12-core Transrectal Prostate Biopsy Research Articles

Prediction of prostate cancer by deep learning with multilayer artificial neural network.

To predict the rate of prostate cancer detection on prostate biopsy more accurately, the performance of deep learning using a multilayer artificial neural network was investigated. A total of 334 patients who underwent multiparametric magnetic resonance imaging before ultrasonography guided transrectal 12-core prostate biopsy were enrolled in the analysis. Twenty-two non-selected variables, as well as selected ones by least absolute shrinkage and selection operator (Lasso) regression analysis and by stepwise logistic regression analysis, were input into the constructed multilayer artificial neural network (ANN) programs; 232 patients were used as training cases of ANN programs and the remaining 102 patients were for the test to output the probability of prostate cancer existence, accuracy of prostate cancer prediction, and area under the receiver operating characteristic (ROC) curve with the learned model. With any prostate cancer objective variable, Lasso and stepwise regression analyses selected 12 and nine explanatory variables, respectively, from 22. Using trained ANNs with multiple hidden layers, the accuracy of predicting any prostate cancer in test samples was about 5-10% higher compared to that with logistic regression analysis (LR). The area under the curves (AUC) with multilayer ANN were significantly larger on inputting variables that were selected by the stepwise LR compared with the AUC with LR. The ANN had a higher net benefit than LR between prostate cancer probability cutoff values of 0.38 and 0.6. ANN accurately predicted prostate cancer without biopsy marginally better than LR. However, for clinical application, ANN performance may still need improvement.

Role of prostate magnetic resonance imaging in active surveillance.

Active surveillance (AS) has emerged as a beneficial strategy for management of low risk prostate cancer (PCa) and prevention of overtreatment of indolent disease. However, selection of patients for AS using traditional 12-core transrectal prostate biopsy is prone to sampling error and presents a challenge for accurate risk stratification. In fact, around a third of men are upgraded on repeat biopsy which disqualifies them as appropriate AS candidates. This uncertainty affects adoption of AS among patients and physicians, leading to current AS protocols involving repetitive prostate biopsies and unclear triggers for progression to definitive treatment. Prostate magnetic resonance imaging (MRI) has the potential to overcome some of these limitations through localization of significant tumors in the prostate. In conjunction with MRI-targeted prostate biopsy, improved sampling and detection of clinically significant PCa can help streamline the process of selecting suitable men for AS and early exclusion of men who require definitive treatment. MRI can also help minimize the invasive nature of monitoring for disease progression while on AS. Men with stable MRI findings have high negative predictive value for Gleason upgrade on subsequently biopsy, suggesting that men may potentially be monitored by serial MRI examinations with biopsy reserved for significant changes on imaging. Targeted biopsy on AS also allows for specific sampling of concerning lesions, although further data is necessary to evaluate the relative contribution of systematic and targeted biopsy in detecting the 25–30% of men who progress on AS. Further research is also warranted to better understand the nature of clinically significant cancers that are missed on MRI and why certain men have progression of disease that is not visible on prostate MRI. Consensus is also needed over what constitutes progression on MRI, when prostate biopsy can be safely avoided, and how to best utilize this additional information in current AS protocols. Despite these challenges, prostate MRI, either alone or in conjunction with MRI-targeted prostate biopsy, has the potential to significantly improve our current AS paradigm and rates of AS adoption among patients moving forward.

Evaluation of the Prostate Imaging Reporting and Data System for Magnetic Resonance Imaging Diagnosis of Prostate Cancer in Patients with Prostate-specific Antigen

