Significant Prostate Cancer Detection Rate Research Articles

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

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

Does Experience Affect the Cancer Detection Rate in Cognitive Fusion Prostate Biopsy? A Comparison of the First and Last 60 Cases

Objective: We aimed to determine the contribution of the clinical experience gained in cognitive fusion prostate biopsy with the increase in the number of cases to the cancer detection rate. Materials and Methods: The records of 120 patients who underwent cognitive fusion biopsy were retrospectively analyzed. All patients underwent 3-T multiparametric magnetic resonance imaging (Mp-MRI) and they were evaluated with Prostate Imaging Reporting and Data System (PIRADS). The initial 60 cases were included in group 1, and the later subsequent 60 cases performed by the same surgeon were included in group 2. Any cancer and clinically significant prostate cancer (CSPrCa) detection rates in groups 1 and 2 were compared. Results: The mean ages of the patients for group 1 and group 2 were determined as 64.08 ± 8.15 and 65.15 ± 6.93 years, respectively. Age, prostate specific antigen (PSA), prostate volumes and the number of suspicious lesions of the groups were similar. Any cancer positivity rate was 33.3% for group 1, and 40% for group 2, without any significant intergroup difference (p=0.494). CSPrCa positivity was 40% and 70.83% for groups 1 and 2, respectively, and there was a significant improvement in CSPrCa detection in favor of group 2 (p=0.027). Conclusion: Regarding the cognitive fusion biopsies, a learning curve is required. It was concluded that the rate of detecting clinically significant prostate cancer was almost doubled with the increased experience in fusion biopsy. Keywords: Biopsy, Cognitive Fusion, Learning Curve, Magnetic Resonance Imaging, Prostate Cancer

Combination of PI-RADS score and mRNA urine test-A novel scoring system for improved detection of prostate cancer.

Available tests to detect clinically significant prostate cancer frequently lead to overdiagnosis and overtreatment. Our study assessed the feasibility of combining a urinary biomarker-based risk score (SelectMDx®) and multiparametric MRI outcomes in order to identify patients with prostate cancer on prostate biopsy with increased accuracy and reliability. Samples of 74 men with suspicion of prostate cancer and available multiparametric MRI were analysed in a prospective cross-sectional study design. First-voided urine for determination of HOXC6 and DLX1 mRNA levels was collected after digital rectal examination and prior to MRI/ultrasound fusion-guided prostate biopsy. All multiparametric MRI images were centrally reviewed by two experienced radiologists blinded for urine test results and biopsy outcome. The PI-RADS v2 was used. SelectMDx® score, PI-RADS and Gleason Sore were obtained. Associations between Gleason Score, PI-RADS scores and SelectMDx® were assessed using ANOVA and t-test. Sensitivity and specificity were assessed and evaluated as area-under-the-curve of the receiver operating characteristic. Upon biopsy, 59.5% of patients were diagnosed with prostate cancer, whereby 40.6% had high-grade prostate cancer (GS ≥ 7a). SelectMDx® scores were significantly higher for patients with positive biopsy findings (49.07 ± 25.99% vs. 22.00 ± 26.43%; p < 0.001). SelectMDx® scores increased with higher PI-RADS scores. Combining SelectMDx®, history of prior biopsy with benign histology and PI-RADS scores into a novel scoring system led to significant prostate cancer detection rates with tiered detection rate of 39%, 58%, 81% and 100% for Gleason grade group II, III, IV, and V, respectively. The area-under-the-curve for our novel sum score in receiver operating characteristic analysis was 0.84. The synergistic combination of two non-invasive tests into a sum score with increased sensitivity may help avoiding unnecessary biopsies for initial prostate cancer diagnosis. For confirmation, further prospective studies with larger sample sizes and univariate and multivariate regression analyses and decision curve analyses are required.

Avoiding Unnecessary Systematic Biopsy in Clinically Significant Prostate Cancer: Comparison Between MRI-Based Radiomics Model and PI-RADS Category.

