Standard Transrectal Ultrasound-guided Biopsy Research Articles

A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer. Reply.

No AccessJournal of UrologyReply to Letters to the Editor16 Mar 2023A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer. Reply. Kai Zhang, Jeremy Teoh, Pilar Laguna, Chi-Fai Ng, and Jean de la Rosette Kai ZhangKai Zhang Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China More articles by this author , Jeremy TeohJeremy Teoh S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author , Pilar LagunaPilar Laguna Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author , Chi-Fai NgChi-Fai Ng S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author , and Jean de la RosetteJean de la Rosette Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003405AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer. Reply.." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . A multicenter, randomized, single-blind, 2-arm intervention study evaluating the adverse events and quality of life after irreversible electroporation for the ablation of localized low-intermediate risk prostate cancer. J Urol.2023; 209(2):347-353. Link, Google Scholar 2. . Focal therapy in prostate cancer-report from a consensus panel. J Endourol. 2010; 24(5):775-780. Crossref, Medline, Google Scholar 3. . Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol.2015; 68(3):438-450. Crossref, Medline, Google Scholar 4. . Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol.2020; 17(1):41-61. Crossref, Medline, Google Scholar 5. . Transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy combined with standard template improves prostate cancer detection. J Urol.2022; 207(1):86-94. Link, Google Scholar 6. . Schema and cancer detection rates for transperineal prostate biopsy templates: a review. Ther Adv Urol.2022; 14:175628722211050. Crossref, Google Scholar 7. . EAU—EANM—ESTRO—ESUR—ISUP—SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol.2021; 79(2):243-262. Crossref, Medline, Google Scholar 8. . Effect of focal vs extended irreversible electroporation for the ablation of localized low- or intermediate-risk prostate cancer on early oncological control: a randomized clinical trial. JAMA Surg.2023. doi: 10.1001/jamasurg.2022.7516. Crossref, Google Scholar 9. . An updated systematic review on focal therapy in localized prostate cancer: what has changed over the past 5 years?Eur Urol.2022; 81(1):5-33. Crossref, Medline, Google Scholar 10. . Pair-matched patient-reported quality of life and early oncological control following focal irreversible electroporation versus robot-assisted radical prostatectomy. World J Urol.2018; 36(9):1383-1389. Crossref, Medline, Google Scholar Submitted February 26, 2023; accepted March 2, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kai Zhang Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China More articles by this author Jeremy Teoh S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author Pilar Laguna Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author Chi-Fai Ng S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China More articles by this author Jean de la Rosette Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey More articles by this author Expand All Submitted February 26, 2023; accepted March 2, 2023; published 000. Advertisement PDF downloadLoading ...

Comparison of Prostate Cancer Detection Rates of Cognitive Fusion-targeted Biopsy and Standard Transrectal Ultrasound-guided Biopsy

Comparison of Prostate Cancer Detection Rates of Cognitive Fusion-targeted Biopsy and Standard Transrectal Ultrasound-guided Biopsy

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.

Diagnostic Accuracy of a Rapid Biparametric MRI Protocol for Detection of Histologically Proven Prostate Cancer

ObjectiveTo evaluate the performance of a rapid, low cost, noncontrast MRI examination as a secondary screening tool in detection of clinically significant prostate cancer. MethodsIn this prospective single institution study, 129 patients with elevated prostate-specific antigen levels or abnormal digital rectal examination findings underwent MRI with an abbreviated biparamatric MRI protocol consisting of high-resolution axial T2- and diffusion-weighted images. Index lesions were classified according to modified Prostate Imaging – Reporting and Data System (mPI-RADS) version 2.0. All patients underwent standard transrectal ultrasound-guided biopsy after MRI with the urologist being blinded to MRI results. Subsequently, all patients with suspicious lesions (mPI-RADS 3, 4, or 5) underwent cognitively guided targeted biopsy after discussion of MRI results with the urologist. Sensitivity and negative predictive value for identification of clinically significant prostate cancer (Gleason score 3+4 and above) were determined. ResultsRapid biparametric MRI discovered 176 lesions identified in 129 patients. Rapid MRI detected clinically significant cancers with a sensitivity of 95.1% with a negative predictive value of 95.1% and positive predictive value of 53.2%, leading to a change in management in 10.8% of the patients. False negative rate of biparametric (bp) MRI was 4.7%. ConclusionWe found that a bp-MRI examination can detect clinically significant lesions and changed patient management in 10.8% of the patients. A rapid MRI protocol can be used as a useful secondary screening tool in men presenting with suspicion of prostate cancer.

