dc.contributor.author
Maxeiner, Andreas
dc.contributor.author
Nest, Alexander M.
dc.contributor.author
Stephan, Carsten
dc.contributor.author
Cash, Hannes
dc.contributor.author
Baur, Alexander D. J.
dc.contributor.author
Fischer, Thomas
dc.contributor.author
Kilic, Ergin
dc.contributor.author
Piper, Sophie K.
dc.contributor.author
Nowak, Claus-P.
dc.contributor.author
Busch, Jonas
dc.contributor.author
Miller, Kurt
dc.contributor.author
Mang, Josef
dc.date.accessioned
2021-06-24T12:56:43Z
dc.date.available
2021-06-24T12:56:43Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/31149
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-30885
dc.description.abstract
Introduction: Patients with consistent suspicion for prostate cancer (PCa) and multiple negative prebiopsies prior to multiparametric magnetic resonance imaging (mpMRI) are still frequently evaluated for an image-guided biopsy and are reported with heterogeneous detection rates. The inclusion of a systematic biopsy (SB) is also still recommended with predominant sampling within the posterior/peripheral zone of the prostate. The aim of this study was (I) to evaluate PCa detection rates using a modified 10 core SB template including anterior biopsies in combination with mpMRI/ultrasound fusion-guided targeted biopsy (TB) in patients with 3 or more negative prebiopsies and (II) to compare mpMRI index lesion localization with histologically confirmed locali-zation from associated prostatectomy samples.
Methods: Overall 1,337 consecutive patients underwent sensor-based registration TB of the prostate and a subsequent 10-core SB between January 2012 and December 2015 at our institution. For this study, 101 patients with ≥3 negative prebiopsies and prostate imaging - reporting data system lesions ≥3 were pooled prospectively and underwent TB and a modified SB including 2 ventral (anterior) biopsies. Detection rates were estimated for the modified SB, TB, and its combination. A subgroup analysis of 35 patients undergoing prostatectomy was performed by a head-to-head comparison of mpMRI index lesion and histologically confirmed PCa index lesion localization.
Results: The overall detection rate for PCa was 54.5%. The combination of TB and SB detected 14 (25.4%) more cases missed by TB alone (p < 0.001) and 7 (12.7%) more cases missed by SB alone (p = 0.016), respectively. A postoperative Gleason upgrade was seen in 12/35 (34.3%) cases within the TB group and in 14/35 (40.0%) in the SB group, respectively. The subgroup analysis showed a predominant location of PCa index lesions anteriorly at the level of the midgland. The MRI detection rate of the anteriorly located index lesions was 70.4% (15/21 cases) with a clinically significant Gleason score (≥3 + 4 = 7a [International Society of Urological Pathology grade 2]) in 80.9%. Interestingly a modified SB template detected 90.5% (19/21) of the anteriorly located index lesions.
Conclusion: Our data suggest that in patients with multiple prebiopsies PCa seems to be predominantly located anteriorly. We suggest the general integration of anterior biopsies despite TB in repeat biopsy patients.
en
dc.subject
Prostate cancer
en
dc.subject
Multiparametric magnet resonance imaging
en
dc.subject
Fusion-guided biopsy
en
dc.subject
Systematic TRUS-guided biopsy
en
dc.subject
Repeat biopsy
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.doi
10.1159/000504266
dcterms.bibliographicCitation.journaltitle
Urologia Internationalis
dcterms.bibliographicCitation.number
3-4
dcterms.bibliographicCitation.originalpublishername
Karger
dcterms.bibliographicCitation.pagestart
205
dcterms.bibliographicCitation.pageend
213
dcterms.bibliographicCitation.volume
104
dcterms.rightsHolder.note
Copyright applies in this work.
dcterms.rightsHolder.url
http://rightsstatements.org/vocab/InC/1.0/
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.note.author
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
de
refubium.note.author
This publication is shared with permission of the rights owner and made freely accessible through a DFG (German Research Foundation) funded license at either an alliance or national level.
en
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
31801153
dcterms.isPartOf.issn
0042-1138
dcterms.isPartOf.eissn
1423-0399