MRI-targeted biopsy (MRTB) improves the clinically significant prostate cancer (csPCa) detection rate with fewer biopsy cores in men with suspected PCa. However, whether concurrent systematic biopsy (SB) can be avoided in patients undergoing MRTB remains unclear. To evaluate the potential value of MRI-based radiomics models in avoiding unnecessary SB in biopsy-naïve patients. Retrospective. A total of 226 patients (mean age 66.6 ± 9.02 years) with suspicion of PCa (PI-RADS score ≥ 3) and received combined cognitive MRTB with SB were retrospectively recruited and randomly divided into training (N=180) and test (N=46) cohorts at an 8:2 ratio. A 3.0 T, biparametric MRI (bpMRI) including T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) map. The whole prostate gland (PG) and the index lesion (IL) were delineated. Three radiomics models of bpMRIPG , bpMRIIL , and bpMRIPG+IL were constructed, respectively, and the performance of each radiomics model was compared with that of PI-RADS assessment. The least absolute shrinkage and selection operator (LASSO) regression method was used to select texture features. The area under the curve (AUC) and decision curve analysis were used to estimate the models. The bpMRIPG+IL radiomics model exhibited good discrimination, calibration, and net benefits, which would reduce the SB biopsy in 71.2% and 71.4% of men with PI-RADS ≥ 5 lesions in the training and test cohorts, respectively. A bpMRIPG+IL radiomics model may outperform PI-RADS category in help reducing unnecessary SB in biopsy-naïve patients. 3 TECHNICAL EFFICACY: Stage 6.

Combination of biparametric magnetic resonance imaging with prostate‐specific antigen density to stratify the risk of significant prostate cancer: Initial biopsy and long‐term follow‐up results

To assess whether the combination of biparametric magnetic resonance imaging with prostate-specific antigen density can properly stratify the risk of significant prostate cancer in patients undergoing prostate biopsies and how this approach affects the detection of prostate cancer during follow-up in patients who do not undergo prostate biopsy. In total, 411 biopsy-naïve patients who had elevated prostate-specific antigen levels and then underwent biparametric magnetic resonance imaging for suspicious prostate cancer were analyzed: 203 patients underwent prostate biopsies, whereas 208 patients did not. Significant prostate cancer detection rates stratified by the combination of Prostate Imaging Reporting and Data System score and prostate-specific antigen density were assessed in patients who underwent prostate biopsies. The cumulative incidence of prostate cancer detection during the follow-up was assessed in patients who omitted biopsy. The negative predictive value for significant prostate cancer was 89% for Prostate Imaging Reporting and Data System scores 1-3, which increased to 97% when prostate-specific antigen density <0.15 ng/ml/cm3 was combined. Among patients who did not undergo biopsy, patients with Prostate Imaging Reporting and Data System scores 1-3 plus prostate-specific antigen density <0.15 ng/ml/cm3 included significantly less cases in which significant prostate cancer was detected during the follow-up, compared with the others (3.2% versus 17% at 36 months). Restriction of prostate biopsies to patients with Prostate Imaging Reporting and Data System scores 4-5 or prostate-specific antigen density ≥0.15 ng/ml/cm3 proved to be the good biopsy strategy, effectively balancing risks and benefits.

MP53-05 CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION RATE OF PROSTATE IMAGING REPORTING AND DATA SYSTEM SCORE 4 IN THE PERIPHERAL ZONE

