MRI-targeted Biopsy Research Articles

MP13-02 IN MEN WITH PROSTATE MRI LESIONS, WHEN CAN WE FORGO SYSTEMATIC BIOPSIES?

INTRODUCTION AND OBJECTIVE: Multiple recent studies have suggested combined MRI-targeted and 12-core systematic biopsies lead to improved clinically significant cancer detection. However, increasing the number of prostate biopsy cores can increase urinary and infectious complications. We sought to determine if systematic biopsy could be safely forgone in some patients based on pre-biopsy PIRADS score. METHODS: Between April 2015 and January 2019, patients enrolled in a prospective nationally registered clinical trial evaluating the use of MRI-targeted fusion biopsy(NCT00102544). All patients with MRI visible lesions underwent MRI-targeted and systematic biopsies during the same setting for prostate cancer diagnosis. The highest Gleason Grade(GG) cancer detected by each biopsy method was recorded and stratified by MRI PIRADS v2 score. Additional clinically significant cancer(GG 4+3=7) detected by MRI targeted or systematic biopsy were calculated. RESULTS: In total, 723 men with PIRADS≥2 lesions underwent prostate biopsy. PIRADS score of 2, 3, 4, and 5 lesions were detected in 51(7.1%), 87(12.0%), 346(47.9%), and 239(33.1%) biopsied men, respectively. Among PIRADS 5 (n=239) patients, cancer was diagnosed in 226(94.6%). If MRI targeted biopsies were performed, the addition of systematic biopsies only led to 0.8% (n=2) more detection of GG≥3 patients. In both of these patients, the MRI targeted biopsy alone characterized these patients as GG=2 cancer whereas systematic biopsy diagnosed them as GG=3 cancer. Men with PIRADS scores of 4, 3, and 2 had greater rates of additional GG≥3 cancer detection by systematic biopsy compared to PIRADS 5 lesions (See Table). Of men with PIRADS 4, 3, and 2 scores, 12(3.5%), 3(3.5%), and 1(2%) patients were diagnosed with GG≥3 cancer by systematic biopsy alone, respectively, and 26(7.5%), 2(2.3%), and 1(2%) patients were diagnosed by MRI-targeted biopsy only, respectively. Combination biopsy of these patients had a greater likelihood of detecting clinically significant cancer than either targeted or systematic biopsy alone. CONCLUSIONS: For men with PIRADS 5 lesions on prostate MRI, omission of systematic biopsies in favor of targeted biopsy alone leads to a marginal decline in cancer diagnosis. However, for PIRADS 2-4 lesions, systematic biopsy adds significant diagnostic value and should be considered in combination with MRI-targeted biopsy.Source of Funding: This research was funded by the Intramural Research Program of the NIH.

PD54-07 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER THROUGH MRI FUSION-GUIDED VS. SYSTEMATIC STANDARD PROSTATE BIOPSIES

INTRODUCTION AND OBJECTIVE: Prostate biopsies are critical to diagnose prostate cancer (PCa) and to determine when treatment is appropriate. MRI-fusion biopsies have been utilized to try to improve detection rates of clinically significant prostate cancer (csPCa), but their exact value remains unclear. Our objective was to determine the unique contributions of MRI-targeted and systematic prostate biopsies, and how results may differ across institutions. METHODS: Biopsy (bx) results for patients receiving concurrent systematic and MRI-targeted prostate biopsies (UroNav system) were reviewed. The incidence was considered to be any bx positive for csPCa by either method, with csPCa defined as ≥ grade group 2. Patients were stratified as: active surveillance (AS), bx naïve, prior negative bx, or prior radiation (XRT) for PCa. Detection rates of systematic versus MRI-targeted biopsies within each institution and overall were calculated and compared utilizing McNemar’s tests. Rates between institutions were compared using Pearson’s chi square. RESULTS: Patient demographics and cancer detection rates for 457 individual biopsies are listed below. The figure details the percent of csPCa that would be missed if MRI-targeted or systematic biopsies were omitted, stratified by AS, bx naïve, or prior negative bx; rates were not calculated for prior XRT given the small number. Within each institution, there were no statistically significant differences in the ability of systematic versus MRI-targeted biopsies to detect csPCa, either overall or when stratified. Overall, the rates of csPCa detection were higher at institution B than institution A, with the largest differences in MRI targeted and in naïve biopsies. CONCLUSIONS: At both institutions, a significant number of csPCa diagnoses would have been missed if either bx modality was excluded. These data support concurrent MRI-fusion and systematic biopsies to achieve maximal detection of csPCa. Individual centers should evaluate their own data to determine optimal biopsy paradigms.Source of Funding: None

