and a suspected mpMRI (3–5) was computed as a correct registration, the positivity of a biopsy in an adjacent sextant as a quasi-correct registration. Results: 49 out of 59 and 5 out 59 correct and quasi-correct registrations were finally computed. Assuming acceptable 90% of correct and 95% of quasi-correct rate, the expected figures are respectively 53 and 3. The chi-square goodness of fit test show a X square value of 2.97 and a p-value of 0.23. Therefore, the null hypothesis that the two distributions are homogeneous cannot be rejected. Conclusions: The introduction of some tips and trick in the daily clinical practice contributed to some extent to a satisfactory rate of correct rigid registration in our series of fusion prostate biopsies.

Should Targeted Biopsy be Performed in Patients Who Have Only Pi-rads 3 Lesions?

To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions.Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a software guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Urooncology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC.A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion- based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG ≥ 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53-0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51-0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15-10.91], p = 0.024).Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions.

Head-to-head comparison of biparametric versus multiparametric MRI of the prostate before robot-assisted transperineal fusion prostate biopsy.

PurposeProstate biparametric magnetic resonance imaging (bpMRI) including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) might be an alternative to multiparametric MRI (mpMRI, including dynamic contrast imaging, DCE) to detect and guide targeted biopsy in patients with suspected prostate cancer (PCa). However, there is no upgrading peripheral zone PI-RADS 3 to PI-RADS 4 without DCE in bpMRI. The aim of this study was to evaluate bpMRI against mpMRI in biopsy-naïve men with elevated prostate-specific antigen (PSA) scheduled for robot-assisted-transperineal fusion-prostate biopsy (RA-TB).MethodsRetrospective single-center-study of 563 biopsy-naïve men (from 01/2015 to 09/2018, mean PSA 9.7 ± 6.5 ng/mL) with PI-RADSv2.1 conform mpMRI at 3 T before RA-TB. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥ 2 in any core. Two experienced readers independently evaluated images according to PI-RADSv2.1 criteria (separate readings for bpMRI and mpMRI sequences, 6-month interval). Reference standard was histology from RA-TB.ResultsPI-RADS 2 was scored in 5.1% of cases (3.4% cancer/3.4% csPCa), PI-RADS 3 in 16.9% (32.6%/3.2%), PI-RADS 4 in 57.6% (66.1%/58.3%) and PI-RADS 5 in 20.4% of cases (79.1%/74.8%). For mpMRI/bpMRI test comparison, sensitivity was 99.0%/97.1% (p < 0.001), specificity 47.5%/61.2% (p < 0.001), PPV 69.5%/75.1% (p < 0.001) and NPV 97.6%/94.6% (n.s.). csPCa was considered gold standard. 35 cases without cancer were upgraded to PI-RADS 4 (mpMRI) and six PI-RADS 3 cases with csPCa were not upgraded (bpMRI).ConclusionIn patients planned for RA-TB with elevated PSA and clinical suspicion for PCa, specificity was higher in bpMRI vs. mpMRI, which could solve constrains regarding time and contrast agent.

Histopathological Analysis of False-positive Lesions in mpMRI/TRUS Fusion Prostate Biopsy.

Multi-parametric magnetic resonance imaging (mpMRI)/ultrasonography fusion prostate biopsy (FB) is a more accurate method of diagnosis than conventional prostate biopsy, but false-positive lesions still exist. Limited studies have examined the cause of false-positive lesions by histological analysis. We examined 322 patients who underwent mpMRI/transrectal ultrasonography (TRUS) FB. We classified prostate imaging-recording and data system (PI-RADS) 3 and PI-RADS 4-5 as low PI-RADS lesions and high PI-RADS lesions, respectively. In total, 105 lesions were identified as false-positive lesions. We performed histological analysis of atrophy, hyperplasia, and lymphocyte infiltration in these lesions, comparing low PI-RADS lesions and high PI-RADS lesions. The frequencies of prostate hyperplasia and lymphocyte infiltration were higher in high PI-RADS lesions than in low PI-RADS lesions (p=0.028 and 0.024, respectively). There was no significant difference regarding atrophy (p=0.295). Histopathological change may be one of the reasons for false-positive lesions.

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.