You have accessJournal of UrologyCME1 May 2022MP53-05 CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION RATE OF PROSTATE IMAGING REPORTING AND DATA SYSTEM SCORE 4 IN THE PERIPHERAL ZONE Gang Song, and Zhoujie Sun Gang SongGang Song More articles by this author , and Zhoujie SunZhoujie Sun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 recommends that lesions in the peripheral zone (PZ) are mainly assessed by diffusion-weighted imaging (DWI) and adjusted by dynamic contrast-enhanced (DCE). There are two possible images for PI-RADS 4 lesions in PZ. One is DWI 4, the other is DWI 3 with positive DCE (hereinafter called ‘DWI 3/DCE+’). Our objectives are to compare the clinically significant prostate cancer (csPCa) detection rate between DWI 4 and DWI 3/DCE+ in PZ and to explore the diagnostic performances of targeted biopsy (TB) alone or systematic biopsy (SB) alone for patients with DWI 3/DCE+. METHODS: We retrospectively enrolled 206 patients who underwent multiparametric magnetic resonance imaging and had at least one PI-RADS 4 lesion in the PZ. All patients subsequently underwent combined magnetic resonance imaging/ultrasound fusion-guided TB and ultrasound-guided SB. The chi-square test was used to compare the csPCa detection rates between DWI 4 and DWI 3/DCE+ lesions. Based on the TB+SB results as a standard reference, we analyzed the sensitivity, negative predictive values, and diagnostic accuracies of TB alone or SB alone. RESULTS: Patients with DWI 4 lesions had higher csPCa detection rates than those with DWI 3/DCE+ lesions when using TB+SB, TB, and SB, and the differences were significant for TB+SB or SB alone. For DWI 3/DCE+ patients whose prostate-specific antigen levels ranged from 4 to 10 ng/mL, TB alone showed the highest negative predictive value. CONCLUSIONS: Our finding suggested that DWI 4 tends to have worse results than DWI 3/DCE+. TB has an excellent ability to exclude negative csPCa in patients with DWI 3/DCE+ lesions and prostate-specific antigen levels from 4 to 10 ng/mL. Source of Funding: The Ministry of Science and Technology of China © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e897 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gang Song More articles by this author Zhoujie Sun More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP58-11 COMPARISON OF PROSTATE CANCER DETECTION RATES BETWEEN TRANS-RECTAL MRI/US FUSION AND TRANS-PERINEAL COGNITIVE TARGETED PROSTATE BIOPSY APPROACHES

You have accessJournal of UrologyCME1 May 2022MP58-11 COMPARISON OF PROSTATE CANCER DETECTION RATES BETWEEN TRANS-RECTAL MRI/US FUSION AND TRANS-PERINEAL COGNITIVE TARGETED PROSTATE BIOPSY APPROACHES Johnathan Drevik, Zafardjan Dalimov, Allen Rojhani, Phillip Abbosh, Steven Sterious, Joshua Cohn, Jay Simhan, Justin Friedlander, Eric Ghiraldi, Robert Uzzo, and Serge Ginzburg Johnathan DrevikJohnathan Drevik More articles by this author , Zafardjan DalimovZafardjan Dalimov More articles by this author , Allen RojhaniAllen Rojhani More articles by this author , Phillip AbboshPhillip Abbosh More articles by this author , Steven SteriousSteven Sterious More articles by this author , Joshua CohnJoshua Cohn More articles by this author , Jay SimhanJay Simhan More articles by this author , Justin FriedlanderJustin Friedlander More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Serge GinzburgSerge Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Many urology practices have access to MRI/US fusion technology for prostate targeting via transrectal (TR) approach. The adoption of transperineal (TP) prostate biopsy is increasing, but conversion to TP fusion technology can be financially prohibitive. Cognitive TP targeting is a cost-effective alternative but may be perceived as a barrier and assumed to result in lower cancer detection. We describe a single surgeon’s transition from TR MRI/US fusion to cognitive TP targeted biopsies. METHODS: A retrospective chat review of patients that underwent targeted prostate biopsy (either TP cognitive or TR MRI/US fusion) from 2015 - 2021 was performed. Patients with PSA > 20, concomitant procedures or metastatic disease were excluded. In patients with multiple biopsies only the first targeted biopsy was abstracted. Chi-Square and Mann-Whitney tests were utilized for univariable analysis of categorical and continuous variables, respectively. Multivariable logistic regression models were fit to evaluate variables associated with clinically significant prostate cancer on targeted biopsy. RESULTS: Of the 146 patients that underwent targeted prostate biopsy, 40% underwent TP cognitive approach. Clinicopathologic characteristics between the two groups differed in demographic distribution, prostate size, and MRI findings (Table 1). The detection of any prostate cancer (64% vs 39%, p=0.003) and clinically significant prostate cancer (csPCa) (48% vs 19%, p<0.001) were higher in the TP cognitive targeted group. On multivariable analysis, controlling for clinicopathologic characteristics, only PSA density above >0.15 ng/ml2 was associated with csPCa on targeted biopsy (Table 2). Targeted biopsy approach, TR fusion vs. TP cognitive targeted biopsy, was not associated with detection of csPCa. CONCLUSIONS: Clinically significant prostate cancer detection rate was not compromised when switching from transrectal MRI/US fusion to transperineal cognitive targeted biopsy technique. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e996 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johnathan Drevik More articles by this author Zafardjan Dalimov More articles by this author Allen Rojhani More articles by this author Phillip Abbosh More articles by this author Steven Sterious More articles by this author Joshua Cohn More articles by this author Jay Simhan More articles by this author Justin Friedlander More articles by this author Eric Ghiraldi More articles by this author Robert Uzzo More articles by this author Serge Ginzburg More articles by this author Expand All Advertisement PDF DownloadLoading ...

