Standard 12-core Prostate Biopsy Research Articles

Voided Urine Sample in the Diagnosis of Prostate Cancer in Patients with Serum PSA Ranging between 2.6 to 10 ng/mL

Introduction: Prostate cancer (PCa) cells are known to be shed into the prostatic urethra and thus can be collected through a voided urine sample. In this preliminary prospective study, we have assessed the feasibility of detecting cancer of the prostate using a voided urine sample and targeting the genomic VPAC receptors in patients with lower urinary tract symptoms and a serum PSA ranging between 2.6 to 10 ng/mL. Materials & Methods: Patients ≥40 years old, with lower urinary tract symptoms and serum prostate-specific antigen (PSA) ranging between 2.6 - 10 ng/mL formed the study group. The voided urine sample was collected from all these patients for biomarker testing. All patients underwent a standard 12-core prostate biopsy. The results of the histopathological studies were then compared to the results of the urine biomarker. Results: A total of 76 male subjects presented to our hospital with lower urinary tract symptoms and a serum PSA ≥ 2.6 and ≤ 10 ng/mL. The voided urine sample was positive for malignant cells in 24/25 (96%) patients with PCa. There was one case of a false negative in this group. Histopathological examination of the core biopsy specimens was positive for malignancy in 23 (92%) cases of PCa. Conclusions: Voided urine samples can be used to diagnose PCa by targeting the VPAC receptors that are expressed on malignant cells. This test is highly sensitive and serum PSA levels or Gleason’s score have no impact on the sensitivity of this test.

Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy

We evaluated the surgical margin status after radical prostatectomy according to sites positive for prostate cancer on standard 12-core transrectal ultrasound-guided prostate biopsy. Among patients who underwent radical prostatectomy at Boramae Medical Center, 520 patients with preoperative prostate-specific antigen (PSA) level < 20 ng/mL and locally confined prostate cancer on preoperative magnetic resonance imaging, treated with nerve-sparing radical prostatectomy, were included in the analysis. The surgical margin was positive for cancer in 166 (31.9% of the total) patients. The preoperative PSA level (9.3 vs. 8.0, ng/mL p = 0.001) and number of positive cores on 12-core prostate biopsy (4.1 vs. 3.4, p = 0.003) were significantly higher in patients with positive surgical margins. Moreover, the biopsy Gleason grade was higher in patients with positive surgical margins (p = 0.001). However, the pathologic Gleason grade and tumor volume were equivalent between the 2 groups. On multivariate analysis, the detection of prostate cancer on anterior lateral biopsy was associated with an increased rate of positive surgical margins (hazard ratio [HR]: 1.781, p = 0.008) after adjusting for other variables. Anterior lateral (HR: 1.919, p = 0.020), basal lateral (HR: 9.176, p < 0.001), basal medial (HR: 3.302, p = 0.031), and mid lateral (HR: 2.501, p = 0.044) biopsies were associated with positive apical, posterior, basal, and lateral surgical margins, respectively, after adjusting for other variables. The sites of prostate cancer on standard 12-core prostate biopsy could be useful for predicting surgical margin positivity after radical prostatectomy. In other words, clinicians should consider the sites of prostate cancer on prostate biopsy to reduce margin positivity after radical prostatectomy.

Clinical factors for predicting malignancy in patients with PSA &lt; 10 ng/mL and PI‐RADS 3 lesions

To determine clinical risk factors in patients with PI-RADS 3 lesions and prostate-specific antigen (PSA)<10ng/mL. In this prospective study, all patients underwent multiparametric magnetic resonance imaging. Following the 2-5 core fusion-targeted biopsy, standard 12-core prostate biopsy was performed in each patient (combined biopsy). The cutoff values were calculated with receiver-operating characteristic analysis. First, univariate logistic regression analysis was used to evaluate the relationship between total eight parameters and prostate cancer. Subsequently, multiple logistic regression analysis was performed to the parameters associated with prostate cancer. Two hundred and eighty-eight patients were included in the study. Some clinical parameters are determined to be significant in univariate and multiple logistic regression analyses, including PSA, free/total PSA ratio, PSA density (PSA/total prostate volume), positive family history of PCa, and PI-RADS 3 lesion diameter. Patients were classified between 0 and 5 according to the number of risk factors. While the risk of cancer was 7.1% in patients with one or less risk factors, the PCA rate was 45.2% among patients with all risk factors. In patients with PI-RADS 3 lesion and PSA<10ng/mL, histopathological results of biopsy can be estimated with higher accuracy using some clinical parameters.

Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy.

ABSTRACTObjectives Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB.Materials and Methods Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS <3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps.Results 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p <0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140).Conclusion FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.