Clinical Application of SPECT-CT Imaging with 99mTc-PSMA in Patients with Recurrent Prostate Cancer

Introduction: Prostate cancer is the most common malignancy in men in Europe. One of the important clinical problems is the early detection and visualization of recurrence after radical prostatectomy, radiation therapy or other radical topical treatment, in patients with PSA values above 0.2 ng/ml. With the introduction of molecular highly sensitive imaging methods after administration of radiolabeled prostate-specific membrane antigen (PSMA), it became possible to detect early functional changes associated with the development of a metastatic process in this disease, with a negative CT or MRI result. 99mTc-PSMA is a new radiopharmaceutical and is a small ligand that binds to the active core of PSMA. The aim of our study was to evaluate the clinical role of 99mTc-PSMA in imaging local recurrence and/or loco-regional and distant metastases in patients with recurrent prostate cancer and biochemical disease progression. Material and methods: A cohort of 36 prostate cancer patients was evaluated with established laboratory data for biochemical progression of the disease - increase in the serum value of the tumor marker PSA and its doubling time within 6 months. In 3/36 of the patients, prostate adenocarcinoma was accidentally detected after transurethral resection of the prostate. Hormonal and cytoreductive radiotherapy was performed in these patients as a therapy. The remaining 33/36 patients underwent radical treatment of primary cancer after a systematic or MRI/US fusion prostate biopsy. Results: All of these patients underwent a whole body scan followed by a targeted SPECT-CT study, 1–3 hours after intravenous administration of 99mTc-PSMA. The sensitivity of the SPECT-CT test with 99mTc-PSMA for the detection of recurrent prostate cancer in 36 followed patients was 84.37% (27/32), specificity - 100% (4/4) and accuracy - 86.11% 31/36). Conclusion: For the clinical application of 99mTc-PSMA SPECT-CT we can summarize that this method finds the greatest clinical application for early diagnosis of recurrent disease in patients with prostate cancer and biochemical progression, at serum PSA levels ≥0.50 ng / ml, in order to determine a personalized treatment for each individual patient. Key words: Prostate cancer, recurrent prostate cancer, 99mTc-PSMA, SPECT-CT

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.

Diagnostic outcomes from transrectal and transperineal prostate biopsies – experiences from a Swedish tertiary care Centre

Objective The aim of this study was to compare diagnostic and infectious outcomes between MRI-guided transrectal (TR) and transperineal (TP) prostate biopsies, in order to evaluate implementation of local-anaesthesia TP biopsies in a Swedish university hospital setting. Methods In this non-randomized observational study, we recruited 105 patients who underwent TR or TP software-based MRI-ultrasound fusion prostate biopsies between April and August 2020. Information on outcome and covariates were obtained from hospital records. We compared detection rates of overall prostate cancer (PCa) and clinically significant PCa (≥ISUP2) between the two groups using simple and multivariable-adjusted analyses. As a secondary outcome, we descriptively compared infection-related outcomes between the two groups. Results Of the total population, 72 patients underwent TR and 33 patients underwent TP biopsies. Biopsies were positive for PCa in 50 (69.4%) patients of the TR group and 23 (69.7%) patients of the TP group. Clinically significant cancer was found in 28 (38.9%) patients of the TR group and 10 (30.3%) patients of the TP group. Simple and multivariable-adjusted analyses did not indicate any statistically significant difference between groups. Post-biopsy infection was diagnosed in one patient (3%) of the TP group and eight patients (11.1%) in the TR group, conforming to previous reports of low infection rates after TP biopsies. Conclusions Our results conform to data suggesting that the transition from TR to TP MRI-guided biopsies is feasible and safe, maintaining a high diagnostic quality while possibly reducing the risk of infection-related complications.

