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 | piepepe@hotmail.com Urology Unit, Cannizzaro Hospital, Catania, Italy.
  • 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.

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Published
2016-12-30
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Section
SIEUN Congress: Original Articles
Keywords:
Active Surveillance, Prostate cancer, Confirmatory prostate biopsy, MRI/TRUS fusion biopsy
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  • PDF: 964
How to Cite
Pepe, P., Cimino, S., Garufi, A., Priolo, G., Russo, G. I., Giardina, R., Reale, G., Barbera, M., Panella, P., Pennisi, M., & Morgia, G. (2016). 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. Archivio Italiano Di Urologia E Andrologia, 88(4), 300-303. https://doi.org/10.4081/aiua.2016.4.300

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