Transperineal Template-guided Mapping Biopsy Research Articles

Utility of transperineal template-guided mapping prostate biopsy in biopsy-naïve men with PI-RADS 1-2 on multiparametric magnetic resonance imaging

ObjectiveTo analyze the outcomes of transperineal template-guided mapping biopsy (TTMB) in biopsy-naïve men with multiparametric magnetic resonance imaging (mpMRI) results of Prostate Imaging-Reporting and Data System (PI-RADS) 1-2. Patients and methodsWe retrospectively reviewed TTMB outcomes in biopsy naïve patients with PI-RADS 1-2 at a single center from August 2018 to May 2023. The patients' clinicopathologic data were reviewed, clinically significant prostate cancer (csPCa) detection rates were identified. We determined significant predictive factors and determined those optimal cutoff point using receiver operating characteristic (ROC) curves. Results255 biopsy naïve patients with PI-RADS 1-2 underwent TTMB. 72 (28.2%) were diagnosed with prostate cancer and 30 (11.8%) were diagnosed with csPCa. ROC curves were used to identify predictive factors for diagnosing csPCa. Age (area under ROC curve [AUC]: 0.74, 95% CI: 0.65–0.83, P < 0.001) and prostate specific antigen density (PSAD) (AUC: 0.63, 95% CI: 0.53–0.72, P = 0.025) were significant predictive factors, and the optimal cutoff points determined using the Youden index were 65 years and 0.15 ng/mL/mL, respectively. ConclusionOf biopsy-naïve patients classified as PI-RADS 1–2, 11.8% were diagnosed with csPCa, and we identified age and PSAD as significant predictive factors. Our study will help determine the biopsy method for patients with PI-RADS 1–2 without biopsy experience.

Utility of multiple core biopsies during transperineal template-guided mapping biopsy for patients with large prostates and PI-RADS 1-2 on multiparametric magnetic resonance imaging.

BackgroundWe investigated the necessity of multiple core biopsies when performing transperineal template-guided mapping biopsy (TTMB) for patients with large prostates and no suspicious lesions on multiparametric magnetic resonance imaging (mpMRI).Materials and methodsWe retrospectively analyzed 304 patients on active surveillance (AS), 212 patients with previously negative transrectal ultrasound-guided biopsy (TRUS-Bx) and 67 biopsy naïve patients who underwent TTMB between May 2017 and December 2020. The number of core biopsies and acute urinary retention (AUR) rates were analyzed in relation to the prostate volume (PV). Cancer detection rate according to the prostate volume and Prostate Imaging-Reporting and Data System (PI-RADS) scores were compared using the Pearson Chi-square test.ResultsAUR occurred more frequently in patients with PV over 39 cc (5.5% vs. 24.4%, P < 0.001). In addition, incidence of AUR was more in patients with PV over 39 cc and PI-RADS score of 1–2 on mpMRI (3.7% vs. 22.2%, P < 0.001). There was no significant difference in the detection rates of any prostate cancer or clinically significant prostate cancer (csPCA) between the patients on AS with PV < 39 cc and PV ≥ 39 cc and PI-RADS score 1–2 (57.4% vs. 50%, P = 0.507; 17% vs. 8.8%, P = 0.412, respectively). Additionally, no significant difference was found in the detection rates of any prostate cancer or csPCA between the patients with PV < 39 cc and PV ≥ 39 cc and PI-RADS score 1–2 who either had a previously negative TRUS-Bx or were biopsy naïve (27.9% vs. 16.2%, P = 0.101, 8.2% vs. 4.1%, P = 0.31, respectively).ConclusionIncreasing the number of core biopsies of prostates measuring ≥39 cc with PI-RADS 1–2 on mpMRI does not significantly increase the detection rates of any prostate cancer or csPCA.