PD57-02 WHEN IS MP-MRI RELIABLE IN PREDICTING EXTRA-PROSTATIC EXTENSION IN PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY? RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES

PD57-02 WHEN IS MP-MRI RELIABLE IN PREDICTING EXTRA-PROSTATIC EXTENSION IN PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY? RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES

MP56-03 DIRECT VERSUS FUSION MAGNETIC RESONANCE IMAGING TARGETED BIOPSY OF THE PROSTATE: A RETROSPECTIVE MULTIVARIABLE COMPARATIVE ANALYSIS WITH PROPENSITY SCORE WEIGHTING

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP56)1 Apr 2020MP56-03 DIRECT VERSUS FUSION MAGNETIC RESONANCE IMAGING TARGETED BIOPSY OF THE PROSTATE: A RETROSPECTIVE MULTIVARIABLE COMPARATIVE ANALYSIS WITH PROPENSITY SCORE WEIGHTING Morgan Prince*, Bryan Foster, Andy Kaempf, Yiyi Chen, Jen-Jane Liu, Christopher Amling, and Fergus Coakley Morgan Prince*Morgan Prince* More articles by this author , Bryan FosterBryan Foster More articles by this author , Andy KaempfAndy Kaempf More articles by this author , Yiyi ChenYiyi Chen More articles by this author , Jen-Jane LiuJen-Jane Liu More articles by this author , Christopher AmlingChristopher Amling More articles by this author , and Fergus CoakleyFergus Coakley More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000925.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evolution of multiparametric prostate magnetic resonance (MR) imaging in recent years has facilitated new prostate biopsy techniques, including direct and fusion biopsies. Few studies have compared these two techniques directly, and those that have are conflicting. Our objective was to compare the positive biopsy rate of direct versus fusion MR imaging targeted biopsy of the prostate using a retrospective multivariable regression that incorporates propensity score weights. METHODS: We retrospectively identified patients with unknown or untreated low risk prostate cancer who underwent MR imaging targeted fusion or direct “in bore” biopsy of one or more suspicious prostate lesions as identified on multiparametric MR imaging. Both fusion and direct biopsy techniques were introduced at our institution within the last five years, and patients were referred based on physician choice. Pre-biopsy multiparametric MR images were blindly re-analyzed to determine target size, location (peripheral zone or central gland), and PIRADS version 2 score. Patient history (no prior biopsy, prior biopsy negative, or prior biopsy positive on active surveillance) and targeted biopsy results were collated by review of our institutional electronic medical record. RESULTS: The final study population (n=326) consisted of 208 men who underwent direct biopsy of 236 targets and 118 men who underwent fusion biopsy of 136 targets (total of 372 biopsied targets). We observed a significantly higher positive biopsy rate for direct biopsy as compared to fusion biopsy, at 75.4% (178/236) versus 57.4% (78/136); Fisher’s exact test p < 0.001. After applying propensity score weighting to account for differences between groups and statistically adjusting for covariates using multivariable logistic regression, the likelihood of a positive result remained significantly higher for direct biopsy versus fusion biopsy (odds ratio = 2.41, 95% confidence interval = 1.30 – 4.46; p = 0.005). CONCLUSIONS: In our retrospective institutional experience, direct MRI targeted biopsy of the prostate significantly outperforms fusion targeted biopsy. The superiority of the direct approach should be a consideration when patients are referred for MRI-targeted biopsy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e848-e848 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Morgan Prince* More articles by this author Bryan Foster More articles by this author Andy Kaempf More articles by this author Yiyi Chen More articles by this author Jen-Jane Liu More articles by this author Christopher Amling More articles by this author Fergus Coakley More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of clinically significant prostate cancer detection by MRI cognitive biopsy and in-bore MRI-targeted biopsy for naïve biopsy patients.

BackgroundMultiparametric magnetic resonance imaging (mpMRI) targeted prostate biopsy increases the diagnostic accuracy of clinically significant prostate cancer (PCa). Currently there is no consensus on which type of MRI-targeted biopsy performs better in a given setting. In this study, we aimed to compare the detection rate of (clinically significant) PCa by MRI cognitive targeted biopsy (COG) and in-bore MRI-targeted biopsy (IB) techniques for naïve prostate biopsy patients in China.MethodsOur study included 85 men from Beijing United Family Hospital and Clinics and 88 men from Beijing Hospital, National Center of Gerontology. All men had no history of prostate biopsy, undergoing mpMRI scan due to elevated PSA and/or abnormal DRE. The men in Beijing United Family Hospital group received COG plus systematic biopsy. The men in Beijing Hospital group only received IB.ResultsThe median age in COG and IB group was 63.0 years and 70.0 years (P<0.01). The median PSA was 7.4 and 6.8 ng/mL in COG and IB group respectively (P=0.124). The detection rate of PCa was 36.5% by COG and 52.3% by IB (P=0.037). The detection rate of clinically significant PCa (Gleason score ≥7) was 23.5% and 29.5% by COG and IB (P=0.371) respectively. In COG group, combination biopsy (COG + systematic biopsy) achieved improved PCa (42.4%) and clinically significant PCa (28.2%) detection rate compared with COG alone. However, there was no difference in overall PCa and clinically significant PCa detection between combination biopsy and IB.ConclusionsIB had a higher rate of overall PCa detection compared with COG, but the two approaches did not differ significantly in the detection of clinically significant PCa. There was no significant difference in detection rate of PCa and clinically significant PCa between the combination biopsy and IB.