Utilizing lesion diameter and prostate specific antigen density to decide on magnetic resonance imaging guided confirmatory biopsy of prostate imaging reporting and data system score three lesions in African American prostate cancer patients managed with active surveillance.

The objective of the study is to identify the rate of significant prostate cancer (PCa) detection in PI-RADS3 lesions in AA patients stratified by PSAD threshold of < 0.15 vs. ≥ 0.15ng/ml2and lesion diameter of < 1cm vs ≥ 1cm. We analyzed our institutional database 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 < 0.15 vs. ≥ 0.15ng/ml2and lesion diameter of < 1cm vs ≥ 1cm. Significant prostate cancer was defined as Gleason grade group 2 or higher on MRI-TB of the PI-RADS 3 lesion. Of 768 patients included in the database, 211 (27.5%) patients identified themselves as AAs. Mean age of AA patients was 63years 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 0.21ng/ml2as well. Fifty percent of AA patients with PI-RADS 3 lesions had PSAD ≥ 0.15ng/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 < 0.15ng/ml2(OR 7.056, CI 1.017-167.9, P = 0.04). Stratification by lesion diameter (< 1cm vs. > 1cm) resulted in missing 0% of significant PCa when only AA patients with PSAD ≥ 0.15ng/ml2 and lesion diameter ≥ 1cm received MRI-TB. 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.

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.

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

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

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

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

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

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

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

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

In-bore MRI-guided prostate biopsy in a patient group with PI-RADS 4 and 5 targets: A single center experience

PurposeTo determine the diagnostic yield of magnetic resonance imaging (MRI) guided in-bore biopsy in patients with high likelihood multiparametric MRI (mpMRI) findings, regarding overall and clinically significant prostate cancer (csPCa) detection rates and concordance of biopsy and radical prostatectomy (RP) Gleason scores (GS). MethodsThis retrospective study consisted of 277 Prostate Imaging Reporting and Data System (PI-RADS) assessment category 4 and 5 targets in 246 patients (mean age, 65.7 years; median prostate specific antigen value, 7.75 ng/mL) who had undergone in-bore biopsy at our institution between 2012 and 2020. Eighty-one patients who underwent RP were eligible for the concordance analysis of biopsy and RP specimen GS. ResultsOverall PCa detection rates were 80.5 % per patient (198/246) and 78 % per target (216/277) and 83.5 % and 67.4 % in primary (biopsy naive) and secondary (at least one negative prior biopsy) settings. csPCa was found in 63 % overall, 66 % of patients (132/200) in the primary, and 50 % of patients (23/46) in the secondary biopsy settings (p < 0.001). The prostate cancer detection rate was 68 % and 92 % in PI-RADS 4 and 5, respectively (p < 0.001).In the radical prostatectomy subcohort, 27.2 % of patients were upgraded, 8.6 % of patients were downgraded from needle biopsy. Significant complications occurred in 1.2 % of patients. ConclusionsMRI-guided in-bore prostate biopsy has a high detection rate of csPCa in primary and secondary biopsy cohorts. Biopsy results were satisfactory in terms of the number of positive cores, cancer percentage in positive cores, and concordance of GS in needle biopsy and RP specimen.