Predictive Factors for Acute Urinary Retention After Transperineal Template-Guided Mapping Biopsy

Purpose: We investigated the predictive factors for acute urinary retention (AUR) after transperineal template-guided mapping biopsy (TTMB).Materials and Methods: We retrospectively reviewed the records of 459 patients who had undergone TTMB between May 2017 and July 2020. Overall complications after TTMB were analyzed and categorized according to the Clavien-Dindo classification. Factors that were likely to affect AUR were analyzed using a logistic regression model.Results: Overall complications after TTMB were observed in 95 of the 459 patients (20.7%), of which AUR was the most commonly reported (17.4%, n=80), followed by hematuria (3.1%, n=14). Hematuria in one patient was categorized as Clavien-Dindo grade IIIa. All remaining complications were Clavien-Dindo grade I. In the multivariate regression model, age ≥65 (odds ratio, 2.44; 95% confidence interval [CI], 1.42–4.17; p=0.001), prostate volume ≥30 mL (odds ratio, 3.72; 95% CI, 1.19–11.62; p&lt;0.02), and number of biopsy cores ≥30 (odds ratio, 2.89; 95% CI, 1.29–6.43; p=0.01) were identified as the predictors for AUR after TTMB.Conclusions: AUR is the most common complication after TTMB. Age ≥65 years, prostate volume ≥30 mL, and number of biopsy cores ≥30 were significant predictors of AUR following TTMB.

The Impact of Body Mass Index on Freedom From Therapeutic Intervention and Quality of Life in Active Surveillance Prostate Cancer Patients.

The objective of this study was to evaluate the impact of body mass index (BMI) on overall survival, freedom from distant metastases, rates of therapeutic intervention (TI), and quality of life (QOL) in active surveillance (AS) prostate cancer patients. Three hundred forty consecutive, prospectively evaluated AS patients underwent a staging transperineal template-guided mapping biopsy before AS enrollment and were stratified by BMI (<25, 25 to 29.9, 30 to 34.9, and >35 kg/m2). Evaluated outcomes included overall survival, freedom from distant metastases, TI, QOL to include urinary, bowel, sexual function and depression and serial postvoid residual urine measurements. The relationship between BMI and anterior prostate cancer distribution was evaluated. Repeat biopsy was based on prostate specific antigen kinetics, abnormal digital rectal examination and patient preference. Of the 340 patients, 323 (95%) were Gleason 3+3 and 17 patients (5.0%) were Gleason 3+4. The median follow-up was 5.2 years (range: 1 to 14 y). At 10 years, TI was instituted in 4.7%, 2.2%, 9.5%, and 25.0% of patients in BMI cohorts <25, 25 to 29.9, 30 to 34.9, and ≥35 (P=0.075). No patient has developed distant metastases. The median time to TI was 4.86 years. In multivariate analysis, TI was most closely predicted by prostate specific antigen density (P=0.071). At 8 years, no statistical differences in urinary function, bowel function, depression or postvoid residual were noted. However, a trend for erectile dysfunction was identified (P=0.106). At 10 years, BMI did not statistically predict for TI, geographic distribution of prostate cancer or QOL parameters.

The impact of age on prostate cancer progression and quality of life in active surveillance patients.

ObjectivesTo evaluate the impact of age on overall survival (OS), freedom from distant metastasis (FDM), rates of therapeutic intervention (TI), and quality of life (QOL) in active surveillance (AS) prostate cancer patients.Materials and methodsThree hundred and five consecutive, prospectively evaluated AS patients who underwent a staging transperineal template‐guided mapping biopsy (TTMB) prior to enrollment on AS were evaluated and stratified by age. Evaluated outcomes included OS, FDM, TI, and QOL to include urinary, bowel, sexual function, and depression. Post void residual (PVR) urine measurements were also followed. Repeat biopsy was based on PSA kinetics, abnormal digital rectal examination or patient preference.ResultsOf the 305 patients, 290 (95.1%) were Gleason 3 + 3 and 15 patients (4.9%) were Gleason 3 + 4. The median follow‐up was 5.5 years (range 1‐14 years). At 10 years, TI was 0%, 1.0%, and 11.4% for patients ≤59, 60‐69, and ≥70 years of age (P < .001). No patient has developed distant metastasis. The median time to TI was 4.71 years. No statistical differences in urinary function, bowel function, or depression were noted. Potency preservation was dependent on patient age.ConclusionWithin the confines of the follow‐up of our series, younger patients were less likely to proceed to therapeutic intervention. In addition, patient age did not adversely impact QOL outcomes.

Trans-Perineal Template-Guided Mapping Biopsy vs. Freehand Trans-Perineal Biopsy in Chinese Patients With PSA < 20 ng/ml: Similar Cancer Detection Rate but Different Lesion Detection Rate.