МРТ- ТРУЗИ фьюжн-биопсия в диагностике рака предстательной железы

Introduction. Significant improvement in the quality of visualization of the prostate using magnetic resonance imaging (MRI), as well as the development of technologies for virtual combination of MRI and ultrasound images opens new horizons in the diagnosis of prostate cancer. The introduction of the PI-RADS system has allowed the standardization of MRI findings, and the development of fusion biopsy systems seeks to make diagnostics more accurate and less operator-dependent. Materials and methods. In this literature review, we evaluate the effectiveness of various biopsy approaches and discuss the prospects for targeted biopsies. The search for publications was carried out in the databases PubMed, e-library, Web of Scince et al. For citation, 55 literature sources were selected that met the search criteria for the keywords, «prostate cancer», «biopsy», «MRI», «TRUS», «fusion». Results. Diagnosis of prostate cancer using MRI. Modern technologies for radiological diagnosis of prostate cancer using magnetic resonance imaging (MRI) are based on the standardized PI-RADS protocol, using different modes (T2, diffusion-weighted images and contrast enhancement), which provides the best visualization of tumor-suspicious nodes in the prostate gland, allowing determination of lesion localization and size for subsequent targeted biopsy. Options for performing a prostate biopsy to diagnose prostate cancer. A description of the methods and effectiveness of transrectal and transperineal biopsy under ultrasound guidance is carried out - due to the fact that ultrasound diagnostics of prostate cancer has a rather low sensitivity due to small differences in the ultrasound structure of normal and tumor tissue of the prostate, an extended template biopsy technique was proposed, which involves puncture of the prostate through a special lattice. It also describes the technology of fusion biopsy and also provides literature data comparing the diagnostic accuracy of standard TRUS and fusion prostate biopsy, as well as the importance of transrectal / transperineal access. Questions for further study. Given the desire to reduce the number of biopsies while maintaining or even increasing the accuracy of diagnosing prostate cancer, data from studies investigating the feasibility of combining polyfocal (non-targeted) and targeted (targeted) biopsies are presented. Conclusion. The existing methods of non-targeted biopsy (polyfocal, saturation, template) and targeted (fusion biopsy) have their advantages and disadvantages, which currently do not allow making certain recommendations for their use, but a significant number of authors prefer MRI-as sisted, fusion -biopsy.

V14-10 MRI/US FUSION GUIDED PROSTATE BIOPSY AND CRYOTHERAPY IN A CLINICAL OFFICE SETTING

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-10 MRI/US FUSION GUIDED PROSTATE BIOPSY AND CRYOTHERAPY IN A CLINICAL OFFICE SETTING Fernando Bianco, Eusebio Luna, Luanda Perez, Alberto Lopez-Prieto, Edward Gheiler, Ariel Kaufman, Farshad Shafizadeh, Michael Zachareas, Juan Martinez-Salamanca, Gloria Egui-Benatuil, and Michael Kattan Fernando BiancoFernando Bianco More articles by this author , Eusebio LunaEusebio Luna More articles by this author , Luanda PerezLuanda Perez More articles by this author , Alberto Lopez-PrietoAlberto Lopez-Prieto More articles by this author , Edward GheilerEdward Gheiler More articles by this author , Ariel KaufmanAriel Kaufman More articles by this author , Farshad ShafizadehFarshad Shafizadeh More articles by this author , Michael ZachareasMichael Zachareas More articles by this author , Juan Martinez-SalamancaJuan Martinez-Salamanca More articles by this author , Gloria Egui-BenatuilGloria Egui-Benatuil More articles by this author , and Michael KattanMichael Kattan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Cancer Society estimates that 248,530 men (1 out of every 8) will be diagnosed with prostate cancer during 2021. MR/US has brought precision a in diagnosis and opportunity to decrease harm associated to whole gland radical interventions. The interest to develop new ablative therapies has risen as a resource to prevent overtreatment. We have developed a transperineal fusion approach that allows for precise diagnosis and treatment in the office setting under local anesthesia. METHODS: NCT02381990 represents a meticulous prospective registry that aims to characterize outcomes after MR/US Fusion Cryoablation in the office setting. Between 2014 and 2020, 369 patients positive for prostate cancer after MR/US Transperineal Fusion Biopsy (TPFBx) underwent targeted MR/US Transperineal Fusion Cryoablation (TPFTx) across 4 institutions. The video shows a representative case. We present short term outcomes for these patients. RESULTS: The median time from biopsy to treatment for the 369 patient cohort was 6 weeks. All 738 procedures were completed with median times (TPFBx and TPFTx, 24’ and 55’, respectively) and median pain scores (1-10 scale) were 3(TPFBx) and 2(TPFTx). 160 of these patients had TPFTx within during 2020. Of the reminder 209, 173 completed 1-year TPFBx and 57 (32%) were positive. The Gleason groups distribution for those with a 1-year positive biopsy were more favorable than the initial diagnostic TPFBx CONCLUSIONS: MRI/US Fusion prostate biopsies and cryoablation allow targeting prostate cancer lesions in a safe, accurate, and reproducible manner. This approach prevents overtreatment and could be considered an alternative to active surveillance as 68% of patients have no evidence of disease a year after treatment. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1168-e1168 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fernando Bianco More articles by this author Eusebio Luna More articles by this author Luanda Perez More articles by this author Alberto Lopez-Prieto More articles by this author Edward Gheiler More articles by this author Ariel Kaufman More articles by this author Farshad Shafizadeh More articles by this author Michael Zachareas More articles by this author Juan Martinez-Salamanca More articles by this author Gloria Egui-Benatuil More articles by this author Michael Kattan More articles by this author Expand All Advertisement Loading ...