Analyzing the learning curves of a novice and an experienced urologist for transrectal magnetic resonance imaging-ultrasound fusion prostate biopsy.

BackgroundThe aim of the current study was to evaluate and compare the learning curves of transrectal magnetic resonance imaging-ultrasound fusion biopsy for two urologists with different backgrounds (Operator 1: experienced, self-trained and Operator 2: novice, trained by a mentor/MRI reading courses).MethodsA cohort of 400 patients who underwent fusion prostate biopsy in our department was analyzed. The learning curves were assessed in terms of overall and clinically significant prostate cancer (PCa) detection rates, percentage of positive biopsy cores/targeted and the percentage of PCa tissue on positive targeted cores.ResultsIncreasing trends were observed for both urologists in terms of all biopsy outcomes during the study time. For the novice urologist, a significant increase was observed for overall PCa detection rate, but not for clinically significant disease (25.44%, P=0.04/15%, P=0.145). Operator 1 showed an increasing diagnosis yield of clinically significant disease up to 104 cases. Similar cancer detection rates were observed when comparing the first and last biopsies performed by both operators. Multivariate analysis adjusted for age, PSA, prostate volume, lesion diameter and PIRADS score showed an increase of PCa detection with 51% for every 52 biopsies performed (P=0.022).ConclusionsWhen starting with magnetic resonance imaging-ultrasound fusion prostate biopsy, mentoring and prostate magnetic resonance imaging reading training allow a novice urologist to demonstrate a good initial PCa detection rate. After about 52 cases, he reached a stable PCa and clinically significant PCa detection rate, that was similar to that of an experienced urologist.

Diagnostic yield of fusion magnetic resonance-guided prostate biopsy versus cognitive-guided biopsy in biopsy-naive patients: a head-to-head randomized controlled trial

The combination of MRI-guided targeted biopsy (MRGB) with systematic biopsy (SB) provides the highest accuracy in detecting prostate cancer. There is a controversy over the superiority of fusion targeted biopsy (fus-MRGB) over cognitive targeted biopsy (cog-MRGB). The present head-to-head randomized controlled trial was performed to compare diagnostic yield offus-MRGB in combination with SB with cog-MRGB in combination with SB. Biopsy-naive patients with a prostate-specific antigen level between 2 and 10 ng/dL who were candidates for prostate biopsy were included in the study. Multiparametric MRI was performed on all patients and patients with suspicious lesions with Prostate Imaging Reporting and Data System score of 3 or more were randomized into two groups. In the cog-MRGB group, a targeted cognitive biopsy was performed followed by a 12-core SB. Similarly, in the fus-MRGB group, first targeted fusion biopsy and then SBs were performed. The overall and clinically significant prostate cancer detection rates between the two study groups were compared by the Pearson χ2 test. McNemar test was used to compare detection rates yielded by SB and targeted biopsy in each study group. One-hundred men in the cog-MRGB group and 99 men in the fus-MRGB group were compared. The baseline characteristics of patients including age, PSA level, prostate volume, PSA density, and clinical stage were similar in the two groups (p > 0.05). Both the overall and clinically significant prostate cancer detection rates in the fus-MRGB group (44.4% and 33.3%, respectively) were significantly higher than cog-MRGB group (31.0% and 19.0%, respectively) (p = 0.035 and p = 0.016, respectively). The accuracy of identifying overall and clinically significant prostate cancer by fus-MRGB in biopsy-naive patients with PSA levels between 2 and 10 ng/dL is significantly higher than cog-MRGB and if available, we recommend using fus-MRGB over cog-MRGB in these patients.

Prostate cancer detection by targeted prostate biopsy using the 3D Navigo system: a prospective study.