Background:The European Society of Urogenital Radiology has built the Prostate Imaging Reporting and Data System (PI-RADS) for standardizing the diagnosis of prostate cancer (PCa). This study evaluated the PI-RADS diagnosis method in patients with prostate-specific antigen (PSA) <20 ng/ml.Methods:A total of 133 patients with PSA <20 ng/ml were prospectively recruited. T2-weighted (T2WI) and diffusion-weighted (DWI) magnetic resonance images of the prostate were acquired before a 12-core transrectal prostate biopsy. Each patient's peripheral zone was divided into six regions on the images; each region corresponded to two of the 12 biopsy cores. T2WI, DWI, and T2WI + DWI scores were computed according to PI-RADS. The diagnostic accuracy of the PI-RADS score was evaluated using histopathology of prostate biopsies as the reference standard.Results:PCa was histologically diagnosed in 169 (21.2%) regions. Increased PI-RADS score correlated positively with increased cancer detection rate. The cancer detection rate for scores 1 to 5 was 2.8%, 15.0%, 34.6%, 52.6%, and 88.9%, respectively, using T2WI and 12.0%, 20.2%, 48.0%, 85.7%, and 93.3%, respectively, using DWI. For T2WI + DWI, the cancer detection rate was 1.5% (score 2), 13.5% (scores 3–4), 41.3% (scores 5–6), 75.9% (scores 7–8), and 92.3% (scores 9–10). The area under the curve for cancer detection was 0.700 (T2WI), 0.735 (DWI) and 0.749 (T2WI + DWI). The sensitivity and specificity were 53.8% and 89.2%, respectively, when using scores 5–6 as the cutoff value for T2WI + DWI.Conclusions:The PI-RADS score correlates with the PCa detection rate in patients with PSA <20 ng/ml. The summed score of T2WI + DWI has the highest accuracy in detection of PCa. However, the sensitivity should be further improved.

Low testosterone level is an independent risk factor for high-grade prostate cancer detection at biopsy.

To investigate the relationship between low testosterone levels and prostate cancer detection risk in a biopsy population. In all, 681 men who underwent initial 12-core transrectal prostate biopsy at our institution were included in this retrospective study. Patients were divided into groups with low (<300ng/dL) and normal testosterone levels (≥300ng/dL). Clinical and pathological data were analysed. Among 681 men, 86 men (12.6%) had low testosterone levels, 143 (32.7%) had a positive biopsy, and 99 (14.5%) had high-grade prostate cancer. The mean age, prostate-specific antigen (PSA) level, PSA density, body mass index (BMI), number of abnormal digital rectal examination (DRE) findings, and diabetes mellitus (DM) history were significantly different between the low and normal level testosterone groups. A low testosterone level was significantly associated with a higher risk of detection of overall prostate cancer than a normal testosterone level in univariate analysis (odds ratio [OR] 2.545, P = 0.001), but not in multivariate analysis adjusting for parameters such as age, PSA, prostate volume, BMI, abnormal DRE findings and DM (OR 1.583, P = 0.277). Meanwhile, a low testosterone level was significantly related to a higher rate of high-grade prostate cancer compared with a normal testosterone level in univariate (OR 3.324, P<0.001) and multivariate analysis adjusting for other parameters (OR 2.138, P = 0.035). Low testosterone level is an independent risk factor for high-grade prostate cancer detection at biopsy. Therefore, checking testosterone levels could help to determine whether prostate biopsy should be carried out.

MP11-07 T2-WEIGHTED/DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING AS A NOVEL SCORING MODE FOR THE EARLY DETECTION OF PROSTATE CANCER