MP56-16 A NEW SCORING SYSTEM USING PROSTATE IMAGING REPORTING AND DATA SYSTEM (PI-RADS) TO DETECT SIGNIFICANT CANCER FOR MAGNETIC RESONANCE IMAGING-TARGETED PROSTATE BIOPSY

INTRODUCTION AND OBJECTIVE: Prostate Imaging Reporting and Data system (PI-RADs) is associated with significant cancer (SC) detection. Although PI-RADs≥ 3 is considered to be positive, there are many reports suggesting the significant different of the detection rates of SC between PI-RADs 3 and 4-5. In using PIRADs for MRI-targeted prostate biopsy (TgB), what kind of men have SC have been not fully examined. In this study, we examined the detective ability between PI-RADs 3/4-5 and developed a new scoring system for prediction for SC detection of TgB using PI-RADs. METHODS: Between April 2013 and April 2019, 470 men with PSA <20 ng/mL received TgB. PI-RADs ver. 2 was used and considered as positive in ≥3. TgB was performed 4 cores for a lesion and TgB was performed for each lesions with multiple positive PI-RADs. SC in this study was defined as Gleason Score ≥ 3+4 or maximum cancer length ≥ 5 mm. We assessed the association between the detection of SC and PI-RADs using multivariable regression analyses. Clinical variables examined included age, PSA, DRE finding, prostate volume (PV), TgB location (TZ/PZ), and PI-RADS score (3/4-5). We developed a new scoring system with first 300 cases using estimated value of multivariable analysis; we validated it with the latter 170 cases. Predictive accuracy and performance characteristics were assessed using the area under the receiver operating characteristic curve (AUC), respectively. RESULTS: In first 300 cases, the median age and PSA were 69 years and 7.7 ng/mL, respectively. Location of TgB was TZ/PZ in 75/225 men. PI-RADs were 3/4/5 in 65/178/57 men. SC was detected in 160 (53 %) men of TgB. In multivariable analysis, PI-RADS 4-5 (odds ratio [OR] 5.9, p<.01), the positive DRE (OR 4.4, p<.01), lower PV (< 30 mL, OR 2.6, p<.01), higher PSA (> 8.0 ng/mL, OR 2.4, p<.01) and PZ (OR 1.9, p< .01) were significantly associated with positive TgB for SC. From the results of the analysis, we assigned 1 to 3 points to each variable and developed a scoring system predicting positive TgB for SC (total of 0-8 points, as shown in Table) and AUC for detecting SC was 0.813. In validated group (170 cases) for this new scoring system, AUC for detecting SC was 0.811. CONCLUSIONS: We developed a new scoring system using PI-RADs for detecting SC by TgB and verified its validity. PIRDAS3 might not predict SC.Source of Funding: none

LBA02-06 PHASE IIB MULTICENTER STUDY ON MRI-GUIDED FOCUSED ULTRASOUND (MRGFUS) FOCAL THERAPY FOR INTERMEDIATE RISK PROSTATE CANCER