Comparison of the Upgrading Rates of International Society of Urological Pathology Grades and Tumor Laterality in Patients Undergoing Standard 12-Core Prostate Biopsy versus Fusion Prostate Biopsy for Prostate Cancer

Background: Histopathological discrepancies between biopsy and radical prostatectomy (RP) specimens may lead to unnecessary, excessive, or incomplete treatment in prostate cancer (PCa) patients. Objectives: To compare the upgrading rates of International Society of Urological Pathology (ISUP) grades and tumor laterality in patients that underwent standard 12-core transrectal ultrasound-guided standard prostate biopsy (SPB) versus multiparametric magnetic resonance-guided fusion prostate biopsy (FPB) for PCa. Methods: This retrospective study included 152 patients that underwent prostate biopsy and RP in our clinic. The patients were divided into 2 groups: Group A (n = 90) included patients that underwent SPB and Group B (n = 62) included patients that underwent FPB (targeted biopsy + standard biopsy). Upgrading of ISUP grades, tumor laterality, and upgrading of tumor laterality were compared between the 2 groups. Upgrading of tumor laterality defined as detection of tumor at both lobes in RP pathology while it was at unilateral lobe in biopsy pathology. Results: ISUP grade 1 was the most common histopathology in both groups. The ISUP upgrading rate on final pathology was significantly lower in the FPB group compared to the SPB group (22.7 vs. 37.7%; p < 0.048). Similarly, the upgrading rate of tumor laterality was lower in the FPB group compared to the SPB group (37.7 vs. 9.7%; p < 0.001). Conclusion: The results suggested that FPB can provide more accurate results compared to SPB.

Improving Detection of Clinically Significant Prostate Cancer: Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Guided Prostate Biopsy

Given the limitations of prostate specific antigen and standard biopsies for detecting prostate cancer, we evaluated the cancer detection rate and external validity of a magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy system used at the National Institutes of Health. We performed a phase III trial of a magnetic resonance imaging/transrectal ultrasound fusion guided prostate biopsy system with participants enrolled between 2012 and 2013. A total of 153 men consented to the study and underwent 3 Tesla multiparametric magnetic resonance imaging with an endorectal coil for clinical suspicion of prostate cancer. Lesions were classified as low or moderate/high risk for prostate cancer. Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy and standard 12-core prostate biopsy were performed and 105 men were eligible for analysis. Mean patient age was 65.8 years and mean prostate specific antigen was 9.5 ng/ml. The overall cancer detection rate was 62.9% (66 of 105 patients). The cancer detection rate in those with moderate/high risk on imaging was 72.3% (47 of 65) vs 47.5% (19 of 40) in those classified as low risk for prostate cancer (p<0.05). Mean tumor core length was 4.6 and 3.7 mm for fusion biopsy and standard 12-core biopsy, respectively (p<0.05). Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy detected prostate cancer that was missed by standard 12-core biopsy in 14.3% of cases (15 of 105), of which 86.7% (13 of 15) were clinically significant. This biopsy upgraded 23.5% of cancers (4 of 17) deemed clinically insignificant on 12-core biopsy to clinically significant prostate cancer necessitating treatment. Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy can improve prostate cancer detection. The results of this trial support the external validity of this platform and may be the next step in the evolution of prostate cancer management.

A Real-Time Electrical Impedance Sensing Biopsy Needle

Diagnostic confirmation of cancer in solid organs is based on biopsy findings. In a standard 12-core prostate biopsy protocol, conventional biopsy needles sample only 0.95% (∼0.228 cm³) of a typical 24-cm³ prostate gland. The primary objective of this study was to enhance the sensitivity of standard biopsy protocol by gauging electrical properties of tissue simultaneously with tissue extraction for histopathology analysis. A conventional biopsy (Bx) needle was instrumented with an electrical impedance spectroscopy (EIS) sensor to interrogate the tissue volume surrounding the needle tip. The EIS-Bx device was evaluated in a series of saline bath and ex vivo porcine experiments. It was found to sense a volume of 0.286 cm³ of tissue around the needle tip. EIS measurements were recorded from three ex vivo human prostates using the device, and the extracted biopsy cores were histologically assessed. Prostate conductivity σ ranged from 0.179 to 0.3310 S/m for benign tissues and 0.0746 to 0.0837 S/m for malignant tissues at frequencies ranging from 1 to 100 kHz. Relative permittivity ϵ(r) ranged from 2.10×10⁶ to 2.9 × 10⁴ for benign and 6.63×10⁵ to 5.3 × 10³ for cancer tissues over the same frequency range. Both are found to be significantly higher in normal prostate tissues than in malignant tissue (p < 0.00001).