Lucy A M Simmons1, Abi Kanthabalan1, Manit Arya2, Tim Briggs3, Dean Barratt4, Susan C Charman5, Alex Freeman6, David Hawkes4, Yipeng Hu4, Charles Jameson6, Neil McCartan1, Caroline M Moore1, Shonit Punwani7, Jan van der Muelen8, Mark Emberton1, Hashim U Ahmed9. 1. Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom. 2. Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom. 3. Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom; Department of Urology, Royal Free London NHS Foundation Trust, London, United Kingdom. 4. Centre for Medical Imaging and Computing, Department of Computer Science, University College London, London, United Kingdom. 5. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. 6. Department of Pathology, University College London Hospital NHS Foundation Trust, London, United Kingdom. 7. Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom. 8. Department of Pathology, University College London Hospital NHS Foundation Trust, London, United Kingdom; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom. 9. Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. Electronic address: hashim.ahmed@imperial.ac.uk.
Abstract
PURPOSE: We evaluated the detection of clinically significant prostate cancer using magnetic resonance imaging targeted biopsies and compared visual estimation to image fusion targeting in patients requiring repeat prostate biopsies. MATERIALS AND METHODS: The prospective, ethics committee approved PICTURE trial (ClinicalTrials.gov NCT01492270) enrolled 249 consecutive patients from January 11, 2012 to January 29, 2014. Men underwent multiparametric magnetic resonance imaging and were blinded to the results. All underwent transperineal template prostate mapping biopsies. In 200 men with a lesion this was preceded by visual estimation and image fusion targeted biopsies. As the primary study end point clinically significant prostate cancer was defined as Gleason 4 + 3 or greater and/or any grade of cancer with a length of 6 mm or greater. Other definitions of clinically significant prostate cancer were also evaluated. RESULTS: Mean ± SD patient age was 62.6 ± 7 years, median prostate specific antigen was 7.17 ng/ml (IQR 5.25-10.09), mean primary lesion size was 0.37 ± 1.52 cc with a mean of 4.3 ± 2.3 targeted cores per lesion on visual estimation and image fusion combined, and a mean of 48.7 ± 12.3 transperineal template prostate mapping biopsy cores. Transperineal template prostate mapping biopsies detected 97 clinically significant prostate cancers (48.5%) and 85 insignificant cancers (42.5%). Overall multiparametric magnetic resonance imaging targeted biopsies detected 81 clinically significant prostate cancers (40.5%) and 63 insignificant cancers (31.5%). In the 18 cases (9%) of clinically significant prostate cancer on magnetic resonance imaging targeted biopsies were benign or clinically insignificant on transperineal template prostate mapping biopsy. Clinically significant prostate cancer was detected in 34 cases (17%) on transperineal template prostate mapping biopsy but not on magnetic resonance imaging targeted biopsies and approximately half was present in nontargeted areas. Clinically significant prostate cancer was found on visual estimation and image fusion in 53 (31.3%) and 48 (28.4%) of the 169 patients (McNemar test p = 0.5322). Visual estimation missed 23 clinically significant prostate cancers (13.6%) detected by image fusion. Image fusion missed 18 clinically significant prostate cancers (10.8%) detected by visual estimation. CONCLUSIONS: Magnetic resonance imaging targeted biopsies are accurate for detecting clinically significant prostate cancer and reducing the over diagnosis of insignificant cancers. To maximize detection visual estimation as well as image fusion targeted biopsies are required.
PURPOSE: We evaluated the detection of clinically significant prostate cancer using magnetic resonance imaging targeted biopsies and compared visual estimation to image fusion targeting in patients requiring repeat prostate biopsies. MATERIALS AND METHODS: The prospective, ethics committee approved PICTURE trial (ClinicalTrials.gov NCT01492270) enrolled 249 consecutive patients from January 11, 2012 to January 29, 2014. Men underwent multiparametric magnetic resonance imaging and were blinded to the results. All underwent transperineal template prostate mapping biopsies. In 200 men with a lesion this was preceded by visual estimation and image fusion targeted biopsies. As the primary study end point clinically significant prostate cancer was defined as Gleason 4 + 3 or greater and/or any grade of cancer with a length of 6 mm or greater. Other definitions of clinically significant prostate cancer were also evaluated. RESULTS: Mean ± SD patient age was 62.6 ± 7 years, median prostate specific antigen was 7.17 ng/ml (IQR 5.25-10.09), mean primary lesion size was 0.37 ± 1.52 cc with a mean of 4.3 ± 2.3 targeted cores per lesion on visual estimation and image fusion combined, and a mean of 48.7 ± 12.3 transperineal template prostate mapping biopsy cores. Transperineal template prostate mapping biopsies detected 97 clinically significant prostate cancers (48.5%) and 85 insignificant cancers (42.5%). Overall multiparametric magnetic resonance imaging targeted biopsies detected 81 clinically significant prostate cancers (40.5%) and 63 insignificant cancers (31.5%). In the 18 cases (9%) of clinically significant prostate cancer on magnetic resonance imaging targeted biopsies were benign or clinically insignificant on transperineal template prostate mapping biopsy. Clinically significant prostate cancer was detected in 34 cases (17%) on transperineal template prostate mapping biopsy but not on magnetic resonance imaging targeted biopsies and approximately half was present in nontargeted areas. Clinically significant prostate cancer was found on visual estimation and image fusion in 53 (31.3%) and 48 (28.4%) of the 169 patients (McNemar test p = 0.5322). Visual estimation missed 23 clinically significant prostate cancers (13.6%) detected by image fusion. Image fusion missed 18 clinically significant prostate cancers (10.8%) detected by visual estimation. CONCLUSIONS: Magnetic resonance imaging targeted biopsies are accurate for detecting clinically significant prostate cancer and reducing the over diagnosis of insignificant cancers. To maximize detection visual estimation as well as image fusion targeted biopsies are required.
Authors: Masatomo Kaneko; Dordaneh Sugano; Amir H Lebastchi; Vinay Duddalwar; Jamal Nabhani; Christopher Haiman; Inderbir S Gill; Giovanni E Cacciamani; Andre Luis Abreu Journal: Curr Urol Rep Date: 2021-03-22 Impact factor: 3.092
Authors: Anwar R Padhani; Jelle Barentsz; Geert Villeirs; Andrew B Rosenkrantz; Daniel J Margolis; Baris Turkbey; Harriet C Thoeny; François Cornud; Masoom A Haider; Katarzyna J Macura; Clare M Tempany; Sadhna Verma; Jeffrey C Weinreb Journal: Radiology Date: 2019-06-11 Impact factor: 11.105
Authors: Frank-Jan H Drost; Daniël F Osses; Daan Nieboer; Ewout W Steyerberg; Chris H Bangma; Monique J Roobol; Ivo G Schoots Journal: Cochrane Database Syst Rev Date: 2019-04-25
Authors: Jiří Stejskal; Vanda Adamcová; Miroslav Záleský; Vojtěch Novák; Otakar Čapoun; Vojtěch Fiala; Olga Dolejšová; Hana Sedláčková; Štěpán Veselý; Roman Zachoval Journal: World J Urol Date: 2020-08-06 Impact factor: 4.226
Authors: Joseph M Norris; Lucy A M Simmons; Abi Kanthabalan; Alex Freeman; Neil McCartan; Caroline M Moore; Shonit Punwani; Hayley C Whitaker; Mark Emberton; Hashim U Ahmed Journal: Eur Urol Open Sci Date: 2021-06-15