Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies
Autor: | Josef Mang, Hannes Cash, Alexander M. Nest, Thomas Fischer, Sophie K. Piper, Jonas Busch, Andreas Maxeiner, Carsten Stephan, Claus-P. Nowak, Alexander D. J. Baur, Kurt Miller, Ergin Kilic |
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Rok vydání: | 2019 |
Předmět: |
Image-Guided Biopsy
Male Urology medicine.medical_treatment Biopsy Subgroup analysis Multimodal Imaging Prostate cancer Prostate Systematic TRUS-guided biopsy Medicine Humans Sampling (medicine) Multiparametric magnet resonance imaging Prospective Studies Ultrasonography Interventional Aged Aged 80 and over medicine.diagnostic_test Index Lesion Repeat biopsy business.industry Prostatectomy Ultrasound Rectum Prostatic Neoplasms Fusion-guided biopsy Middle Aged medicine.disease Magnetic Resonance Imaging medicine.anatomical_structure business Nuclear medicine 600 Technik Medizin angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit |
Zdroj: | Urologia internationalis. 104(3-4) |
ISSN: | 1423-0399 |
Popis: | Introduction: Patients with consistent suspicion for prostate cancer (PCa) and multiple negative prebiopsies prior to multiparametric magnetic resonance imaging (mpMRI) are still frequently evaluated for an image-guided biopsy and are reported with heterogeneous detection rates. The inclusion of a systematic biopsy (SB) is also still recommended with predominant sampling within the posterior/peripheral zone of the prostate. The aim of this study was (I) to evaluate PCa detection rates using a modified 10 core SB template including anterior biopsies in combination with mpMRI/ultrasound fusion-guided targeted biopsy (TB) in patients with 3 or more negative prebiopsies and (II) to compare mpMRI index lesion localization with histologically confirmed localization from associated prostatectomy samples. Methods: Overall 1,337 consecutive patients underwent sensor-based registration TB of the prostate and a subsequent 10-core SB between January 2012 and December 2015 at our institution. For this study, 101 patients with ≥3 negative prebiopsies and prostate imaging – reporting data system lesions ≥3 were pooled prospectively and underwent TB and a modified SB including 2 ventral (anterior) biopsies. Detection rates were estimated for the modified SB, TB, and its combination. A subgroup analysis of 35 patients undergoing prostatectomy was performed by a head-to-head comparison of mpMRI index lesion and histologically confirmed PCa index lesion localization. Results: The overall detection rate for PCa was 54.5%. The combination of TB and SB detected 14 (25.4%) more cases missed by TB alone (p < 0.001) and 7 (12.7%) more cases missed by SB alone (p = 0.016), respectively. A postoperative Gleason upgrade was seen in 12/35 (34.3%) cases within the TB group and in 14/35 (40.0%) in the SB group, respectively. The subgroup analysis showed a predominant location of PCa index lesions anteriorly at the level of the midgland. The MRI detection rate of the anteriorly located index lesions was 70.4% (15/21 cases) with a clinically significant Gleason score (≥3 + 4 = 7a [International Society of Urological Pathology grade 2]) in 80.9%. Interestingly a modified SB template detected 90.5% (19/21) of the anteriorly located index lesions. Conclusion: Our data suggest that in patients with multiple prebiopsies PCa seems to be predominantly located anteriorly. We suggest the general integration of anterior biopsies despite TB in repeat biopsy patients. |
Databáze: | OpenAIRE |
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