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2015MP11-07 T2-WEIGHTED/DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING AS A NOVEL SCORING MODE FOR THE EARLY DETECTION OF PROSTATE CANCER Xuan Wang, Ming Liu, Jianye Wang, Min Chen, Ben Wan, Chunmei Li, Gang Wan, Wei Zhang, Yong Zhang, and Yuanyuan Zhang Xuan WangXuan Wang More articles by this author , Ming LiuMing Liu More articles by this author , Jianye WangJianye Wang More articles by this author , Min ChenMin Chen More articles by this author , Ben WanBen Wan More articles by this author , Chunmei LiChunmei Li More articles by this author , Gang WanGang Wan More articles by this author , Wei ZhangWei Zhang More articles by this author , Yong ZhangYong Zhang More articles by this author , and Yuanyuan ZhangYuanyuan Zhang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.388AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To explore the clinical efficacy of Magnetic Resonance Imaging (MRI) in the early diagnosis of prostate cancer for the patients with prostate specific antigen (PSA) level < 20ng/ml, to provide quantitative evaluation of a standardized scoring system based on Prostate Imaging Reporting and Data System (PI-RADS) to correlate the chance of prostate cancer with each scale on the identified lesion at T2 weighted imaging (T2WI) and diffusion weighted imaging (DWI) in combination and to assess the accuracy of the image scoring system of T2WI combined with DWI for the early diagnosis of prostate cancer. METHODS In total, 133 patients with PSA < 20 ng/ml were prospectively recruited. The patients'PSA level ranged from 0.2-19.8 ng/mL (Median 6.9 ng/mL ¡À 4.0). Pelvic MRI was performed before 12-core transrectal prostate biopsy. The prostate peripheral zone of each patient was divided into six regions on MR images in the same fashion of biopsy: right and left at apex, mid and base level, each region corresponds to 2 out of 12 biopsy cores. T2WI and DWI image features on peripheral zone of the prostate were evaluated according to the pre-established image scoring standards. We compared the accuracy of the scoring system of T2WI in diagnosis of prostate cancer with T2WI and DMI in combination. Histopathologic evaluation of prostate biopsies was the reference standard. RESULTS 60 patients (45.1%) were diagnosed with prostate cancer by tissue biopsies. 169 foci of peripheral zone tumor were identified from the total 798 regions (21.2%). Prostate cancer detection rate of score 0∼5 on T2WI image was 2.8%, 13.4%, 20.3%, 34.6%, 52.6% and 88.9% respectively, and the rate was 11.1%, 16.1%, 48.5%, 71.0% and 86.1% respectively on score 1∼5 of T2WI+DWI image grading. With the increase of pre-established T2WI or T2WI+DWI image score, prostate cancer detection rate showed a significant increase by Cochran-Armitage trend test (P< 0.0001, P< 0.0001). The receiver operating characteristic (ROC) analysis found that the ability of T2WI+DWI was greater than that of T2WI alone in detection of prostate cancer (Area under the ROC curve (AUC)=0.743 vs. AUC=0.715, P=0.0072). CONCLUSIONS The signals of the peripheral zone on T2WI+DWI are strongly associated with the diagnosis of prostate cancer. Clinic efficiency and accuracy of T2WI plus DWI was superior to that of T2WI alone in the early detection of prostate cancer. The proposed scoring system of T2WI+DMI can predict the risk of prostate cancer for patients with PSA < 20 ng/ml. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e121 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xuan Wang More articles by this author Ming Liu More articles by this author Jianye Wang More articles by this author Min Chen More articles by this author Ben Wan More articles by this author Chunmei Li More articles by this author Gang Wan More articles by this author Wei Zhang More articles by this author Yong Zhang More articles by this author Yuanyuan Zhang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

765 Transrectal 12-core prostate biopsy and MRI have a comparable risk of missing significant prostate cancer in men with PSA less than 10 ng/ml and normal DRE

765 Transrectal 12-core prostate biopsy and MRI have a comparable risk of missing significant prostate cancer in men with PSA less than 10 ng/ml and normal DRE

833 Do additional cores from MRI-cancer suspicious lesion to systematic 12-core transrectal prostate biopsy give better cancer detection?

833 Do additional cores from MRI-cancer suspicious lesion to systematic 12-core transrectal prostate biopsy give better cancer detection?

High Diagnostic Ability of Multiparametric Magnetic Resonance Imaging to Detect Anterior Prostate Cancer Missed by Transrectal 12-Core Biopsy

