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Detection rate for significant cancer at confirmatory biopsy in men enrolled in Active Surveillance protocol: 20 cores vs 30 cores vs MRI/TRUS fusion prostate biopsy

Pietro Pepe, Sebastiano Cimino, Antonio Garufi, Giandomenico Priolo, Giorgio Ivan Russo, Raimondo Giardina, Giulio Reale, Michele Barbera, Paolo Panella, Michele Pennisi, Giuseppe Morgia
  • Sebastiano Cimino
    Department of Urology, University of Catania, Italy
  • Antonio Garufi
    Imaging Unit, Cannizzaro Hospital, Catania, Italy
  • Giandomenico Priolo
    Imaging Unit, Cannizzaro Hospital, Catania, Italy
  • Giorgio Ivan Russo
    Department of Urology, University of Catania, Italy
  • Raimondo Giardina
    Department of Urology, University of Catania, Italy
  • Giulio Reale
    Department of Urology, University of Catania, Italy
  • Michele Barbera
    Urology Unit, Cannizzaro Hospital, Catania, Italy
  • Paolo Panella
    Urology Unit, Cannizzaro Hospital, Catania, Italy
  • Michele Pennisi
    Urology Unit, Cannizzaro Hospital, Catania, Italy
  • Giuseppe Morgia
    Department of Urology, University of Catania, Italy

Abstract

Introduction: The detection rate for significant prostate cancer of extended vs saturation vs mMRI/TRUS fusion biopsy was prospectively evaluated in men enrolled in active surveillance (AS) protocol. Mterials and methods: From May 2013 to September 2016 75 men aged 66 years (median) with very low risk PCa were enrolled in an AS protocol and elegible criteria were: life expectancy greater than 10 years, cT1C, PSA below 10 ng/ml, PSA density < 0.20, 2 < unilateral positive biopsy cores, Gleason score (GS) equal to 6, greatest percentage of cancer (GPC) in a core < 50%. All patients underwent 3.0 Tesla pelvic mpMRI before confirmatory transperineal extended (20 cores) or saturation biopsy (SPBx; 30 cores) combined with mpMRI/TRUS fusion targeted biopsy (4 cores) of suspicious lesions (PI-RADS 3-5). Results: 21/75 (28%) patients were reclassified by SPBx based on upgraded GS ≥ 7; mpMRI lesions PI-RADS 4-5 vs PI-RADS 3-5 diagnosed 9/21 (42.8%) vs 16/21 (76.2%) significant PCa with 2 false positives (6.5%). The detection rate for significant PCa was equal to 76.2% (mpMRI/TRUS fusion biopsy) vs 81% (extended) vs 100% (SPBx) (p = 0.001); mpMRI/TRUS targeted biopsy and extended biopsy missed 5/21 (23.8%) and 4/21 (19%) significant PCa which were found by SPBx (p = 0.001) being characterised by the presence of a single positive core of GS ≥ 7 with GPC < 10%. Conclusions: Although mpMRI improve the diagnosis of clinically significant PCa, SPBx is provided of the best detection rate for PCa in men enrolled in AS protocols who underwent confirmatory biopsy.

Keywords

Active Surveillance; Prostate cancer; Confirmatory prostate biopsy; MRI/TRUS fusion biopsy

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Submitted: 2017-01-10 13:56:12
Published: 2016-12-30 00:00:00
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Copyright (c) 2017 Pietro Pepe, Sebastiano Cimino, Antonio Garufi, Giandomenico Priolo, Giorgio Ivan Russo, Raimondo Giardina, Giulio Reale, Michele Barbera, Paolo Panella, Michele Pennisi, Giuseppe Morgia

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