The present study aimed to investigate the diagnostic efficacy and the regional location of prostate cancer (PCa) as well as the accuracy of assessment between trans-perineal template-guided mapping biopsy (TTMB) and freehand trans-perineal biopsy (FTPB) for men with PSA < 20 ng/ml. Thus, we evaluated 623 consecutive patients with PSA < 20 ng/ml who had prostate biopsies in our institute between July 2017 and September 2018. Patients were divided into two groups based on different biopsy methods: 217 (34.83%) patients with TTMB and 406 (65.17%) with FTPB. Thirty six patients with TTMB and 80 with FTPB had continued undergone radical prostatectomy after a cancer diagnosis. Then the Gleason score of the biopsy and the post-radical prostatectomy specimens in each patient were compared. Overall, the PCa detection rate was 34.35%. There was no significant difference in PCa detection rate between TTMB and FTPB (35.48 vs. 33.74%, respectively; p = 0.663). Besides, the detection rate of significant PCa (Gleason score ≥ 7) in TTMB was 29.03% while FTPB was 23.89% (p = 0.162). The detection rate at the apex of the prostate was higher than the detection rate at the base of the prostate (9.80 vs. 5.79%; p < 0.01) when performing the TTMB. The FTPB would miss 10% of the positive diagnosis and almost half of the lesions. The upgraded of Gleason score from biopsy to post-radical prostatectomy was 16.67% with the TTMB and 36.25% with the FTPB (p = 0.034). The TTMB had a similar cancer detection rate, but a higher lesion detection rate and more accuracy in assess the actual Gleason score when comparing to FTPB for men with PSA < 20 ng/ml. By performing a 20-core TTMB, the cancer detection rate at the apex of the prostate was higher than the base.

Cancer Location in Upgrading and Detection after Transperineal Template-Guided Mapping Biopsy for Patients in Active Surveillance and Negative Transrectal Ultrasonography-Guided Prostate Biopsy

Objectives: We investigated the efficacy of transperineal template-guided mapping biopsy (TTMB) for patients on active surveillance (AS) or those with previous negative transrectal ultrasound-guided biopsy (TRUS-Bx). Methods: We retrospectively analyzed 99 patients on AS and 60 patients with previous negative TRUS-Bx, which is a total of 159 patients who underwent TTMB from May 2017 to January 2019. Cancer location was analyzed with focus on the anterior and apex lesions of the prostate after TTMB. Multiparametric magnetic resonance imaging was performed before TTMB. Cancer location after TTMB in 138 patients, excluding 21 patients who were not eligible for analysis (4 patients on AS and 17 patients with previous negative TRUS-Bx) was compared with Prostate Imaging-Reporting and Data System version 2 (PI-RADS^TM v2) score. Factors that may affect detecting cancer after TTMB with previous negative TRUS-Bx was analyzed using a logistic regression model. Results: In AS patients, 29 patients (29.3%) exhibited an upgrade in Gleason score (GS) after TTMB. Among them, 22 patients (75.9%) showed at the anterior or apex lesions. In patients with previous negative TRUS-Bx, 18 patients (30.0%) were diagnosed with prostate cancer. Among them, 13 patients (72.2%) exhibited cancer at the anterior or apex lesion. Among the 25 AS patients with PI-RADS^TM score 1–2, 5 patients (20.0%) showed an upgrade in GS. Among the 26 patients with previous negative TRUS-Bx and PI-RADS^TM score 1–2, 6 patients (23.1%) had cancer. In multivariate regression model, prostate volume (OR 0.951) was identified as the predictor for a positive biopsy result after TTMB with previous negative TRUS-Bx. Conclusions: TTMB is efficient for patients on AS in the detection of upgraded cancer located in anterior or apex or those with previous negative TRUS-Bx in the detection of anterior or apex cancer. In PI-RADS^TM score 1–2, a substantial proportion of patients after experienced upgrade in GS on AS patients or cancer detection on previous negative TRUS-Bx. Moreover, we identified prostate volume is the independent predictor for a positive biopsy result after TTMB with previous negative TRUS-Bx.

Active surveillance outcomes in prostate cancer patients: the use of transperineal template-guided mapping biopsy for patient selection.