MP30-07 ADDED PERFORMANCE OF SYSTEMATIC BIOPSY TO 3T MULTIPARAMETRIC MRI DERIVED MR/US FUSION BIOPSY FOR THE DETECTION AND GRADING OF PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (MP30)1 Sep 2021MP30-07 ADDED PERFORMANCE OF SYSTEMATIC BIOPSY TO 3T MULTIPARAMETRIC MRI DERIVED MR/US FUSION BIOPSY FOR THE DETECTION AND GRADING OF PROSTATE CANCER Sohrab Afshari Mirak, Kyunghyun Sung, Ely Felker, Anthony Sisk, Robert Reiter, and Steven Raman Sohrab Afshari MirakSohrab Afshari Mirak More articles by this author , Kyunghyun SungKyunghyun Sung More articles by this author , Ely FelkerEly Felker More articles by this author , Anthony SiskAnthony Sisk More articles by this author , Robert ReiterRobert Reiter More articles by this author , and Steven RamanSteven Raman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002027.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Systematic 12-core transrectal ultrasound-guided biopsy (TRUS) is the gold standard for the detection of Prostate Cancer (PCa) lesions, which might result in over diagnosis of clinically insignificant PCa or under diagnosis of clinically significant PCa. MR/US fusion biopsy provides an opportunity for more accurate detection of PCa. In this study, we investigated the performance of 3 Tesla multiparametric MRI (3TmpMRI) with subsequent MR/US fusion prostate biopsy with subcohort analysis of Targeted Biopsy (MRgFBx) & Systematic Biopsy (SB) for the detection & grading of PCa with Whole Mount Histopathology (WMHP) reference. METHODS: This IRB approved, HIPAA compliant observational study included 309 men, who underwent 3TmpMRI with subsequent MRgFBx & SB prior to radical prostatectomy. The per-patient performance of MRgFBx with & without SB for the detection & grading (ISUP groups) of PCa was evaluated & correlated to final WMHP. RESULTS: Mean total & positive cores were 11.4 & 2.9 for SB & 5.4 & 3.3 for MRgFBx, respectively. The per-patient detection rates (DR) for SB & MRgFBx were 86.4% (267/309) & 95.5% (295/309), respectively. MRgFBx ISUP grading was concordant with WMHP in 47.9% (148/309) patients, discordant with upgrading in 27.8% (86/309) & downgrading in 20.1% (62/309) of patients. Among upgraded cases, 69.8% (60/86), 25.6% (22/86) & 4.6% (4/86) cases were upgraded by 1,2 & 3 ISUP groups, respectively. In 12% (37/309) of cases, upgrading was from PCa ISUP group 1 to ISUP group>1. SB increased the DR of PCa & csPCA of MRgFbx by 4.5% (14/309) & 3.6% (11/309.) In cases with lower prediction of grading by MRgFBx, SB increased the ISUP group of the MRgFBx in 9.4% (29/309), among which 5.5%(17/309), 2.6%(8/309) & 1.3%(4/309) were upgraded to the same grading group as WMHP, lower than the group of WMHP & falsely to higher group than WMHP, respectively. In 72.4% (21/29), the upgrading SB cores were ipsilateral to the target in MRgFbx. True upgrading by SB from ISUP group 1 to group >1 was 5.2% (16/309). CONCLUSIONS: MRgFBx has high performance for detection & grading of PCa & csPCa. SB has minimal added value to MRgFBx for improving the detection & grading. Source of Funding: This work was supported by funds from the Integrated Diagnostics Program, Department of Radiological Sciences & Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e501-e502 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sohrab Afshari Mirak More articles by this author Kyunghyun Sung More articles by this author Ely Felker More articles by this author Anthony Sisk More articles by this author Robert Reiter More articles by this author Steven Raman More articles by this author Expand All Advertisement Loading ...