You have accessJournal of UrologyLate-Breaking Abstracts (LBA2)1 Apr 2020LBA02-06 PHASE IIB MULTICENTER STUDY ON MRI-GUIDED FOCUSED ULTRASOUND (MRGFUS) FOCAL THERAPY FOR INTERMEDIATE RISK PROSTATE CANCER Behfar Ehdaie*, Clare Tempany, Ford Holland, Adam Kibel, Quoc-Dien Trinh, Jeremy Durack, Oguz Akin, Dan Sperling, Jeffrey Wong, Bertram Yuh, David Woodrum, Lance Mynderse, Steven Raman, Allan Pantuck, Marc Schiffman, Timothy McClure, Pejman Ghanouni, and Geoffrey Sonn Behfar Ehdaie*Behfar Ehdaie* More articles by this author , Clare TempanyClare Tempany More articles by this author , Ford HollandFord Holland More articles by this author , Adam KibelAdam Kibel More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Jeremy DurackJeremy Durack More articles by this author , Oguz AkinOguz Akin More articles by this author , Dan SperlingDan Sperling More articles by this author , Jeffrey WongJeffrey Wong More articles by this author , Bertram YuhBertram Yuh More articles by this author , David WoodrumDavid Woodrum More articles by this author , Lance MynderseLance Mynderse More articles by this author , Steven RamanSteven Raman More articles by this author , Allan PantuckAllan Pantuck More articles by this author , Marc SchiffmanMarc Schiffman More articles by this author , Timothy McClureTimothy McClure More articles by this author , Pejman GhanouniPejman Ghanouni More articles by this author , and Geoffrey SonnGeoffrey Sonn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000958.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Introduction: Radical whole-gland therapy for prostate cancer can lead to significant side-effects. Patients with Grade Group (GG) 2 or 3 prostate cancer are often ineligible for active surveillance (AS) or experience early disease progression requiring radical therapy while on AS. We investigated whether targeted focal therapy can safely reduce treatment burden for such patients. Methods: Men with unilateral, MRI-visible intermediate risk prostate cancer confirmed on MR-targeted systematic biopsy (PSA =20 ng/mL, GG 2 or 3, stage =T2), no previous treatment for prostate cancer were eligible for this prospective multicenter Phase IIb study (NCT01657942). MRgFUS (Exablate, Insightec) was delivered focally to the GG 2 or 3 lesion, with a margin of normal tissue (=5 mm). The treatment was monitored with real-time MR thermometry. Concurrent GG 1 prostate cancer foci were untreated. Safety (adverse events reported up to 12 months), oncologic outcomes (MRI-targeted systematic prostate biopsy at 6 months in all men), and genitourinary functional outcomes were assessed. Results: 101 men were treated from May 4, 2017 to December 21, 2018 at 8 healthcare centers. Median age and PSA were 63 years and 5.7 ng/mL, respectively. Percentage of men treated with GG 2 and 3 prostate cancer were 78% and 22%, respectively. No serious treatment-related adverse events were reported. Ninety-six men (95%; 95% CI 89%, 98%) had no evidence of GG=2 prostate cancer in the treated area and 79 men (78%; 95% CI 69%, 86%) had no evidence of GG=2 prostate cancer on 6-month MR-targeted systematic biopsy anywhere in the prostate gland. Median overall International Index of Erectile Function-15 (IIEF-15) erectile function scores were slightly lower at 12 months than at baseline (mean score diff of -3.50; 95% CI -5.25, -1.76), as were mean intercourse satisfaction (-1.54; 95% CI -2.46, -0.61), and overall satisfaction (-0.65; 95% CI -1.16, -0.15). Lower urinary tract symptoms, assessed by International Prostate Symptom Score (IPSS), were similar at baseline and at 12-months (difference 0.53; 95%CI -0.22, 1.28), as was IPSS-quality of life score (-0.05; 95% CI -0.25, 0.16). There was non-significant differences in mean Functional Assessment of Cancer Therapy -Prostate (-1.0, 95% CI -3.4, 1.4). Conclusions: MRgFUS focal therapy using real-time MR thermometry has a low rate of genitourinary adverse events and is effective for GG 2 and 3 prostate cancer, based on 6-month biopsy outcomes. This approach may enable men to consider a tissue-preserving approach and defer or avoid radical therapy. Source Of Funding: Insightec, Inc © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1117-e1117 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Behfar Ehdaie* More articles by this author Clare Tempany More articles by this author Ford Holland More articles by this author Adam Kibel More articles by this author Quoc-Dien Trinh More articles by this author Jeremy Durack More articles by this author Oguz Akin More articles by this author Dan Sperling More articles by this author Jeffrey Wong More articles by this author Bertram Yuh More articles by this author David Woodrum More articles by this author Lance Mynderse More articles by this author Steven Raman More articles by this author Allan Pantuck More articles by this author Marc Schiffman More articles by this author Timothy McClure More articles by this author Pejman Ghanouni More articles by this author Geoffrey Sonn More articles by this author Expand All Advertisement PDF downloadLoading ...