The 3D Navigo™ system is a magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion device for prostate targeted biopsies (TB). Our aim was to evaluate the clinically significant prostate cancer (CSC) detection rate of TB using the 3D Navigo™ system. Patients who underwent TB with the 3D Navigo™ system in our center between June 2014 and May 2018 were prospectively included, excluding those who have previously received treatment for prostate cancer. A 3-Tesla MRI imaging was performed before biopsies; findings were reported according to the Prostate Imaging Reporting and Data System version 2 (PIRADS). CSC was defined by an ISUP score ≥ 2. 304 patients underwent TB. Median age was 66years (51-84). Median PSA was 7.75ng/ml (0.6-70.0). Median prostate volume was 45.0ml (15.9-221.7). PCa and CSC were found in 70.4% (214/304) and 47.7% (145/304) of the patients, respectively. The proportion of patients diagnosed with CSC among those with PCa was 67.8% (145/214). There was a significant risk of having a CSC in case of PIRADS score ≥ 4 and 5 (OR 5.0, 95% CI [2.7-9.2], P < 0.001; OR 3.2, 95% CI [1.8-5.5], P < 0.001). PIRADS score was an independent risk factor of having a CSC (OR 4.19, 95% CI [2.49-7.05], P < 0.001). There was no significant difference between pathological outcomes of TB and RP in paired analysis (P = 0.892). There was a correlation between TB and RP specimens for PCa detection (r = 0.60, P < 0.001). Detecting CSC with MRI-TRUS fusion targeted biopsies using the 3D Navigo™ system is feasible and safe. We found a positive correlation between TB and RP for ISUP scores.

Systematic Biopsy of the Prostate can Be Omitted in Men with PI-RADS™ 5 and Prostate Specific Antigen Density Greater than 15.

We evaluated the prostate cancer and clinically significant prostate cancer detection on systematic biopsy (SB), target biopsy (TB) alone and combined SB and TB in men with Prostate Imaging Reporting and Data System™ (PI-RADS™) 5 lesion. From a prospectively maintained prostate biopsy database, we identified consecutive patients with PI-RADS 5 lesion on multiparametric magnetic resonance imaging. The patients underwent multiparametric magnetic resonance imaging followed by transrectal TB of PI-RADS 5 lesion and 12-core SB. The prostate cancer and clinically significant prostate cancer (Grade Group, GG ≥2) detection on SB, TB and SB+TB were determined for all men and accordingly to prostate specific antigen density. Statistic significant was set a p <0.05. Overall, 112 patients met inclusion criteria. The detection rate of prostate cancer for SB, TB and SB+TB was 89%, 93% and 95%, respectively, and for clinically significant prostate cancer it was 72%, 81% and 85%, respectively. SB added 2% prostate cancer and 4% clinically significant prostate cancer detection to TB. A total of 78 patients had prostate specific antigen density >0.15 ng/ml2, and the detection rate of PCa for SB, TB and SB+TB was 92%, 97% and 97%, respectively, and for clinically significant prostate cancer it was 79%, 91% and 95%, respectively. In this population, if SB was omitted, 0 prostate cancer and only 4% (3) of clinically significant prostate cancer would be missed. The clinically significant prostate cancer detection rate improved with increased prostate specific antigen density for SB (p=0.01), TB (p <0.0001) and combined SB+TB (p=0.002). In patients with PI-RADS 5 on multiparametric magnetic resonance imaging and prostate specific antigen density >0.15 ng/ml2, SB marginally increases clinically significant prostate cancer detection, but not overall prostate cancer detection in comparison to TB alone. Systematic biopsy did not affect patients' management and can be omitted on this population.

Can combined multiparametric magnetic resonance imaging of the prostate and prostate-specific antigen density improve the detection of clinically significant prostate cancer: A prospective single-center cross-sectional study.