To evaluate active surveillance (AS) outcomes including overall survival (OS), freedom from distant metastases (FDM), freedom from therapeutic intervention (FTI), and quality of life (QOL) outcomes in prostate cancer patients using transperineal template-guided mapping biopsy (TTMB) for patient selection. From April 2005-January 2016, 226 consecutive, prospectively evaluated prostate cancer patients underwent TTMB for either low-grade prostate cancer or persistently elevated prostate-specific antigen (PSA) and/or the presence of ASAP. Evaluated outcomes included OS, FDM, FTI and QOL including urinary, bowel, sexual function and depression. Repeat biopsy was based on PSA kinetics and/or abnormal digital rectal examination. Of the 226 patients, 212 (93.8%) were Gleason 3 + 3 and 14 (6.2%) were Gleason 3 + 4. The median follow-up was 5.0years (range 0.8-13.0years). The mean prostate volume was 61.3cm3 with a mean of 59.5 TTMB cores/patient. At the time of AS enrollment, an average of 72.9 cores (TRUS + TTMB) had been obtained for each patient. At 8years, OS, FTI and FDM were 92.5, 96.8 and 100%. Two hundred and twenty-two patients (98.2%) had a PSA doubling time of more than 3years. No statistical changes in urinary function, bowel function or depression were noted. At 8years, 73% of the patients maintained erectile function. Within the confines of the follow-up of this study, the use of TTMB for patient selection identifies a cohort of patients unlikely to develop biochemical or clinical progression and maintain a favorable quality of life.

Whole-gland salvage treatment for recurrent prostate cancer after initial definitive radiotherapy: A case series of 125I brachytherapy and robot-assisted radical prostatectomy.

PurposeTo analyze outcomes following whole-gland salvage treatments applied to patients with pathology-proven, locally recurrent prostate cancer following primary definitive radiotherapy.Material and methodsEighteen consecutive patients who received whole-gland salvage treatments at our institution were retrospectively reviewed. All patients underwent transperineal template-guided mapping biopsy (TTMB) using the standard iodine-125 (125I) brachytherapy (BT) setup. Twelve patients received 125I BT, and six patients underwent robot-assisted laparoscopic prostatectomy (RARP). Prostate-specific antigen (PSA) failure was determined using the Phoenix definition (nadir + 2 ng/ml) following BT and a PSA level of > 0.2 ng/ml following RARP. Toxicities were graded according to CTCAE version 4.0.ResultsThe median follow-up times were 71 and 11 months for the BT and RARP groups, respectively. In the BT group, the median dose to 90% of the prostate was 131 Gy. The median time to biochemical failure was 47 months, and the biochemical relapse-free survival (BRFS) rates were 56% (95% confidence interval [CI]: 33-94%) and 46% (95% CI: 25-88%) at 3 years and 5 years, respectively. Four patients (33%) developed grade 2 genitourinary (GU) toxicity, and two (17%) developed grade 3 GU toxicity. No patients developed grade ≥ 2 gastrointestinal (GI) toxicity. In the RARP group, three out of six patients (50%) had PSA failure, and four patients (67%) developed grade 2 GU toxicity. No patients developed grade 3 GU toxicity or grade ≥ 2 GI toxicity. On pre-salvage magnetic resonance imaging (MRI), no patients were suspected of having T3 or higher stage lesions. However, three patients (50%) had pT3a and two patients (33%) had pT3b (i.e., seminal vesicle invasion) stage lesions.ConclusionsWhole-gland salvage BT is an effective treatment with an acceptable toxicity profile. The pathology findings from RARP imply that there is a room for improvement in diagnoses made by MRI in the pre-salvage setting.

Location and Grade of Prostate Cancer Diagnosed by Transperineal Template-guided Mapping Biopsy After Negative Transrectal Ultrasound-guided Biopsy.