A multicentre randomised controlled trial assessing whether MRI-targeted biopsy is non-inferior to standard transrectal ultrasound guided biopsy for the diagnosis of clinically significant prostate cancer in men without prior biopsy: a study protocol

IntroductionThe classical pathway for the diagnosis of prostate cancer is transrectal ultrasound-guided (TRUS) biopsy of the prostate initiated on the basis of a raised prostate-specific antigen (PSA). An alternative pathway...

Additional value of magnetic resonance-targeted biopsies to standard transrectal ultrasound-guided biopsies for detection of clinically significant prostate cancer

Objective: The aim of this study was to evaluate the additional value of magnetic resonance imaging-targeted biopsy (MRI-TB) to standard transrectal ultrasound-guided biopsy (SB) for detection of clinically significant prostate cancer (PCa). An additional aim was to compare the biopsy results to MRI evaluation using a Likert scale.Materials and methods: Patients with newly diagnosed localized PCa (n = 53) by clinical routine SB were prospectively included. The majority of the patients were scheduled for curative therapy before enrollment. The patients underwent multiparametric MRI (mpMRI) at 3 T using an endorectal coil followed by two MRI-TBs, using ultrasound with cognitive fusion. All included patients underwent MRI-TB, even those who had low to very low suspicion of significant PCa on mpMRI. The detection rate of significant cancer on SB versus SB + MRI-TB was compared in the 53 included patients and with whole-mounted histopathology as reference in 34 cases. Comparison of the biopsy results to MRI evaluation and interreader agreement calculation of five-point Likert score evaluation were performed.Results: In total, 32 significant (Gleason ≥7) PCa were detected by SB, while SB + MRI-TB detected an additional five significant PCa. MRI-TB alone detected 20 and missed 17 significant PCa. Ten of the significant PCa cases missed by MRI-TB had a Likert score of 3 or lower. Interreader agreement using the Likert scale was high, with a kappa value of 0.77 (95% confidence interval 0.63–0.92, p < 0.0001).Conclusion: Detection of significant PCa increased by adding MRI-TB to SB. This may not be of enough clinical value to justify the use of targeted biopsies in this patient group.

AB049. Comparison of magnetic resonance imaging-targeted prostate biopsy with standard transrectal ultrasound-guided biopsy for diagnosis of prostate cancer: a meta-analysis

ObjectiveThe implications of magnetic resonance imaging-targeted biopsy (MRI-TBx) versus transrectal ultrasound-guild biopsy (TRUS-Bx) are not well understood. To update the current evidence on the diagnostic efficacy of the MRI-TBx with TRUS-Bx for prostate cancer detection .MethodsA comprehensive literature review was conducted in Medline, Web of Science, Embase prior to January 1, 2016. We included studies that comparing MRI-TBx and TRUS-Bx in detection of overall prostate cancer and significant cancer. The meta-analysis was conducted with RevMan 5.3, and data was presented as risk difference (RD) and 95% confidence interval (CI).ResultsThirty-one clinical trials with a total of 11,117 participants were ultimately enrolled in this meta-analysis. Overall, MRI-TBx had a higher rate of overall prostate cancer detection and significant cancer detection compared to TRUS-Bx (RD: 0.08; 95% CI, 0.04–0.12; P<0.01 and RD: 0.16; 95% CI, 0.12–0.19; P<0.01). In subset of patients with initial biopsy, MRI-TBx showed a significant advantage in significant cancer detection over TRUS-Bx (RD: 0.16; 95% CI, 0.10–0.21; P<0.01). In addition, we also found an improvement in overall prostate cancer detection and significant cancer detection by MRI-TBx in men with previous negative biopsy (RD: 0.09; 95% CI, 0.03–0.14; P<0.01; and RD: 0.18; 95% CI, 0.11–0.25; P<0.01).ConclusionsThe existing evidence indicates that MRI-TBx is more efficient than TRUS-Bx for overall prostate cancer detection and significant cancer detection, especially for patients with prior negative biopsy. In addition, MRI-TBx had a higher rate of detection of significant prostate cancer in men with initial biopsy compared with TRUS-Bx.