MP27-10 DIRECT AND MARGINAL COST ANALYSIS OF NOT AIMING FOR THE TARGET IN A MRI-TARGETED PROSTATE BIOPSY PATHWAY

INTRODUCTION AND OBJECTIVE: The overall diagnostic yield of clinically significant prostate cancer (csPCa) in non-targeted biopsies in men with a suspicious mpMRI is reported to be 1 to 11%. The aim of this multi-centre study was to evaluate non-targeted prostate biopsies when performed alongside MRI-targeted biopsies, in terms of direct cost and marginal analysis (MA), pathologist reporting and MDT reviewing time. METHODS: A prospective online cancer pathway registry of 1,719 consecutive patients (Apr/2017-Oct/2019). MA defined as cost to diagnose one additional case of csPCa. reference cost of GBP£119/biopsy. Pathologist reporting and tumour board reviewing time of 8 minute/biopsy and 1 minute/biopsy, respectively, were used. Patients were advised transperineal biopsy if MRI score was 4-5 or 3 with PSA-density >/=0.12. csPCA was defined as Gleason >/=3+4. RESULTS: Mean age, median PSA and median prostate volume 65.7yrs (SD 8.5), of 6.7 (IQR 4.9-9.9) ng/ml and 50cc (IQR 35-75), respectively. 846 (49.2%) underwent biopsy with csPCa identified in 51.4% (435/846). csPCa was exclusively present in non-targeted prostate biopsies (i.e targeted biopsies had no cancer) in 2.5% (16/638). Direct cost of non-targeted negative or insignificant PCa was at £74,018.00 with 4,976 minutes of pathologist reporting and 622 minutes of tumour board reviewing time required. MA reported average cost per targeted and non-targeted case was £246.89 and £602.57, respectively. Marginal cost per case was £246.89 for targeted and £9,013.65 for exclusively non-targeted biopsy csPCa. CONCLUSIONS: Non-targeted biopsies performed in an MRI targeted-biopsy pathway have large direct and marginal costs per case. These consume valuable pathologist time but confer diminishing marginal benefit.Source of Funding: Imperial College Healthcare Charity

MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis

BackgroundThe use of 12-core systematic prostate biopsy is associated with diagnostic inaccuracy that contributes to both overdiagnosis and underdiagnosis of prostate cancer. Biopsies performed with magnetic resonance imaging (MRI) targeting may reduce the misclassification of prostate cancer in men with MRI-visible lesions.MethodsMen with MRI-visible prostate lesions underwent both MRI-targeted and systematic biopsy. The primary outcome was cancer detection according to grade group (i.e., a clustering of Gleason grades). Grade group 1 refers to clinically insignificant disease; grade group 2 or higher, cancer with favorable intermediate risk or worse; and grade group 3 or higher, cancer with unfavorable intermediate risk or worse. Among the men who underwent subsequent radical prostatectomy, upgrading and downgrading of grade group from biopsy to whole-mount histopathological analysis of surgical specimens were recorded. Secondary outcomes were the detection of cancers of grade group 2 or higher and grade group 3 or higher, cancer detection stratified by previous biopsy status, and grade reclassification between biopsy and radical prostatectomy.ResultsA total of 2103 men underwent both biopsy methods; cancer was diagnosed in 1312 (62.4%) by a combination of the two methods (combined biopsy), and 404 (19.2%) underwent radical prostatectomy. Cancer detection rates on MRI-targeted biopsy were significantly lower than on systematic biopsy for grade group 1 cancers and significantly higher for grade groups 3 through 5 (P<0.01 for all comparisons). Combined biopsy led to cancer diagnoses in 208 more men (9.9%) than with either method alone and to upgrading to a higher grade group in 458 men (21.8%). However, if only MRI-target biopsies had been performed, 8.8% of clinically significant cancers (grade group ≥3) would have been misclassified. Among the 404 men who underwent subsequent radical prostatectomy, combined biopsy was associated with the fewest upgrades to grade group 3 or higher on histopathological analysis of surgical specimens (3.5%), as compared with MRI-targeted biopsy (8.7%) and systematic biopsy (16.8%).ConclusionsAmong patients with MRI-visible lesions, combined biopsy led to more detection of all prostate cancers. However, MRI-targeted biopsy alone underestimated the histologic grade of some tumors. After radical prostatectomy, upgrades to grade group 3 or higher on histopathological analysis were substantially lower after combined biopsy. (Funded by the National Institutes of Health and others; Trio Study ClinicalTrials.gov number, NCT00102544.)

MRI-Targeted and Systematic Biopsy for Prostate Cancer Diagnosis

For the past several decades, transrectal, ultrasonographically guided, 12-core systematic biopsy has been the most widely applied technique for the

Complication Rates After TRUS Guided Transrectal Systematic and MRI-Targeted Prostate Biopsies in a High-Risk Region for Antibiotic Resistances.

