Further reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance

• Verfasst von: Radtke, Jan Philipp [VerfasserIn]
• Verfasst von: Kuru, Timur Hasan [VerfasserIn]
• Verfasst von: Bonekamp, David [VerfasserIn]
• Verfasst von: Alt, Céline D. [VerfasserIn]
• Verfasst von: Hatiboglu, Gencay [VerfasserIn]
• Verfasst von: Boxler, Silvan [VerfasserIn]
• Verfasst von: Pahernik, Sascha [VerfasserIn]
• Verfasst von: Roth, Wilfried [VerfasserIn]
• Verfasst von: Schlemmer, Heinz-Peter [VerfasserIn]
• Verfasst von: Hohenfellner, Markus [VerfasserIn]
• Verfasst von: Hadaschik, Boris [VerfasserIn]
• Titel: Further reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance
• Verf.angabe: J.P. Radtke, T.H. Kuru, D. Bonekamp, M.T. Freitag, M.B. Wolf, C.D. Alt, G. Hatiboglu, S. Boxler, S. Pahernik, W. Roth, M.C. Roethke, H.P. Schlemmer, M. Hohenfellner, B.A. Hadaschik
• E-Jahr: 2016
• Jahr: 17 May 2016
• Umfang: 9 S.
• Fussnoten: Gesehen am 21.02.2018
• Titel Quelle: Enthalten in: Prostate cancer and prostatic diseases
• Ort Quelle: Basingstoke : Stockton Press, 1997
• Jahr Quelle: 2016
• Band/Heft Quelle: 19(2016), 3, Seite 283-291
• ISSN Quelle: 1476-5608
• DOI: doi:10.1038/pcan.2016.16
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1570048282

Abstract

Background:Active surveillance (AS) is commonly based on standard 10-12-core prostate biopsies, which misclassify ~50% of cases compared with radical prostatectomy. We assessed the value of multiparametric magnetic resonance imaging (mpMRI)-targeted transperineal fusion-biopsies in men under AS.Methods:In all, 149 low-risk prostate cancer (PC) patients were included in AS between 2010 and 2015. Forty-five patients were initially diagnosed by combined 24-core systematic transperineal saturation biopsy (SB) and MRI/transurethral ultrasound (TRUS)-fusion targeted lesion biopsy (TB). A total of 104 patients first underwent 12-core TRUS-biopsy. All patients were followed-up by combined SB and TB for restratification after 1 and 2 years. All mpMRI examinations were analyzed using PIRADS. AS was performed according to PRIAS-criteria and a NIH-nomogram for AS-disqualification was investigated. AS-disqualification rates for men initially diagnosed by standard or fusion biopsy were compared using Kaplan-Meier estimates and log-rank tests. Differences in detection rates of the SB and TB components were evaluated with a paired-sample analysis. Regression analyses were performed to predict AS-disqualification.Results:A total of, 48.1% of patients diagnosed by 12-core TRUS-biopsy were disqualified from AS based on the MRI/TRUS-fusion biopsy results. In the initial fusion-biopsy cohort, upgrading occurred significantly less frequently during 2-year follow-up (20%, P<0.001). TBs alone were significantly superior compared with SBs alone to detect Gleason-score-upgrading. NPV for Gleason-upgrading was 93.5% for PIRADS⩽2. PSA level, PSA density, NIH-nomogram, initial PIRADS score (P<0.001 each) and PIRADS-progression on consecutive MRI (P=0.007) were significant predictors of AS-disqualification.Conclusions:Standard TRUS-biopsies lead to significant underestimation of PC under AS. MRI/TRUS-fusion biopsies, and especially the TB component allow more reliable risk classification, leading to a significantly decreased chance of subsequent AS-disqualification. Cancer detection with mpMRI alone is not yet sensitive enough to omit SB on follow-up after initial 12-core TRUS-biopsy. After MRI/TRUS-fusion biopsy confirmed AS, it may be appropriate to biopsy only those men with suspected progression on MRI.