24 Core Systematic (random) Biopsy missed 1 in 5 Gleason >6 cancers. Combined with targeted reduced misses to 1 in 8.
A new “gold standard” for detection of prostate cancer? | THE "NEW" PROSTATE CANCER INFOLINK
A combination of systematic and targeted biopsy methods may well be the
ideal that we seek to establish for the detection of prostate cancer.
Making such methodology available to every patient will require patience
and greater thought about who actually needs this type of biopsy. It
would, for example, become more practical if we could cut down the
number of men who are being given unnecessary biopsies every year.
|
Study compared effectiveness of 4 targeted vs. 24 systematic core biopsy |
Comparative
Analysis of Transperineal Template Saturation Prostate Biopsy Versus
Magnetic Resonance Imaging Targeted Biopsy with Magnetic Resonance
Imaging-Ultrasound Fusion Guidance - The Journal of Urology
Results
Overall 150 cancers and 86
Gleason score 7 or greater cancers were diagnosed.
Systematic,
transperineal biopsy
missed 18 Gleason score 7 or greater tumors (20.9%)
while
targeted biopsy did not detect 11 (12.8%). Targeted biopsy of
PI-RADS 2—5 alone overlooked 43.8% of Gleason score 6 tumors. McNemar’s
tests for detection of Gleason score 7 or greater cancers in both
modalities were not statistically significant but showed a trend of
superiority for targeted primary biopsies (p=0.08). Sampling efficiency
was in favor of magnetic resonance imaging targeted prostate biopsy with
46.0% of targeted biopsy vs 7.5% of systematic, transperineal biopsy
cores detecting Gleason score 7 or greater cancers. To diagnose 1
Gleason score 7 or greater cancer, 3.4 targeted and 7.4 systematic
biopsies were needed. Limiting biopsy to men with
PI-RADS 3–5 would have
missed 17 Gleason score 7 or greater tumors (19.8%), demonstrating
limited magnetic resonance imaging sensitivity. PI-RADS scores, digital
rectal examination findings and prostate specific antigen greater than
20 ng/ml were predictors of Gleason score 7 or greater disease.
Conclusions
Compared
to systematic, transperineal biopsy as a reference test, magnetic
resonance imaging targeted biopsy alone detected as many Gleason score 7
or greater tumors while simultaneously mitigating the detection of
lower grade disease.
The gold standard for cancer detection in primary
biopsy is a combination of systematic and targeted cores.
No comments:
Post a Comment