Introduction: There is still an ongoing debate whether a transrectal ultrasound (TRUS) approach for prostate biopsies is associated with higher (infectious) complications rates compared to transperineal biopsies. This is especially of great interests in settings with elevated frequencies of multidrug resistant organisms (MDRO).Materials and Methods: Between 01/2018 and 05/2019 230 patients underwent a TRUS-guided prostate biopsy at the department of Urology at University Hospital Frankfurt. Patients were followed up within the clinical routine that was not conducted earlier than 6 weeks after the biopsy. Among 230 biopsies, 180 patients took part in the follow-up. No patients were excluded. Patients were analyzed retrospectively regarding complications, infections and underlying infectious agents or needed interventions.Results: Of all patients with follow up, 84 patients underwent a systematic biopsy (SB) and 96 a targeted biopsy (TB) after MRI of the prostate with additional SB. 74.8% of the patients were biopsy-naïve. The most frequent objective complications (classified by Clavien-Dindo) lasting longer than one day after biopsy were hematuria (17.9%, n = 32), hematospermia (13.9%, n = 25), rectal bleeding (2.8%, n = 5), and pain (2.2%, n = 4). Besides a known high MDRO prevalence in the Rhine-Main region, only one patient (0.6%) developed fever after biopsy. One patient each (0.6%) consulted a physician due to urinary retention, rectal bleeding or gross hematuria. There were no significant differences in complications seen between SB and SB + TB patients. The rate of patients who consulted a physician was significantly higher for patients with one or more prior biopsies compared to biopsy-naïve patients.Conclusion: Complications after transrectal prostate biopsies are rare and often self-limiting. Infections were seen in <1% of all patients, regardless of an elevated local prevalence of MDROs. Severe complications (Clavien-Dindo ≥ IIIa) were only seen in 3 (1.7%) of the patients. Repeated biopsy is associated with higher complication rates in general.

Detection of significant prostate cancer through magnetic resonance imaging targeted biopsy of PI-RADS3 lesions in African American patients based on prostate specific antigen density threshold of 0.15 ng/ml2: Analysis of patient population from the Vattikuti Urology Institute.

286 Background: A prostate specific antigen density (PSAD) threshold of 0.15 ng/ml2 have been suggested for significant cancer detection in PI-RADS 3 lesions to avoid unnecessary magnetic resonance imaging targeted biopsy (MRI-TB) of these lesions. However, the performance of this threshold in African American (AA) patients is not well characterized. Methods: We analyzed our institutional data base of MRI-TB to identify the rate of significant prostate cancer (Pca) detection in PI-RADS3 lesions in AA patients stratified by PSAD threshold of &lt; 0.15 vs. ≥0.15 ng/ml2 and lesion size of &lt; 1 cm vs ≥ 1 cm. Significant prostate cancer was defined as Gleason grade group 2 or higher on MRI-TB of the PI-RADS 3 lesion. Results: Of 768 patients included in the database, 211 (27.5%) patients identified themselves as AAs. Mean age of AA patients was 63 years and mean PSAD was 0.21. Sixty nine (32.7%) AA patients were found to have PI-RADS 3 lesions. Mean PSAD of AA patients with PI-RADS 3 lesions was 0.21 ng/ml2 as well. Fifty percent of AA patients with PI-RADS 3 lesions had PSAD ≥0.15 ng/ml2. Significant Pca detection rate for AA patients with PI-RADS 3 lesions was 9% for PSAD of ≥ 0.15 vs. 0.03% percent for AA patients with PSAD &lt; 0.15 ng/ml2 (OR 7.056, CI 1.017-167.9, P=0.04). Stratification by lesion size (&lt; 1 cm vs. &gt; 1 cm) resulted in missing 0% percentage of significant Pca when only AA patients with PSAD ≥ 0.15 ng/ml2 and lesion size ≥ 1 cm received MRI-TB. Conclusions: We report on the performance of a reported PSAD density threshold in detecting significant Pca in one of the largest series of AA patients receiving MRI-TB of the prostate. Our results have direct clinical implications when counseling AA patients with PI-RADS 3 lesion on whether they should undergo MRI-TB of such lesions.

MRI-targeted biopsies in prostate cancer screening and the value of its combination with blood-based risk-prediction: The randomized, diagnostic study STHLM3MRI.