MP05-06 DIAGNOSTIC ACCURACY OF ADC VALUE ON BIPARAMETRIC MRI FOR DETECTING CLINICALLY SIGNIFICANT PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP05)1 Sep 2021MP05-06 DIAGNOSTIC ACCURACY OF ADC VALUE ON BIPARAMETRIC MRI FOR DETECTING CLINICALLY SIGNIFICANT PROSTATE CANCER Jih Hoon Park, Ja Yoon Ku, and Hong Koo Ha Jih Hoon ParkJih Hoon Park More articles by this author , Ja Yoon KuJa Yoon Ku More articles by this author , and Hong Koo HaHong Koo Ha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001972.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PI-RADS v2 is helpful for the detection of clinically significant prostate cancer (CS-PCa), but does not provide quantitative information. We conducted this study to evaluate the diagnostic accuracy of apparent diffusion coefficient (ADC) value for detecting CS-PCa with TRUS-MR fusion biopsy using 3T biparametric MRI (bpMRI). METHODS: We enrolled 310 patients with elevated PSA level over 4 ng/mL who underwent bpMRI followed by TRUS-MR fusion biopsy of prostate between June 2016 and June 2019. Patients underwent MRI examination on Achieva 3.0T TX MRI Scanner from Philips. The suspicious lesions were indicated by experienced radiologists according to PI-RADS v2, marked as a region-of-interest (ROI) and targeted by TRUS-MR fusion biopsy. ADC values were calculated for a pair of b values: 50 and 1400 s/mm2. ADC values of ROIs were recorded by averaging the values measured at least three times each by two urologists. The size of ROIs was chosen to be as large as possible and with minimal contamination from normal tissue. CS-PCa was defined as ISUP grade of 2 or greater. Lower grade (LG) PCa was defined as ISUP grade 1 or 2, and higher grade (HG) as ISUP grade over 2. RESULTS: Of the 502 lesions indicated and biopsied, 348 (69.3%) were on peripheral zone (PZ) and 154 (30.7%) on transitional zone (TZ). In PZ, 101 (29.0%) lesions were diagnosed with PCa, including 73 (21.0%) with CS-PCa, and in TZ, 39 (25.3%) and 21 (13.6%) were detected with PCa and CS-PCa, respectively. Receiver operating characteristic (ROC) curve analyses showed larger area under curve (AUC) for ADC value compared to PI-RADS (0.902 vs 0.827) for detecting CS-PCa in PZ, but not in TZ (0.797 vs 0.786). According to DeLong test there was a statistically significant better AUC for ADC value on ROC curve analysis compared to PI-RADS in PZ (p=0.0095), but not in TZ (p=0.8496). Mean ADC value (x10-3 mm2/s) of the lesions diagnosed with benign prostatic tissues was 0.929 (95% CI 0.906-0.953), and was different statistically significant with that of LG PCa tissues (mean=0.643, 95% CI 0.591-0.695, p<0.001) and that of HG PCa tissue (mean=0.576, 95% CI 0.540-0.610, p<0.001). The difference between LG and HG PCa tissues was statistically significant (p=0.034). CONCLUSIONS: Predictive role of ADC value on biparametric MRI before TRUS-MR fusion biopsy is better than PI-RADS v2 in detection of CS-PCa. Source of Funding: No source of funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e79-e80 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jih Hoon Park More articles by this author Ja Yoon Ku More articles by this author Hong Koo Ha More articles by this author Expand All Advertisement Loading ...