We clarified the diagnostic ability of multiparametric magnetic resonance imaging to reveal anterior cancer missed by transrectal 12-core prostate biopsy based on the results of 3-dimensional 26-core prostate biopsy, which is a combination of transrectal 12-core and transperineal 14-core biopsies. The study population consisted of 324 patients who prospectively underwent prebiopsy multiparametric magnetic resonance imaging and then 3-dimensional 26-core prostate biopsy at a single institution. We defined transrectal 12-core negative cancer as cancer detected by transperineal 14-core but not transrectal 12-core prostate biopsy. We focused on cancer in the anterior region. Any findings suspicious for malignancy in the region anterior to the urethra on multiparametric magnetic resonance imaging were defined as an anterior lesion on imaging. Significant cancer was defined as a biopsy Gleason score of 4 + 3 or greater, a greater than 20% positive core and/or a maximum cancer length of 5 mm or greater. Associations between an anterior lesion on imaging and transrectal 12-core negative cancer were investigated. The overall cancer detection rate on 3-dimensional 26-core prostate biopsy was 39% (128 of 324 cases), of which 28% (36 of 128) were transrectal 12-core negative cancers. An anterior lesion on prebiopsy multiparametric magnetic resonance imaging was identified in 20% of men overall (65 of 324). Of men with and without an anterior lesion on imaging 40% (26 of 65) and 3.8% (10 of 259), respectively, had transrectal 12-core negative cancer. Significant transrectal 12-core negative cancer was observed in 0.4% (1 of 259 men) without an anterior lesion on imaging. Prebiopsy multiparametric magnetic resonance imaging revealed an anterior lesion in 92% of cases (11 of 12) of significant transrectal 12-core negative cancer. Prebiopsy multiparametric magnetic resonance imaging has the potential to efficiently select men who could advantageously undergo anterior samplings, in addition to transrectal 12-core prostate biopsy.

Burnt-out Metastatic Prostate Cancer

A burnt-out prostate cancer tumor is a very rare clinical entity. The term ‘burnt-out’ refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.

Do Additional Cores from MRI Cancer-Suspicious Lesions to Systematic 12-Core Transrectal Prostate Biopsy Give Better Cancer Detection?

Background: The comparison of systematic prostate biopsies (PBx) with PBx including additional cores based on magnetic resonance imaging (MRI) of lesions suspicious for prostate cancer (PCa) has been controversial. This study focuses on additional cores based on MRI findings for better cancer detection. Methods: Data were collected from 491 men who underwent transrectal ultrasound-guided PBx: a 12-core PBx (group 1: 395 cases) and a 12-core PBx plus 1–3 additional cores based on MRI (group 2: 96 cases). Comparison of two groups revealed how the additional cores taken with MRI findings affected PCa detection. Results: Group 1 had 205 cases (51.9%) and group 2 had 55 cases (57.3%) of PCa detected. This difference was not statistically significant (p = 0.3444). Only 1 of the 55 patients (1.82%) in group 2 had cancer only in the additional cores based on MRI. In other words, only 1/96 (1.04%) patients was diagnosed with PCa only by the additional core PBx. Conclusions: We suggest that systematic 12-core PBx (sextant peripheral zone + 4 transitional zone + 2 far lateral peripheral zone) can be considered an excellent tool for PCa detection and there may be no need for additional cores based on MRI findings for PCa detection.

Prostate Sampling by 12-Core Biopsy: Comparison of the Biopsy Results With Tumor Location in Prostatectomy Specimens

To analyze the diagnostic performance of individual prostate biopsy cores. The 12-core transrectal prostate biopsy scheme has emerged as a standard of care. However, quality of sampling may vary in different areas of the prostate included in this procedure. Two-hundred fifty men underwent radical prostatectomy at our institution. All participants had a systematic 12-core transrectal prostate biopsy containing lateral and medial cores from each side of the apical, medial and basal thirds of the prostate. Biopsy results were matched with histologic maps of the prostatectomy specimens. Sensitivity, negative predictive value (NPV), and overall accuracy were calculated for each biopsy core location and compared between different groups of cores. In addition, patients in the upper quartile of prostate weight were compared with the rest of the cohort. Sensitivity, NPV, and overall accuracy were significantly lower for apical cores. Average NPV and overall accuracy of basal and mid-lateral biopsies were inferior to those of medial biopsies on the same levels. However, sensitivity of these lateral cores was similar to that of the medial cores. Sensitivities of apical and mid cores were significantly lower in patients with larger prostates. Decreased accuracy in lateral mid- and basal cores results from higher frequencies of cancer in corresponding prostate areas, and therefore additional samples should be taken at these locations. In addition, diagnostic accuracy of apical cores may be improved through better targeting of the prostatic apex. This may be particularly important in patients with larger prostates.