To determine the location and grade of prostate cancer diagnosed by transperineal template-guided mapping (TTMB) after negative transrectal ultrasound-guided (TRUS) biopsy. This analysis consisted of 1118 consecutive patients who underwent TTMB from January 2005 to August 2015. Eight hundred thirty-five underwent TTMB after at least 1 negative TRUS biopsy and 283 underwent TTMB as the first biopsy procedure. The study population was divided into cohorts based on the number of prior TRUS biopsy sessions (0, 1, 2, and ≥3). No patient underwent multiparametric magnetic resonance imaging. Differences in location and cancer grade detected on TTMB were evaluated as a function of the number of prior TRUS biopsies. Of the 1118 patients, 679 were diagnosed with prostate cancer. This included 208, 325, 104, and 42 patients who underwent 0, 1, 2, and ≥3 prior TRUS biopsies. The incidence of cancer detection on TTMB decreased as the number of prior TRUS biopsies increased (73.5% vs. 62.4% vs. 51.7% vs. 37.2%, P<0.001); however, it became increasingly likely that TTMB would detect anterior prostate only as the number of prior TRUS biopsies increased (P=0.007). Moreover, the incidence of high grade cancer (Gleason score ≥7) in the anterior gland increased with the number of previous TRUS biopsies. TTMB detected prostate cancer in over half of the patients with one or more negative TRUS biopsies. The majority of TTMB detected cancers were Gleason score ≥7. As the number of prior TRUS biopsies increased, there was a commensurate increase in the proportion of high-grade, anterior only disease.

42 - Multiparametric MRI followed by transperineal template-guided mapping biopsy for detection of prostate cancer in patients after initial negative transrectal ultrasound-guided biopsy

42 - Multiparametric MRI followed by transperineal template-guided mapping biopsy for detection of prostate cancer in patients after initial negative transrectal ultrasound-guided biopsy

Incidence, grade and distribution of prostate cancer following transperineal template-guided mapping biopsy in patients with atypical small acinar proliferation.

To evaluate the role of transperineal template-guided mapping biopsy (TTMB) in patients with atypical small acinar proliferation (ASAP) diagnosed via transrectal ultrasound-guided needle biopsy (TRUS). In total, 132 consecutive patients with TRUS-diagnosed ASAP underwent TTMB by means of an anatomic-based technique with sampling of 24 biopsy regions. For each of the 24 regions, 1-3 biopsy cores were obtained (depending on prostate size). No patient underwent pre-biopsy MRI imaging. The Gleason score, location of each positive biopsy core, the number of biopsy cores and percent involvement of each core were recorded. Anterior versus posterior cancer distribution was determined for both low- and high-grade (Gleason score ≥7) cancer. The mean patient age was 63.8years with a mean PSA of 6.8ng/mL. Of the 132 patients, 86 (65.2%) were diagnosed with prostate cancer. Of the entire cohort, 47 patients (54.7% of cancer patients and 35.6% of the entire cohort) were diagnosed with Gleason score ≥7. For both low- and high-grade cancers, the anterior gland and especially the anterior apex were the most common cancer locations. In patients with ASAP, TTMB diagnosed prostate cancer in 65.2% of patients and 35.6% of the entire cohort had high-grade prostate cancer. A predilection for anterior-based cancers, especially the anterior apex, was identified. Our study may serve as a baseline reference for MRI-guided biopsy regimens.

Clinical performance of transperineal template guided mapping biopsy for therapeutic decision making in low risk prostate cancer

ObjectivesTo evaluate the role of transperineal template guided mapping biopsy (TTMB) in determining the management strategy in patients with low risk prostate cancer (PCa). MethodsWe retrospectively evaluated 169 patients who underwent TTMB at our institution from February 2008 to June 2011. Ninety eight of them harbored indolent PCa defined as: Prostate Specific Antigen<10ng/ml, Gleason score 6 or less, clinical stage T2a or less, unilateral disease and a maximum of one-third positive cores at first biopsy and <50% of the core involved. TTMB results were analyzed for Gleason score upgrading and upstaging as compared to initial transrectal ultrasound (TRUS) biopsies and its influence on the change in the treatment decisions. ResultsTTMB detected cancer in 64 (65%) patients. The upgrade, upstage and both were noted in 33% (n=21), 12% (n=8) and 7% (n=5) respectively of the detected cancers. The disease characteristics were similar to initial TRUS in 30 (48%) patients and TTMB was negative in 34 (35%) patients. Prostate volume was significantly smaller in patients with upgrade and/or upstage noted at TTMB (45.4 vs 37.9; p=0.03). TTMB results influenced 73.5% of upgraded and/or upstaged patients to receive radical treatment while 81% of the patients with unmodified stage and/or grade continued active surveillance or focal therapy. ConclusionsIn patients with low risk PCa diagnosed by TRUS, subsequent TTMB demonstrated cancer upgrade and/or upstage in about one-third of the patients and resulted in eventual change in treatment decision.