MP22-15 ARE UROLOGISTS READY FOR INTERPRETATION OF MULTIPARAMETRIC MRI FINDINGS? A PROSPECTIVE MULTICENTRIC EVALUATION

MP22-15 ARE UROLOGISTS READY FOR INTERPRETATION OF MULTIPARAMETRIC MRI FINDINGS? A PROSPECTIVE MULTICENTRIC EVALUATION

Expedited Workflow for “One-Stop” Magnetic Resonance Imaging and Image Fusion Prostate Biopsy: Implementation and Lessons Learned

Abstract While the standard two-day workflow for magnetic resonance imaging guided ultrasound biopsy of the prostate grants flexibility to health care providers, a one-stop diagnostic pathway may benefit patients. A working relationship between radiology and urology is essential in implementing a streamlined workflow and built-in feedback loops to identify/prevent pitfalls as they arise. Another consideration is the overlap in patient populations at risk for prostate cancer and for poor outcomes from COVID19. Same day MRI and prostate biopsy protocols can reduce hospital/clinic visits and has the potential to optimize patient safety by minimizing the risk of COVID-19 exposure to high risk populations.

Indication for Active Surveillance in the Era of MRI-Targeted Prostate Biopsies

Introduction: Active surveillance (AS) strategies were established to avoid overtreatment of low-risk prostate cancer (PCa) patients. Low tumor volume represents one indication criteria; however, applying this criterion after MRI-targeted prostate biopsies may lead to overestimation of tumor volume; wherefore, patients suitable for AS would be exposed to the risk of overtreatment. Methods: This retrospective analysis included 318 patients in which PCa was detected by MRI-TRUS fusion prostate biopsy. Classic and extended indication for AS included Gleason 6 and Gleason 3 + 4 cancer, respectively. We assessed the effect of targeted biopsies and temporary rating strategies on eligibility for AS and developed new “composite” algorithms to more accurately assess eligibility for AS. Results: Forty-four (13.8%) and 60 (18.9%) of the 318 patients qualified for AS according to “classic” and “extended” criteria, respectively. Application of the “composite 1” definition led to AS eligibility of 52 of 248 patients (20.97%) in the classic and of 77 of 248 patients (31.05%) in the “extended” group. Conclusions: We could demonstrate that classic algorithms led to ineligibility of patients for AS. We propose a new rating algorithm to improve tumor assessment for a more accurate indication for AS.

Manyetik rezonans görüntüleme- ultrason füzyon prostat biyopsisi tek merkez sonuçları

Objective: We aimed to evaluate magnetic resonance imaging-ultrasound guided fusion prostate biopsy (MRI- US FPBx) results from a single center and to compare with current literature. Material and Methods: Between January 2016 and July 2019, MRI-US FPBx pathological and imaging results of 358 men were retrospectively analyzed. PI-RADS scores were determined as 3, 4 and 5 in 222 (62%), 107 (29.8%) and 29 (8.1%) patients, respectively. Totally 454 lesions were underwent MRI-US FPBx. 303 (66.7%) lesions were scored as PI-RADS 3, 120 (26.4%) lesions were scored as PI-RADS 4 and 31 (6.8%) lesions were scored as PI-RADS 5. 315 (69.3%) of lesions were in peripheral zone, 26 (5.7%) were in central zone, 111 (24.4%) were in transitional zone and 2 of them were in anterior fibromuscular stroma. Results: Overall prostate cancer detection rate was 36.3%. Concerning detection rates, MRI-US FPBx alone and transrectal ultrasonography guided prostate biopsy (TRUS-Bx) alone were 27.6% and 26.5%, respectively. Cancer detection rate only through MRI-US FPBx PIRADS-3 and PI-RADS 4&amp;5 were 6.9% and 20.6%, respectively. Clinically significant prostate cancer (csPCa) rates were evaluated and csPCa to overall prostate cancer (PCa) rates for TRUS-Bx, MRI-US FPBx and combined techniques were 16.8%, 35.4% and 39.2%, respectively. Results of 11 patients were evaluated as benign. Conclusion: MRI-US FPBx significantly increases success rate of prostate biopsy procedure. Regarding current MRI technology, it is not appropriate to consider MRI-US FPBx as a stand-alone biopsy option without concomitant with TRUS-Bx. Keywords: prostate cancer; biopsy; MRI; fusion

P0950 - Diagnostic performance of fusion (US/MRI guided) prostate biopsy: Propensity score matched comparison of elastic versus rigid fusion system

P0950 - Diagnostic performance of fusion (US/MRI guided) prostate biopsy: Propensity score matched comparison of elastic versus rigid fusion system

Combined Systematic and MRI-US Fusion Prostate Biopsy Has the Highest Grading Accuracy When Compared to Final Pathology.

