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Comparison of TRUS-Biopsy to transperineal template mapping biopsies stratified by multi-parametric MRI score within the PROMIS trial.

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Title: Comparison of TRUS-Biopsy to transperineal template mapping biopsies stratified by multi-parametric MRI score within the PROMIS trial.
Authors: Lovegrove, C
Miah, S
El-Shater Bosaily, A
Bott, S
Brown, L
Burns-Cox, N
Dudderidge, T
Freeman, A
Henderson, A
Hindley, R
Kaplan, R
Kirkham, A
Oldroyd, R
Parker, C
Persad, R
Punwani, S
Rosario, D
Shergill, I
Winkler, M
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: INTRODUCTION: We evaluated performance of transrectal ultrasound-guided systematic (TRUS) biopsy compared to transperineal template mapping (TPM) with a 5mm sampling frame, stratified by MP-MRI Likert score within the PROMIS study. METHODS: Biopsy-naïve men due prostate biopsy for elevated PSA and/or abnormal digital rectal examination underwent MP-MRI, TPM and TRUS biopsies, conducted and reported blind to other test results. Clinically significant prostate cancer (csPCa) was primarily defined as Gleason >/=4+3 or maximum cancer core length (MCCL) >/=6mm of any grade, and secondarily Gleason >/=3+4 or MCCL >/=4mm of any grade. RESULTS: In 41 months, 740 men at 11 centres were recruited; 576 underwent all three tests. Of 150 with MRI score 1-2, 8 (5.1%) had any Gleason >/=3+4 disease on TRUS-biopsy. In 75 where TRUS-biopsy showed Gleason 3+3 of any MCCL, 61/75 (81%) had Gleason 3+4, 8/75 (11%) Gleason 4+3 and 0/75 (0%) Gleason >/=4+5. For definition1 csPCa, TRUS-biopsy sensitivity remained stable and low across MP-MRI Likert scores (35%-52%). For definition2 csPCa and any cancer, sensitivity increased with higher MP-MRI score. Negative predictive value varied due to varying disease prevalence but for all cancer thresholds declined with increasing MP-MRI score. CONCLUSIONS: TRUS-biopsy in the setting of MP-MRI Likert scores 1-2 finds Gleason 3+4 disease in only 1 in 20 men. Further, for any csPCa definition, TRUS-biopsy had poor sensitivity and variable but low NPV across MP-MRI scores. Men undergoing TRUS-biopsy without targeting in the setting of MP-MRI score 3 to 5 should be advised to undergo a repeat (targeted) biopsy.
Issue Date: 1-Jan-2020
Date of Acceptance: 9-Jul-2019
URI: http://hdl.handle.net/10044/1/72044
DOI: 10.1097/JU.0000000000000455
ISSN: 0022-5347
Publisher: Elsevier
Start Page: 100
End Page: 107
Journal / Book Title: The Journal of Urology
Volume: 203
Issue: 1
Copyright Statement: © 2019 by American Urological Association Education and Research, Inc.
Sponsor/Funder: Wellcome Trust
University College London Hospitals Charity
Imperial Health Charity
Medical Research Council (MRC)
Funder's Grant Number: 204998/Z/16/Z
1348
RF18/100021
WSST_P70374
Keywords: image-guided biopsy
magnetic resonance imaging
predictive value of tests
prostatic neoplasms
ultrasonography
Humans
Image-Guided Biopsy
Magnetic Resonance Imaging
Male
Neoplasm Grading
Prospective Studies
Prostatic Neoplasms
Sensitivity and Specificity
Ultrasonography, Interventional
Humans
Prostatic Neoplasms
Magnetic Resonance Imaging
Ultrasonography, Interventional
Sensitivity and Specificity
Prospective Studies
Male
Neoplasm Grading
Image-Guided Biopsy
MRI
biopsy
prostate
template
transrectal
Urology & Nephrology
1103 Clinical Sciences
Publication Status: Published
Conference Place: United States
Online Publication Date: 2020-01-01
Appears in Collections:Department of Surgery and Cancer