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World Journal of Urology

, Volume 32, Issue 4, pp 945–950 | Cite as

Evolution of repeat prostate biopsy strategies incorporating transperineal and MRI–TRUS fusion techniques

  • Timur H. Kuru
  • Kasra Saeb-Parsy
  • Andrea Cantiani
  • Julia Frey
  • Riccardo Lombardo
  • Eva Serrao
  • Gabriele Gaziev
  • Brendan Koo
  • Matthias Roethke
  • Vincent Gnanapragasam
  • Anne Warren
  • Andrew Doble
  • Boris Hadaschik
  • Christof KastnerEmail author
Original Article

Abstract

Purpose

To test the hypothesis that MRI–TRUS fusion technique can increase the detection rate of prostate cancer (PC) in patients with previously negative biopsy.

Methods

Patient records of men with persisting suspicion for PC after previous negative biopsy having undergone either extensive transrectal prostate biopsies (MD Anderson protocol; MDA), transperineal saturation (STP) or magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) fusion transperineal biopsies (MTTP) in three consecutive time intervals were reviewed retrospectively. The respective approach was the standard for the above indication at these episodes. In Cambridge, 70 patients underwent MDA biopsies, 75 STP underwent biopsies and 74 patients underwent MTTP biopsies. In total, 164 MTTP patients with the same indication from Heidelberg were analysed as reference standard. In total, 383 men were included into analysis. Low-grade PC was defined as Gleason score 7 (3 + 4) or lower.

Results

Even though MTTP patients had significantly larger prostates, the overall cancer detection rate for PC was the highest in MTTP (24.2 % MDA, 41.3 % STP, 44.5 % MTTP, p = 0.027, Kruskal–Wallis test). The detection rate for clinically relevant high-grade PC was highest in MTTP; however, this did not reach statistical significance compared with MDA (23.5 % MDA, 12.9 % STP, 27.2 % MTTP, p = 0.25, Fischer’s exact test). Comparing MTTP between Cambridge and Heidelberg, detection rates did not differ significantly (44.5 vs. 48 %, p = 0.58). There was a higher detection rate of high-grade cancer in Heidelberg. (36.3 vs. 27.2 %, p = 0.04).

Conclusion

Patients whom are considered for repeat biopsies may benefit from undergoing MRI-targeted TRUS fusion technique due to higher cancer detection rate of significant PC.

Keywords

Transperineal prostate biopsy MRI-targeted prostate biopsy Prostate cancer 

Notes

Acknowledgments

We thank all members and friends of the “Ginsburg Study Group for Enhanced Prostate Diagnostics” for their support during the preparation of this manuscript.

Conflict of interest

None.

