Massimo Valerio1,2,3, Chukwuemeka Anele1,2, Susan C Charman4, Jan van der Meulen4, Alex Freeman5, Charles Jameson5, Paras B Singh6, Mark Emberton1,2, Hashim U Ahmed1,2. 1. Division of Surgery and Interventional Science, University College Hospitals NHS Foundation Trust, London, UK. 2. Department of Urology, University College Hospitals NHS Foundation Trust, London, UK. 3. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 4. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. 5. Department of Histopathology, University College Hospitals NHS Foundation Trust, London, UK. 6. Department of Urology, Royal Free Hospital NHS Trust, London, UK.
Abstract
OBJECTIVES: To determine whether modified transperineal template prostate-mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value (NPV) equal to full 5-mm TTPM. PATIENTS AND METHODS: Retrospective analysis of an institutional registry including treatment-naïve men undergoing 5-mm TTPM biopsy analysed in a 20-zone fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5-mm TTPM. Strategy 1, did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was used to calculate reliable estimates of sensitivity and NPV of these three strategies for the detection of clinically significant disease (maximum cancer core length ≥4 mm and/or Gleason score ≥3 + 4). RESULTS: In all, 391 men with a median (interquartile range, IQR) age of 62 (58-67) years were included. The median (IQR) PSA level and PSA density were 6.9 (4.8-10) ng/mL and 0.17 (IQR 0.12-0.25) ng/mL/mL, respectively. A median (IQR) of 6 (2-9) cores out of 48 (33-63) taken per man were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low-, intermediate- and high-risk disease was identified in 78 (20%), 80 (21%), and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% [95% confidence interval (CI) 73-84%], 85% (95% CI 80-90%) and 84% (95% CI 79-89%), respectively. The NPVs of the three strategies were 73% (95% CI 67-80%), 80% (95% CI 74-86%) and 79% (95% CI 72-84%), respectively. CONCLUSION: Altering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM biopsy to exclude clinically significant disease. This should be considered when modified TTPM biopsy strategies are used to select men for tissue-preserving approaches, and when modified TTPM are used to validate new diagnostic tests.
OBJECTIVES: To determine whether modified transperineal template prostate-mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value (NPV) equal to full 5-mm TTPM. PATIENTS AND METHODS: Retrospective analysis of an institutional registry including treatment-naïve men undergoing 5-mm TTPM biopsy analysed in a 20-zone fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5-mm TTPM. Strategy 1, did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was used to calculate reliable estimates of sensitivity and NPV of these three strategies for the detection of clinically significant disease (maximum cancer core length ≥4 mm and/or Gleason score ≥3 + 4). RESULTS: In all, 391 men with a median (interquartile range, IQR) age of 62 (58-67) years were included. The median (IQR) PSA level and PSA density were 6.9 (4.8-10) ng/mL and 0.17 (IQR 0.12-0.25) ng/mL/mL, respectively. A median (IQR) of 6 (2-9) cores out of 48 (33-63) taken per man were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low-, intermediate- and high-risk disease was identified in 78 (20%), 80 (21%), and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% [95% confidence interval (CI) 73-84%], 85% (95% CI 80-90%) and 84% (95% CI 79-89%), respectively. The NPVs of the three strategies were 73% (95% CI 67-80%), 80% (95% CI 74-86%) and 79% (95% CI 72-84%), respectively. CONCLUSION: Altering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM biopsy to exclude clinically significant disease. This should be considered when modified TTPM biopsy strategies are used to select men for tissue-preserving approaches, and when modified TTPM are used to validate new diagnostic tests.
Authors: D A Smit Duijzentkunst; M Peters; J R N van der Voort van Zyp; M A Moerland; M van Vulpen Journal: World J Urol Date: 2016-03-24 Impact factor: 4.226
Authors: Maudy C W Gayet; Anouk A M A van der Aa; Harrie P Beerlage; Bart Ph Schrier; Maaike Gielens; Roel Heesakkers; Gerrit J Jager; Peter F A Mulders; Hessel Wijkstra Journal: Prostate Cancer Date: 2020-04-03
Authors: Pranav Satish; Alex Freeman; Daniel Kelly; Alex Kirkham; Clement Orczyk; Benjamin S Simpson; Francesco Giganti; Hayley C Whitaker; Mark Emberton; Joseph M Norris Journal: BMJ Open Date: 2022-01-05 Impact factor: 2.692
Authors: Ilaria Jansen; Marit Lucas; C Dilara Savci-Heijink; Sybren L Meijer; Henk A Marquering; Daniel M de Bruin; Patricia J Zondervan Journal: World J Urol Date: 2018-02-02 Impact factor: 4.226
Authors: E J Alexander; J R Murray; V A Morgan; S L Giles; S F Riches; S Hazell; K Thomas; S A Sohaib; A Thompson; A Gao; D P Dearnaley; N M DeSouza Journal: Radiother Oncol Date: 2019-09-05 Impact factor: 6.280