Rendimiento clínico de biopsia de mapeo guiada por plantilla transperineal para la toma de decisiones terapéuticas en el cáncer de próstata de bajo riesgo

ObjectivesTo evaluate the role of Transperineal Template guided Mapping Biopsy (TTMB) in determining the management strategy in patients with low risk prostate cancer (PCa). MethodsWe retroscpectively evaluated 169 patients who underwent TTMB at our institution from February 2008 to June 2011. Ninety eight of them harbored indolent PCa defined as: Prostate Specific Antigen<10ng/ml, Gleason score 6 or less, clinical stage T2a or less, unilateral disease and a maximum of one third positive cores at first biopsy and<50% of the core involved. TTMB results were analyzed for Gleason score upgrading and upstaging as compared to initial TransRectal UltraSound (TRUS) biopsies and its influence on the change in the treatment decisions. ResultsTTMB detected cancer in 64 (65%) patients. The upgrade, upstage and both were noted in 33% (n=21), 12% (n=8) and 7% (n=5) respectively of the detected cancers. The disease characteristics was similar to initial TRUS in 30 (48%) patients and TTMB was negative in 34 (35%) patients. Prostate volume was significantly smaller in patients with upgrade and/or upstage noted at TTMB (45.4 vs 37.9; P=.03). TTMB results influenced 73.5% of upgraded and/or upstaged patients to receive radical treatment while 81% of the patients with unmodified stage and/or grade continued active surveillance or focal therapy. ConclusionsIn patients with low risk PCa diagnosed by TRUS, subsequent TTMB demonstrated cancer upgrade and/or upstage in about one-third of the patients and resulted in eventual change in treatment decision.

The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer

We assess the accuracy of multiparametric magnetic resonance imaging for significant prostate cancer detection before diagnostic biopsy in men with an abnormal prostate specific antigen/digital rectal examination. A total of 388 men underwent multiparametric magnetic resonance imaging, including T2-weighted, diffusion weighted and dynamic contrast enhanced imaging before biopsy. Two radiologists used PI-RADS to allocate a score of 1 to 5 for suspicion of significant prostate cancer (Gleason 7 with more than 5% grade 4). PI-RADS 3 to 5 was considered positive. Transperineal template guided mapping biopsy of 18 regions (median 30 cores) was performed with additional manually directed cores from magnetic resonance imaging positive regions. The anatomical location, size and grade of individual cancer areas in the biopsy regions (18) as the primary outcome and in prostatectomy specimens (117) as the secondary outcome were correlated to the magnetic resonance imaging positive regions. Of the 388 men who were enrolled in the study 344 were analyzed. Multiparametric magnetic resonance imaging was positive in 77.0% of patients, 62.5% had prostate cancer and 41.6% had significant prostate cancer. The detection of significant prostate cancer by multiparametric magnetic resonance imaging had a sensitivity of 96%, specificity of 36%, negative predictive value of 92% and positive predictive value of 52%. Adding PI-RADS to the multivariate model, including prostate specific antigen, digital rectal examination, prostate volume and age, improved the AUC from 0.776 to 0.879 (p<0.001). Anatomical concordance analysis showed a low mismatch between the magnetic resonance imaging positive regions and biopsy positive regions (4[2.9%]), and the significant prostate cancer area in the radical prostatectomy specimen (3 [3.3%]). In men with an abnormal prostate specific antigen/digital rectal examination, multiparametric magnetic resonance imaging detected significant prostate cancer with an excellent negative predictive value and moderate positive predictive value. The use of multiparametric magnetic resonance imaging to diagnose significant prostate cancer may result in a substantial number of unnecessary biopsies while missing a minimum of significant prostate cancers.