TPS378 Background: Blood-based biomarkers and magnetic resonance imaging followed by targeted biopsies have been suggested to improve detection of prostate cancer by increasing sensitivity to detect significant disease, decrease over-detection of low-risk cancers and avoid benign biopsies. The STHLM3-MRI projects aims to assess the value of combining blood-based risk prediction with bi-parametric MRI (bpMRI) in the prostate cancer diagnostic chain. Methods: The STHLM3MRI Main Study is a randomized, diagnostic study recruiting ≈10,000 Swedish men aged 50-74 for prostate cancer testing in a screen-by-invitation setting. The study design includes a first paired step (blood-test) followed by a randomized step (biopsy technique). Participants with elevated blood-test levels (PSA≥3ng/ml or Stockholm3 test≥11% risk of GG≥2 cancer) are recommended further work-up and randomized 2:3 to 12-core systematic biopsies (standard arm) or to bpMRI followed by MRI-targeted biopsies and systematic biopsies in men with PI-RADSv2 ≥3 lesions (experimental arm). Endpoints include number of detected prostate cancers, number of performed biopsy procedures and number of performed MRIs. The study is centralized to three biopsy sites, one radiology department and one pathology department. A data safety and monitoring board monitors study progress and participant safety. There are two pre-planned main analyses. First, we will report the first large randomized evidence comparing MRI-targeted biopsies and systematic biopsies for prostate cancer detection in a screen-by-invitation setting. Second, we will report a comparison of a diagnostic strategy including the Stockholm3 blood-test and MRI-targeted biopsies with standard practice using PSA and systematic biopsies. A third analysis will compare the use of the bloodtests PSA and Stockholm3 for risk-stratification of men undergoing MRI-targeted biopsy. 9 Oct 2019 the study had included 47% of planned participants (n = 4,701), aiming to close inclusion by March 2020 with first report during 2020. The study is registered at ClinicalTrials.gov: NCT03377881 and has regional ethical approval (2017-1280/31). Clinical trial information: NCT03377881.

Current status and future prospective of focal therapy for localized prostate cancer: development of multiparametric MRI, MRI-TRUS fusion image-guided biopsy, and treatment modalities.

Multiparametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPC) because of its usefulness in combination with anatomic and functional data. MRI-targeted biopsy, such as MRI-transrectal ultrasound (TRUS) fusion image-guided prostate biopsy, has high accuracy in the detection and localization of csPC. This novel diagnostic technique contributes to the development of tailor-made medicine as focal therapy, which cures the csPC while preserving the anatomical structures related to urinary and sexual function. In the early days of focal therapy, TRUS-guided systematic biopsy was used for patient selection, and treatment was performed for patients with low-risk PC. With the introduction of mpMRI and mapping biopsy, the treatment range is now determined based on individualized cancer localization. In recent prospective studies, 87.4% of treated patients had intermediate- and high-risk PC. However, focal therapy has two main limitations. First, a randomized controlled trial would be difficult to design because of the differences in pathological features between patients undergoing focal therapy and radical treatment. Therefore, pair-matched studies and/or historical controlled studies have been performed to compare focal therapy and radical treatment. Second, no long-term (≥ 10-year) follow-up study has been performed. However, recent prospective studies have encouraged the use of focal therapy as a treatment strategy for localized PC because it contributes to high preservation of continence and erectile function.

The optimal core number and site for MRI-targeted biopsy of prostate? A systematic review and pooled analysis.

Prebiopsy multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized for patients of suspicious prostate cancer (PCa). However, the optimal core number and site for MRI-targeted biopsy have not been clearly elucidated. A systematic search in Pubmed, Embase and Ovid up to June 2019 was conducted and we identified studies reporting detection details of every MRI-targeted core. The incremental diagnostic value of performing additional cores was pooled on per-lesion analysis. Our secondary outcome concentrated on detection accuracy for cores of different site within one lesion. Five studies comprising 2291 patients were identified to elucidate the association between targeted core number and cancer detection rates. Adding the second core to the first one resulted in 19.8% (range: 13.6-26.7%) increase in the detection rate of clinically significant lesions, and adding the third one to the first two resulted in 11.5% (range: 7.8-14.3%) increase. The incremental value of adding the fourth or the fifth core was 6.0% (4.7%, 6.9%) and 4.1% respectively. Four studies arranging MRI-targeted biopsy of more than two cores in well-determined sequences indicated more positive cores with higher cancer grade through center of the lesions. Increasing the number of samples per target from one to two, or two to three resulted in a nonnegligible incremental detection rate of clinically significant lesions, while obtaining more than 3 cores per target provided a diminished incremental value. And performing targeted cores accurately through center of the lesions may help improve diagnostic accuracy.