Background and objectives: Systematic prostate biopsy (SB) has a low Gleason group (GG) accuracy when compared to final pathology. This may negatively impact the inclusion of patients into specific risk groups and treatment choice. The aim of our study was to assess the GG accuracy of magnetic resonance imaging-ultrasound (MRI-US) fusion prostate biopsy. Materials and Methods: Of a cohort of minimally invasive radical prostatectomy (RP), we selected all patients who were diagnosed with prostate cancer (PCa) via MRI-US fusion biopsy (n = 115). Results: Combined biopsy had the highest rate for GG concordance (61.7% vs. 60.4% for SB vs. 45.3% for MRI-US fusion biopsy) and the lowest for upgrading (20.9% vs. 24.5% for SB vs. 34.9% for MRI-US fusion biopsy), p < 0.0001. No clinical data were predictive for upgrading or downgrading at final pathology. Locally advanced PCa was associated with a high Prostate Imaging-Reporting and Data System (PIRADS) score (p = 0.0014) and higher percentages of positive biopsy cores (PBC)/targeted (p = 0.0002) and PBC/total (p = 0.01). Positive surgical margins were correlated with higher percentages of PBC/systematic (p = 0.003) and PBC/total (p = 0.009). Conclusions: Pre-biopsy prostate MRI improves GG concordance between biopsy and RP. Combined biopsy provides the highest grading accuracy when compared to final pathology. Targeted and systematic biopsy data are predictive for adverse pathologic outcomes.

Diagnostic efficiency of systemic immune-inflammation index in fusion prostate biopsy

ObjectiveTo investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA < 10 ng/mL undergoing fusion prostate biopsy. MethodsThe prospective study included patients who were planned for fusion prostate biopsy and had PSA < 10 ng/mL and a PI-RADS ≥ 3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII = platelet × neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity + specificity − 1). ResultsThe study included 508 patients with a mean age of 62.49 ± 6.86 years and a median PSA level of 7.28 (5.69−8.70) ng/mL. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC = 0.487, P = 0.622), it was revealed as a significant marker in PCa patients with an ISUP grade ≥ 3 (AUC = 0.811, P < 0.001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3–5 PCa, though not as effective as SII. ConclusionSII and SII combination with PI-RADS score appear to be a significant diagnostic marker in patients with high-grade PCa (ISUP grade 3–5). These values were found to be higher compared to those of patients with a benign pathology and patients with lower ISUP scores.

912 Comparison of Magnetic Resonance Imaging Cognitive Prostate Biopsy Versus Magnetic Resonance Imaging-Ultrasound Fusion Prostate Biopsy in The Detection of Prostate Cancer

Abstract Introduction Prostate biopsy is performed to obtain tissue specimens to diagnose prostate cancer (CaP). Superimposing magnetic resonance imaging (MRI) on the prostate biopsy machine can improve the targeting of abnormal prostate lesions found on MRI scans. We compare the results of MRI cognitive prostate biopsy to MRI-US fusion biopsy in the detection of prostate cancer. Method Data was collected retrospectively for all patient that had an MRI and prostate biopsy from 01/01/2019 to 31/12/2019. Electronic patient records and radiology imaging software were used to collate data. Results 319 patients with at least PIRADS 3 on MRI prostate were identified. CaP was detected in 70% (26/37) of the cognitive biopsy cohort and 66% (186/282) of the fusion biopsy cohort. None of the patients required additional biopsies. Only the fusion biopsy cohort had complications which were Urosepsis - 7, Haematuria - 3, Urinary retention - 1 and Rectal bleeding- 1. Conclusions Our study suggests the CaP detection rates were similar in both cohorts. However, similar patient numbers are required to avoid selection bias. 66.5% of all PIRADS 3 lesions were found to be ≥ Gleason 7. We recommend using magnetic resonance imaging-ultrasound fusion prostate biopsy to enhance prostate cancer detection rates.