Diagnostic Performance of Initial Transperineal Template-guided Mapping Biopsy of the Prostate Gland

To evaluate the utility of transperineal template-guided mapping biopsy (TTMB) of the prostate as an initial means of establishing tissue diagnosis. A total of 191 consecutive patients underwent TTMB of the prostate using an anatomic-based technique with sampling of 24 regions. All patients had elevated prostate-specific antigen on routine screening which was followed by a confirmatory prostate-specific antigen and none had undergone previous biopsy of the prostate. The locations of cancer involvement were recorded for each patient in an effort to approximate the percentage of men whose cancer would have been missed or Gleason score underestimated on a standard 12-core biopsy. The median number of submitted biopsy cores was 54.0. Of the 191 study patients, 140 (73.3%) were diagnosed with cancer on TTMB. Among these biopsy-positive patients, 124 (88.6%) had clinically significant cancer. Eighty-nine of the biopsy-positive patients (64.6%) had a Gleason score of ≥7. A total of 34 of the 140 diagnosed cancers were identified exclusively in regions that fell outside of the theoretical 12-core biopsy scheme, suggesting that 24.3% of these cancers would have gone undiagnosed in the absence of TTMB. Among the 107 cancers that would have been diagnosed using a 12-core biopsy approach, 18 (16.8%) were upgraded to a Gleason score of ≥7 with mapping biopsy. TTMB appears to provide more detailed information about prostate cancer grade and location compared with standard 12-core biopsy scheme. This information may serve as a baseline reference for image-guided biopsy (ie, magnetic resonance imaging) regimens, may facilitate clinical decision making and aid in the appropriate selection of patients for active surveillance.

Clinical utility of transperineal template-guided mapping biopsy of the prostate after negative magnetic resonance imaging−guided transrectal biopsy

PurposeWe evaluated the prostate cancer detection with transperineal template-guided mapping biopsy in patients with elevated prostate-specific antigen and negative magnetic resonance imaging (MRI)−guided biopsy. Materials and methodsTotally 75 patients underwent transperineal template-guided mapping biopsy for prior negative MRI−guided (cognitive registration) biopsy during April 2013 to August 2014. Primary objective was to report clinically significant cancer detection in this cohort of patients. Significant cancer was defined using varying thresholds of MCL or Gleason grade 3+4 or greater or both. Cancers with more than 80% of positive core length anterior to the level of urethra were termed anterior zone cancer. Secondary objective was to evaluate the potential clinical and radiological predictors for significant cancer detection. ResultsThe mean age was 61.6±6.5 years and median prostate-specific antigen was 10.4ng/dl (7.9−18) with a mean MRI target size of 7.2mm (4−11). Transperineal template-guided mapping biopsy identified cancer in 36% (27/75) patients and 66.6% (18/27) of them were anterior zone cancers. The rates of detection of clinically significant and insignificant cancer according to the several definitions used range from 22.7% to 30.7% and 5.3% to 13.3%, respectively. Multivariate analysis did not identify any predictors for finding clinically significant and anterior cancers in this group of patients. ConclusionTransperineal template-guided mapping biopsy appears to be an excellent biopsy protocol for downstream management following negative MRI−guided biopsy. Most of the cancers detected were predominantly anterior tumors.

MP83-02 COMBINATION OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING (MP-MRI) AND TRANSPERINEAL TEMPLATE-GUIDED MAPPING BIOPSY (TTMB) OF THE PROSTATE TO IDENTIFY CANDIDATES FOR HEMI-ABLATIVE FOCAL THERAPY