The significance of anterior prostate lesions on multiparametric magnetic resonance imaging in African-American men

IntroductionAfrican-American (AA) men tend to harbor high-risk prostate cancer (PCa) and exhibit worse outcomes when compared to other groups. It has been postulated that AA men may harbor more anterior prostate lesions (APLs) that are undersampled by the standard transrectal ultrasound guided-biopsy (SBx), potentially resulting in greater degree of Gleason score (GS) upgrading at radical prostatectomy. We aimed to evaluate the detection rate of anterior PCa significance of APLs in AA men on multiparametric magnetic resonance imaging (mpMRI) and compare it to a matched cohort of White/Other (W/O) men. Materials and methodsA review of 1,267 men who had an mpMRI with suspicious prostate lesions and who underwent magnetic resonance transrectal ultrasound fusion-guided biopsy (FBx) with concurrent SBx in the same biopsy session was performed. All AA men were matched to a control group of W/O using a 1:1 propensity score-matching algorithm with age, prostate-specific antigen, and prostate volume as matching variables. Logistic regression analysis was used to determine predictors of APLs in AA men. ResultsOf the 195 AA men who underwent mpMRI, 93 (47.7%) men had a total of 109 APLs. Prior negative SBx was associated with the presence of APLs in AA men (Odds ratio = 1.81; 95% CI: 1.03–3.20; P = 0.04). On multivariate logistic regression analysis, smaller prostate (P = 0.001) and rising prostate-specific antigen (P = 0.007) were independent predictors of cancer-positive APLs in AA men. Comparative analysis of AA (93/195, 47.7%) vs. W/O (100/194, 52%) showed no difference in the rates of APLs (P = 0.44) or in cancer detection rate within those lesions or the distribution of GS within those cancers (P = 0.63) despite an overall higher cancer detection rate in AA men (AA: 124/195 [63.6%] vs. W/O: 97/194 [50.0%], P = 0.007). In cases where APLs were positive for PCa on FBx, the GS of APL was equal to the highest GS of the entire gland in 82.9% (29/35) and 90.9% (30/33) of the time in AA and W/O men, respectively. ConclusionCancer-positive APLs represented the highest risk GS in most cases. AA men with prior negative SBx are twice as likely to harbor a concerning APL. In our cohort, AA and W/O men had comparable rates of APLs on mpMRI. Thus, differences in APLs do not explain the higher risk of AA men for deahth due to PCa. However, targeting of APLs via FBx can clinically improve PCa risk stratification and guide appropriate treatment options.

Prostate cancer distribution in patients diagnosed by transperineal template-guided saturation biopsy: Implications for brachytherapy treatment planning

15533 Background: Prostate cancer remains undetected in approximately one-third of patients following standard transrectal ultrasound-guided biopsy. In this study, we evaluated prostate cancer incidence, anatomic distribution, Gleason score profile and tumor burden in patients diagnosed by transperineal template-guided saturation biopsy (TTSB). Methods: One hundred and seventeen patients underwent TTSB. TTSB was performed under general anesthesia. All but one patient had undergone at least one prior negative TRUS biopsy. Criteria for inclusion included an elevated PSA and/or the diagnosis of ASAP or high-grade PIN on prior biopsy. The prostate gland was divided into 24 regional biopsy locations with 1–3 biopsies per region. The median number of biopsy cores was 50. Multiple clinical parameters were evaluated as predictors for prostate cancer diagnosis. Results: The mean patient age was 64.8 years with a mean PSA of 9.1 ng/mL and a prostate volume of 78.6 cm3. On average, patients had undergone 2.1 prior negative TRUS biopsies with a mean of 22.4 core biopsies. Prostate cancer was diagnosed in 49 patients (41.9%) with a Gleason score distribution of 6–9. Patients with a prostate volume of = 60 cm3 had a higher rate of cancer diagnosis compared to patients with larger glands (66% vs. 30%). Although no anatomic region of the prostate gland was spared of cancer, there was a preponderance of anterior-based malignancies. In patients with prostate cancer, an average of 9.9 cores were involved. In multivariate analysis, pre-saturation biopsy diagnosis and prostate volume were the best predictors for prostate cancer diagnosis. Conclusions: Transperineal template-guided saturation biopsy diagnosed prostate cancer in 41.9% of previously biopsied patients. Considerable anatomic variability in prostate cancer distribution was documented. Based on this and other reports, cancer eradication will be dependent on treatment of the entire prostate gland. No significant financial relationships to disclose.