994 GLEASON SCORE UPGRADING AFTER PROSTATECTOMY DEPENDS ON TUMOR FOCUS CHARACTERISTICS IN PATIENTS DIAGNOSED VIA STANDARDIZED 12-CORE PROSTATE BIOPSY

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 2011994 GLEASON SCORE UPGRADING AFTER PROSTATECTOMY DEPENDS ON TUMOR FOCUS CHARACTERISTICS IN PATIENTS DIAGNOSED VIA STANDARDIZED 12-CORE PROSTATE BIOPSY Michael Musch, Ulla Roggenbuck, Michael Sahm, Stephan Stoerkel, and Darko Kroepfl Michael MuschMichael Musch Essen, Germany More articles by this author , Ulla RoggenbuckUlla Roggenbuck Essen, Germany More articles by this author , Michael SahmMichael Sahm Essen, Germany More articles by this author , Stephan StoerkelStephan Stoerkel Wuppertal, Germany More articles by this author , and Darko KroepflDarko Kroepfl Essen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1027AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason grading heterogeneity has been observed in multifocal prostate cancer (PCA). We hypothesized that the existence of small secondary tumor foci representing the highest Gleason grade in the prostatectomy specimen contributes to Gleason score upgrading after prostatectomy. METHODS Between 12/00 and 10/06 a total of 931 PCA patients underwent radical retropubic prostatectomy. In 162 of these patients PCA was initially diagnosed via standardized 12-core transrectal prostate biopsy in our institution. Pathohistological examination of the prostatectomy specimen included determination of predominant Gleason grade and volume of all tumor foci. The correlation of biopsy and prostatectomy Gleason scores (2–6, 7, 8–10) was calculated. In addition, the influence of small secondary tumor foci representing the highest Gleason grade in the prostatectomy specimen on the incidence of Gleason score upgrading was examined. RESULTS Due to missing data 146 of the initial 162 patients were suitable for analysis. Based on the prostatectomy specimen Gleason scores 4–6 were assigned to 91 (62.3%) patients, Gleason score 7 to 42 (28.8%) and Gleason scores 8–10 to 13 (8.9%). Upgrading was observed in 24 (16.4%) and downgrading in 13 (8.9%) cases (kappa 0.49; 95% CI 0.35–0.63). In 76/146 (52.0%) patients a small secondary tumor focus showed the highest Gleason grade in the prostatectomy specimen. The Gleason grade of the largest tumor focus was consistent with the overall highest Gleason grade in 48.0% (70/146) of cases. The median volume of the 76 small secondary tumor foci was significantly smaller than the median volume of the 70 largest tumor foci (0.21cc [range 0.01–2.68] vs. 0.83cc [range 0.01–9.67]; p<0.0001). In the 76 patients with a small secondary tumor focus representing the highest Gleason grade upgrading was observed in 23 (30.3%) cases. In contrast, in the 70 patients in whom the largest tumor focus represented the highest Gleason grade upgrading was observed in only 1 (1.4%) case. In a multivariate logistic regression adjusting for PSA, total tumor volume and prostate volume existence of a small secondary tumor focus representing the highest Gleason grade in the prostatectomy specimen remained the only independent risk factor for Gleason score upgrading (p=0.0005). CONCLUSIONS In PCA patients diagnosed via standardized 12-core prostate biopsy Gleason score upgrading after prostatectomy is significantly more frequent when small secondary tumor foci represent the highest Gleason grade in the prostatectomy specimen. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e400-e401 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Musch Essen, Germany More articles by this author Ulla Roggenbuck Essen, Germany More articles by this author Michael Sahm Essen, Germany More articles by this author Stephan Stoerkel Wuppertal, Germany More articles by this author Darko Kroepfl Essen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy

MP-11.21: Diagnostic accuracy of standard 6-core and extended 12-core transrectal prostate biopsy

MP-11.21: Diagnostic accuracy of standard 6-core and extended 12-core transrectal prostate biopsy

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy

The aim of this study is to elucidate the diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy for prostate cancer. We prospectively randomized 200 consecutive men into two groups to undergo systematic prostate biopsy. Overall positivity for cancer was similar (47% by transperineal and 53% by transrectal; P=0.480). However, in case with 'gray zone' PSA (from 4.1 to 10.0 ng/ml), significantly more cores were positive when approach was transperineal, especially among transition zone cores. Therefore, urologist preferences are sufficient for choosing an approach, except for a possible small advantage of transperineal biopsy when PSA is in gray zone.