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 2015MP83-02 COMBINATION OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING (MP-MRI) AND TRANSPERINEAL TEMPLATE-GUIDED MAPPING BIOPSY (TTMB) OF THE PROSTATE TO IDENTIFY CANDIDATES FOR HEMI-ABLATIVE FOCAL THERAPY Minh Tran, James Thompson, Maret Boehm, Marley Pulbrook, Daniel Moses, Ron Shnier, Phillip Brenner, Warick Delprado, Anne-Maree Haynes, Richard Savdie, and Phillip Stricker Minh TranMinh Tran More articles by this author , James ThompsonJames Thompson More articles by this author , Maret BoehmMaret Boehm More articles by this author , Marley PulbrookMarley Pulbrook More articles by this author , Daniel MosesDaniel Moses More articles by this author , Ron ShnierRon Shnier More articles by this author , Phillip BrennerPhillip Brenner More articles by this author , Warick DelpradoWarick Delprado More articles by this author , Anne-Maree HaynesAnne-Maree Haynes More articles by this author , Richard SavdieRichard Savdie More articles by this author , and Phillip StrickerPhillip Stricker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Focal therapy (FT) is an emerging treatment option for patients with localized prostate cancer (PCa) aiming to reduce the morbidity of whole-gland therapy. Successful patient selection requires accurate identification and localization of clinically significant lesions within the prostate. Transperineal mapping biopsy (TTMB) is considered the gold standard diagnostic tool to identify candidates for FT. Multi-parametric magnetic resonance imaging (mp-MRI) has recently been shown to have a high NPV in detecting clinically significant PCa. We evaluated the accuracy of combined mp-MRI and TTMB for identifying lobes with significant cancer for application of hemi-ablative FT. METHODS From January 2012–January 2014, 89 consecutive patients aged ≥40 with PSA ≤15 underwent in sequential order: mp-MRI, TTMB and radical prostatectomy (RP) at a single centre. Analysis was performed on 50 patients that met consensus guidelines for FT (clinical stage ≤T2a, Gleason ≤3+4 and no evidence of extracapsular extension or seminal vesicle invasion on mp-MRI or TTMB). Lobes were stratified into lobes with significant cancer (LSC), insignificant cancer (LIC) and no cancer (LNC). Using histopathology at RP, the predictive performance of combined mp-MRI and TTMB in identifying LSC was evaluated. RESULTS The sensitivity, specificity and PPV for combined mp-MRI+TTMB for LSC was 97%, 64% and 84% respectively. Due to the risk of undertreating significant lesions, NPV was considered the primary parameter of interest. The NPV for combined mp-MRI+TTMB for LSC was 91%. Of the 50 patients, 22 had significant unilateral disease on mp-MRI+TTMB and were thus potential candidates for hemi-ablative FT. Two (91%) of the 22 patients had a significant lesion crossing the sagittal midline with contralateral extension of 4mm and 6mm respectively. One of these two patients additionally had a separate small but moderate risk lesion (<0.1cc Gleason 3+4 with 10% Gleason pattern 4) undetected by mp-MRI+TTMB. CONCLUSIONS In candidates for focal therapy based on consensus guidelines, mp-MRI reported by expert radiologists and TTMB provide an excellent negative predictive value in the application for hemi-ablative focal therapy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1050 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Minh Tran More articles by this author James Thompson More articles by this author Maret Boehm More articles by this author Marley Pulbrook More articles by this author Daniel Moses More articles by this author Ron Shnier More articles by this author Phillip Brenner More articles by this author Warick Delprado More articles by this author Anne-Maree Haynes More articles by this author Richard Savdie More articles by this author Phillip Stricker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

767 Clinical utility of transperineal template guided mapping biopsy of prostate after negative magnetic resonance imaging guided transrectal biopsy

767 Clinical utility of transperineal template guided mapping biopsy of prostate after negative magnetic resonance imaging guided transrectal biopsy

Comprehensive evaluation of the clinical utility of transperineal template guided mapping biopsy of prostate in the era of magnetic resonance imaging.

55 Background: To evaluate the clinical utility of Transperineal Template guided Mapping Biopsy (TTMB) after the routine use of Magnetic Resonance Imaging (MRI) for prostate cancer in our institution. Methods: We retrospectively analyzed 208 TTMB performed at our institution from April 2013 - August 2014. Anterior cancer defined as ≥ 80% of the positive cores anterior to urethra. Clinically significant cancer detection verified at various thresholds of Maximum Cancer Core Length (MCL) – 2mm / 3mm / 4mm / 6mm ± Gleason score (GS) ≥ 3+4. We analyzed TTMB for the indications, cancer detection and correlation with TRUS, MRI and Radical Prostatectomy (RP) specimens. Results: The indications and cancer detection rates of TTMB are in the table. All the patients had MRI before TTMB and 87.7% had it prior to the initial TRUS and all target biopsies were by cognitive registration. Multivariate analysis showed higher number of TTMB cores and prior negative TRUS to predict detection of clinically significant anterior tumor. The laterality of cancer in TTMB correlated with TRUS, MRI and Radical Prostatectomy (RP) in 67.2%, 75.3% and 87.6% respectively. The Gleason upgrade from TRUS to TTMB was 19.2% and TTMB to RP was 14.8%.Clavien-Dindo grade 1 and 2 complication was noted in 40.2% and 7% patients respectively. Conclusions: Even with the routine of MRI prior to TRUS biopsy, TTMB had clinical utility and was very effective in detecting clinically significant cancers in specific clinical situations. [Table: see text]