References

  1. 1.
    Puech P, Rouviere O, Renard-Penna R et al (2013) Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy–prospective multicenter study. Radiology 268:461–469. doi: 10.1148/radiol.13121501 PubMedCrossRefGoogle Scholar
  2. 2.
    Kuru TH, Roethke MC, Seidenader J et al (2013) Critical evaluation of magnetic resonance imaging targeted, transrectal ultrasound guided transperineal fusion biopsy for detection of prostate cancer. J Urol 190:1380–1386. doi: 10.1016/j.juro.2013.04.043 PubMedCrossRefGoogle Scholar
  3. 3.
    Siddiqui MM, Rais-Bahrami S, Truong H et al (2013) Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 64:713–719. doi: 10.1016/j.eururo.2013.05.059 PubMedCrossRefGoogle Scholar
  4. 4.
    Arumainayagam N, Ahmed HU, Moore CM et al (2013) Multiparametric MR imaging for detection of clinically significant prostate cancer: a validation cohort study with transperineal template prostate mapping as the reference standard. Radiology 268:761–769. doi: 10.1148/radiol.13120641 PubMedCrossRefGoogle Scholar
  5. 5.
    Sonn GA, Chang E, Natarajan S et al (2013) Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol. doi: 10.1016/j.eururo.2013.03.025 PubMedGoogle Scholar
  6. 6.
    Pokorny MR, De Rooij M, Duncan E et al (2014) Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. Eur Urol. doi: 10.1016/j.eururo.2014.03.002 PubMedGoogle Scholar
  7. 7.
    Nelson AW, Harvey RC, Parker RA et al (2013) Repeat prostate biopsy strategies after initial negative biopsy: meta-regression comparing cancer detection of transperineal, transrectal saturation and MRI guided biopsy. PloS One 8:e57480. doi: 10.1371/journal.pone.0057480.s002 PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Chen ME, Troncoso P, Tang K et al (1999) Comparison of prostate biopsy schemes by computer simulation. Urology 53:951–960PubMedCrossRefGoogle Scholar
  9. 9.
    Kuru TH, Wadhwa K, Chang RTM et al (2013) Definitions of terms, processes and a minimum dataset for transperineal prostate biopsies: a standardization approach of the Ginsburg Study Group for Enhanced Prostate Diagnostics. BJU Int 112:568–577. doi: 10.1111/bju.12132 PubMedCrossRefGoogle Scholar
  10. 10.
    Moore CM, Kasivisvanathan V, Eggener S et al (2013) Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 64:544–552. doi: 10.1016/j.eururo.2013.03.030 PubMedCrossRefGoogle Scholar
  11. 11.
    Djavan B, Ravery V, Zlotta A et al (2001) Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol 166:1679–1683PubMedCrossRefGoogle Scholar
  12. 12.
    Hambrock T, Somford DM, Hoeks C et al (2010) Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen. J Urol 183:520–527. doi: 10.1016/j.juro.2009.10.022 PubMedCrossRefGoogle Scholar
  13. 13.
    Heidenreich A, Abrahamsson P-A, Artibani W et al (2013) Early detection of prostate cancer: European Association of Urology recommendation. Eur Urol 64:347–354. doi: 10.1016/j.eururo.2013.06.051 PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenkrantz AB, Sigmund EE, Johnson G et al (2012) Prostate cancer: feasibility and preliminary experience of a diffusional kurtosis model for detection and assessment of aggressiveness of peripheral zone cancer. Radiology 264:126–135. doi: 10.1148/radiol.12112290 PubMedCrossRefGoogle Scholar
  15. 15.
    Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757. doi: 10.1007/s00330-011-2377-y PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Roethke MC, Kuru TH, Schultze S et al (2013) Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla. Eur Radiol. doi:  10.1007/s00330-013-3017-5
  17. 17.
    Wassberg C, Akin O, Vargas HA et al (2012) The incremental value of contrast-enhanced MRI in the detection of biopsy-proven local recurrence of prostate cancer after radical prostatectomy: effect of reader experience. Am J Roentgenol 199:360–366. doi: 10.2214/AJR.11.6923 CrossRefGoogle Scholar
  18. 18.
    Mowatt G, Scotland G, Boachie C et al (2013) The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess 17:vii–xix–1–281. doi:  10.3310/hta17200
  19. 19.
    Tsivian M, Abern MR, Qi P, Polascik TJ (2013) Short-term functional outcomes and complications associated with transperineal template prostate mapping biopsy. Urology 82:166–170. doi: 10.1016/j.urology.2013.01.071 PubMedCrossRefGoogle Scholar
  20. 20.
    Losa A, Gadda GM, Lazzeri M et al (2013) Complications and quality of life after template-assisted transperineal prostate biopsy in patients eligible for focal therapy. Urology 81:1291–1296. doi: 10.1016/j.urology.2012.11.078 PubMedCrossRefGoogle Scholar
  21. 21.
    Epstein JI, Allsbrook WC, Amin MB, Egevad LL (2006) Update on the Gleason grading system for prostate cancer: results of an international consensus conference of urologic pathologists. In: Adv Anat Pathol. pp 57–59Google Scholar
  22. 22.
    Pummer K, Rieken M, Augustin H et al (2013) Innovations in diagnostic imaging of localized prostate cancer. World J Urol. doi: 10.1007/s00345-013-1172-6 Google Scholar
  23. 23.
    Salomon G, Drews N, Autier P et al (2014) Incremental detection rate of prostate cancer by real-time elastography targeted biopsies in combination with a conventional 10-core biopsy in 1024 consecutive patients. BJU Int 113:548–553. doi: 10.1111/bju.12517 PubMedCrossRefGoogle Scholar
  24. 24.
    Porpiglia F, Russo F, Manfredi M et al (2014) The roles of multiparametric MRI, PCA3, and PHI: which is the best predictor of prostate cancer after a negative biopsy? Results of a prospective study. J Urol. doi:  10.1016/j.juro.2014.01.030
  25. 25.
    Ahmed HU, Arya M, Freeman A, Emberton M (2012) Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? Lancet Oncol 13:e509–e517. doi: 10.1016/S1470-2045(12)70388-1 PubMedCrossRefGoogle Scholar
  26. 26.
    Iremashvili V, Pelaez L, Manoharan M et al (2012) Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur Urol 62:462–468. doi: 10.1016/j.eururo.2012.03.011 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Timur H. Kuru
    • 1
    • 2
  • Kasra Saeb-Parsy
    • 3
  • Andrea Cantiani
    • 3
  • Julia Frey
    • 3
  • Riccardo Lombardo
    • 3
  • Eva Serrao
    • 3
  • Gabriele Gaziev
    • 3
  • Brendan Koo
    • 4
  • Matthias Roethke
    • 2
  • Vincent Gnanapragasam
    • 3
  • Anne Warren
    • 5
  • Andrew Doble
    • 3
  • Boris Hadaschik
    • 1
  • Christof Kastner
    • 3
    Email author
  1. 1.Department of UrologyUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Department of RadiologyGerman Cancer Research Centre (DKFZ)HeidelbergGermany
  3. 3.Department of UrologyCambridge University HospitalsCambridgeUK
  4. 4.University Department of RadiologyCambridge University HospitalsCambridgeUK
  5. 5.Department of HistopathologyCambridge University HospitalsCambridgeUK

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