The objective of the study was to validate PIRADS v2 on 3T MRI with secondary assessment if combination of the PIRADS v2 and PSA density improves detection of clinically significant prostate cancer. We conducted a prospective study evaluating 58 patients with PSA value of >4 ng/ml from July 2017 to December 2019. Transrectal ultrasonography (TRUS) guided targeted biopsy was performed via cognitive targeting followed by systemic 12 core biopsy. Two cognitive fusion-targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI-RADS scoring system version 2.0 (PI-RADS v2) was used to describe the MRI findings. Total of 112 lesions of 58 patients were assessed via mpMRI followed by TRUS guided biopsy. A PI-RADS v2 score of ≥4 irrespective of PSA density categories and a PI-RADS v2 score of 3 with PSA density of ≥0.15 ng/mL/cc, yielded the highest overall prostate cancer and clinically significant prostate cancer detection rate. Contrary to, a PI-RADS v2 score of ≤3 and a PSA densitay of <0.15 ng/ mL/mL(low risk group), which yielded no clinically significant prostate cancer. Both PIRADS v2 score and PSA density are eminently sensitive and specific in the detection of clinically significant prostate cancers individually. However the combination of PIRADS v2 and PSA density significantly improved the accuracy of clinically significant prostate cancer detection. Patients with combination of PIRADS v2 score 33 and PSA density 30.15 ng/ml/cc should undergo prostate biopsy.

Prevalence of Prostate Cancer in PI-RADS Version 2.1 Transition Zone Atypical Nodules Upgraded by Abnormal DWI: Correlation With MRI-Directed TRUS-Guided Targeted Biopsy.

BACKGROUND. In PI-RADS version 2.1 (v2.1), atypical transition zone (TZ) nodules (homogeneous circumscribed nodules without full encapsulation) assigned category 2 can be upgraded to category 3 when showing markedly restricted diffusion. The prevalence of prostate cancer (PCa) in DWI-upgraded atypical nodules is unknown. OBJECTIVE. The purpose of this study was to evaluate the prevalence of PCa in DWI-upgraded TZ atypical nodules and compare PCa diagnosis rate with that for conventional score 3 TZ nodules. METHODS. We retrospectively identified 104 consecutive cases of men who underwent MRI-directed transrectal ultrasound-guided targeted biopsy of 109 TZ category 3 or lower nodules performed between January 2015 and July 2018. Three radiologists who were blinded to the scores independently rescored lesions using PI-RADS v2.1. Agreement was assessed by Cohen kappa score. Consensus diagnosis was established by a second-round joint review. The number of TZ atypical nodules with or without DWI-upgraded and conventional score 3 TZ nodules were recorded and compared with targeted biopsy results including any PCa or clinically significant PCa (csPCa, defined as International Society of Urological Pathology [ISUP] grade group ≥ 2) using chi-square analysis. RESULTS. There were 95 PI-RADS v2.1 category 3 (55 conventional T2-weighted MRI score 3 and 40 DWI-upgraded atypical nodules) and 14 category 2 or 1 nodules at consensus review with patient mean age of 64.8 ± 8.4 (SD) years, PSA of 10.6 ± 7.2 ng/mL, and nodule size of 15.1 ± 5.5 mm. Interobserver agreement ranged from slight to substantial for radiologists 1 and 2 (κ = 0.329), radiologists 1 and 3 (κ = 0.548), and radiologists 2 and 3 (κ = 0.652). From the 40 upgraded atypical nodules, 27.5% (11/40) had PCa and 7.5% (3/40) had csPCa (8 ISUP grade 1, 2 ISUP grade 2, 1 ISUP grade 3), compared with 43.6% (24/55) PCa and 20.0% (11/55) csPCa (13 ISUP grade 1, 6 ISUP grade 2, 3 ISUP grade 3, 2 ISUP grade 4) diagnosed in conventional T2-weighted score 3 nodules (p = .09 for csPCA and p = .11 for PCa). PCa was not diagnosed in any atypical nodule that was not upgraded on DWI. CONCLUSION. The prevalence of PCa in DWI-upgraded TZ atypical nodules was low (≈ 28% for any PCa and ≈ 8% for csPCa) and compared favorably to csPCa diagnosis rates in conventional TZ score 3 nodules. CLINICAL IMPACT. This study validates the DWI upgrade rule introduced in PI-RADS v2.1 for atypical nodules, which showed significant prostate cancer detection rates at targeted biopsy similar to those of conventional T2-weighted MRI TZ score 3 nodules.