Comparison of Prostate Biopsy with or without Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Detection: An Observational Cohort Study

No AccessJournal of UrologyAdult Urology1 Mar 2019Comparison of Prostate Biopsy with or without Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Detection: An Observational Cohort Study Richard J. Bryant, Catherine P. Hobbs, Katie S. Eyre, Lucy C. Davies, Mark E. Sullivan, William Shields, Prasanna Sooriakumaran, Clare L. Verrill, Fergus V. Gleeson, Ruth E. MacPherson, Freddie C. Hamdy, and Simon F. Brewster Richard J. BryantRichard J. Bryant *Correspondence: Nuffield Department of Surgical Sciences, Oxford Cancer Research Centre, University of Oxford, Old Road Campus Research Building, OxfordOX3 7DQ, United Kingdom (e-mail: E-mail Address: [email protected]). Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom , Catherine P. HobbsCatherine P. Hobbs Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom , Katie S. EyreKatie S. Eyre Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom , Lucy C. DaviesLucy C. Davies Nuffield Departments of Population Health, University of Oxford, Oxford, United Kingdom , Mark E. SullivanMark E. Sullivan Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom , William ShieldsWilliam Shields Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom , Prasanna SooriakumaranPrasanna Sooriakumaran Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom Department of Uro-Oncology, University College London Hospital National Health Service Foundation Trust, London, United Kingdom , Clare L. VerrillClare L. Verrill Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom , Fergus V. GleesonFergus V. Gleeson Department of Radiology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom , Ruth E. MacPhersonRuth E. MacPherson Department of Radiology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom , Freddie C. HamdyFreddie C. Hamdy Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom , and Simon F. BrewsterSimon F. Brewster Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom View All Author Informationhttps://doi.org/10.1016/j.juro.2018.09.049AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We hypothesized that 1) introducing prebiopsy multiparametric magnetic resonance imaging would increase the diagnostic yield of transrectal prostate biopsy and 2) this would inform recommendations regarding systematic transrectal prostate biopsy in the setting of negative prebiopsy multiparametric magnetic resonance imaging. Materials and Methods: A total of 997 biopsy naïve patients underwent transrectal prostate biopsy alone to June 2016 (cohort 1) and thereafter 792 underwent transrectal prostate biopsy following prebiopsy multiparametric magnetic resonance imaging (cohort 2). Patients with lesions on prebiopsy multiparametric magnetic resonance imaging underwent cognitive targeted plus systematic transrectal prostate biopsy. Patients without lesions underwent systematic transrectal prostate biopsy. Results: Cohort 2 comprised younger men (age 68 vs 69 years, p = 0.01) with lower prostate specific antigen (7.6 vs 7.9 ng/ml, p = 0.024) and smaller prostate volume (56.1 vs 62 cc, p = 0.006). In cohort 2 vs cohort 1 there was no increase in overall prostate cancer detection (57.6% vs 56.7%, p = 0.701), the Gleason Grade Group or the number of positive cores (each p >0.05). Increased multifocal prostatic intraepithelial neoplasia, maximum prostate cancer core length (5 mm or greater vs less than 5 mm) and radical surgery/high intensity focused ultrasound (each p <0.05) were observed in cohort 2. For Gleason Grade Group 2-5 prostate cancer negative prebiopsy multiparametric magnetic resonance imaging had 88.1% sensitivity, 59.8% specificity, 67.8% positive predictive value and 84% negative predictive value. For negative prebiopsy multiparametric magnetic resonance images a prostate specific antigen density cutoff of 0.15 ng/ml2 or greater increased clinically significant prostate cancer detection only if the latter was defined as Gleason Grade Group 3-5 disease and/or tumor length 6 mm or greater. Conclusions: Introducing prebiopsy multiparametric magnetic resonance imaging in our clinical setting increased the diagnostic yield of prostate cancer per biopsy core. Not performing a systematic transrectal prostate biopsy when prebiopsy multiparametric magnetic resonance imaging was negative would have led to under detection of 15.1% of Gleason Grade Group 2 or greater prostate cancer cases (approximately 1 in 6). 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Link, Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPagniez M, Kasivisvanathan V, Puech P, Drumez E, Villers A and Olivier J (2020) Predictive Factors of Missed Clinically Significant Prostate Cancers in Men with Negative Magnetic Resonance Imaging: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 204, NO. 1, (24-32), Online publication date: 1-Jul-2020. Volume 201Issue 3March 2019Page: 510-519 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsmagnetic resonance imagingprostate specific antigendiagnosisbiopsyprostatic neoplasmsMetricsAuthor Information Richard J. Bryant Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom *Correspondence: Nuffield Department of Surgical Sciences, Oxford Cancer Research Centre, University of Oxford, Old Road Campus Research Building, OxfordOX3 7DQ, United Kingdom (e-mail: E-mail Address: [email protected]). More articles by this author Catherine P. Hobbs Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom More articles by this author Katie S. Eyre Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom More articles by this author Lucy C. Davies Nuffield Departments of Population Health, University of Oxford, Oxford, United Kingdom More articles by this author Mark E. Sullivan Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom More articles by this author William Shields Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom More articles by this author Prasanna Sooriakumaran Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom Department of Uro-Oncology, University College London Hospital National Health Service Foundation Trust, London, United Kingdom More articles by this author Clare L. Verrill Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom More articles by this author Fergus V. Gleeson Department of Radiology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom More articles by this author Ruth E. MacPherson Department of Radiology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom More articles by this author Freddie C. Hamdy Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom Nuffield Departments of Surgical Sciences, University of Oxford, Oxford, United Kingdom More articles by this author Simon F. Brewster Department of Urology, Oxford University Hospitals National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...