Prostate Multiparametric Magnetic Resonance Imaging Features Following Partial Gland Cryoablation

OBJECTIVETo assess the qualitative and quantitative changes on prostate multiparametric magnetic resonance imaging (mpMRI) following partial gland ablation (PGA) with cryotherapy and correlate with histopathology. METHODSWe used 3D Slicer to generate prostate models and segment ipsilateral (treated) and contralateral peripheral and transition zones in 10 men who underwent MRI/transrectal ultrasound fusion-guided PGA during 2017-2018. Pre- and post-PGA volumes of prostate segments were compared. Post-PGA mpMRI were categorized according to PI-RADS v2 and treatment response on mpMRI was assessed in a manner similar to the radiology evaluation framework following liver lesion ablation. RESULTSMedian volume of ipsilateral peripheral and transition zones decreased from 10.9 mL and 13.0 mL to 7.2 mL and 10.8 mL (P = .005), respectively. Median volume of contralateral peripheral and transition zones also decreased from 12.1 mL and 12.5 mL to 9.9 mL to 10.4 mL (P = .005), respectively. Five men had clinically significant disease (Grade group ≥2) on post-PGA biopsy (3 within treatment field and 2 outside). Of the men with clinically significant prostate cancer, mpMRI revealed PI-RADS 3 lesions in 2. However, the treatment response framework did not detect residual disease. CONCLUSIONPGA results in asymmetrical and significant reductions in prostate volume. Our results highlight the need for a separate assessment framework to enable standardization of the interpretation and reporting of post-PGA surveillance mpMRI. Moreover, our findings have significant implications for MRI-targeted surveillance biopsy following PGA with cryotherapy.

Systematic evidence analysis for comparison of MRI-targeted biopsy versus systematic biopsy in the diagnosis of prostate cancer

Systematic evidence analysis for comparison of MRI-targeted biopsy versus systematic biopsy in the diagnosis of prostate cancer

MRI-targeted biopsy versus standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis of randomized controlled trials.

For men with a suspicion of prostate cancer (PCa), the transrectal ultrasound-guided biopsy (TRUS-Bx) was recommended. Multi-parametric magnetic resonance imaging (mp-MRI) could be more useful to more accurately selected patients who are with a clinical suspicion of PCa and eligible for biopsy, and avoid a biopsy if the result was negative. In the present study, we compared the MRI-targeted biopsy (MRI-TBx) with TRUS-Bx. We searched the following online database: PubMed, Embase, and Cochrane Library, and the search was updated to March 2019. Finally, a total of 8 randomized controlled trials (RCTs) comprising 2593 patients were enrolled in the final analysis. MRI-TBx and TRUS-Bx did not significantly differ in overall PCa (RR = 1.30; 95% CI 0.98-1.72; P = 0.067), clinically significant PCa (RR = 1.35; 95% CI 0.98-1.86; P = 0.065), and clinically insignificant PCa (RR = 0.76; 95% CI 0.40-1.46; P = 0.416). While in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa (RR = 1.40; 95% CI 1.01-1.94; P = 0.045). In the present study, we found that MRI-TBx potentially benefits the detection of overall and clinically significant PCa compared with TRUS-Bx in patients with a suspicion of PCa. Furthermore, in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa and a potentially higher detection rate of clinically significant PCa. While for patients with prior negative biopsy, we did not detect significant differences in overall and clinically significant PCa between two groups. More large and multicenter RCTs are further required.

Developments in MRI-targeted prostate biopsy.

MRI-targeted prostate biopsy may be an attractive alternative to systematic biopsy for diagnosing clinically significant prostate cancer. In this narrative review, we discuss the new developments that have occurred in the advancement of MRI-targeted prostate biopsy, over the past 24 months. MRI-targeted biopsy offers enhanced diagnostic accuracy, when compared with the current standard of care of systematic transrectal ultrasound-guided (TRUS) biopsy, by decreasing the overall number of biopsies needed, maintaining or improving significant prostate cancer detection, and reducing the detection of clinically insignificant prostate cancer. The necessity of combining systematic prostate biopsy with MRI-targeted biopsy is still debated. The use of MRI--ultrasound fusion systems for lesion-targeting is promising for optimizing significant cancer detection, but recent evidence suggests that additional cognitive biopsy cores are still useful in detecting additional cancers. MRI-targeted biopsy in selected men with positive MRI offers a number of benefits over systematic biopsy in all men, and as such, may emerge as the new standard of care for the diagnosis of clinically significant prostate cancer.

MRI-Targeted Prostate Biopsy: What Radiologists Should Know.

Transrectal ultrasound (TRUS)-guided systematic biopsy, the current gold standard for the detection of prostate cancer, suffers from low sensitivity for clinically significant cancer. The use of diagnostic multiparametric MRI has increased the relevance of targeted biopsy techniques such as MRI-TRUS fusion biopsy and direct (in-bore) MRI-guided biopsy, which have higher detection rate for clinically significant cancer. Although primarily used in patients who remain at high clinical suspicion for prostate cancer despite a negative systematic biopsy, with the increasing use of upfront diagnostic MRI, these biopsies are expected to replace routine systematic biopsies. This pictorial essay aims to enhance our understanding of the concepts of these biopsy techniques so that they can be performed safely and provide maximum diagnostic yield.