A Comparison of Prostate Cancer Detection between Visual Estimation (Cognitive Registration) and Image Fusion (Software Registration) Targeted Transperineal Prostate Biopsy

No AccessJournal of UrologyAdult Urology1 Apr 2021A Comparison of Prostate Cancer Detection between Visual Estimation (Cognitive Registration) and Image Fusion (Software Registration) Targeted Transperineal Prostate Biopsy Christopher C. Khoo, David Eldred-Evans, Max Peters, Marieke van Son, Peter S. N. van Rossum, Martin J. Connor, Feargus Hosking-Jervis, Mariana Bertoncelli Tanaka, Deepika Reddy, Edward Bass, Laura Powell, Shahzad Ahmad, Elizabeth Pegers, Suchita Joshi, Denosshan Sri, Kathie Wong, Henry Tam, David Hrouda, Hasan Qazi, Stephen Gordon, Stuart McCracken, Mathias Winkler, and Hashim U. Ahmed Christopher C. KhooChristopher C. Khoo *Correspondence: E-mail Address: [email protected]. Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , David Eldred-EvansDavid Eldred-Evans Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , Max PetersMax Peters Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands More articles by this author , Marieke van SonMarieke van Son Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands More articles by this author , Peter S. N. van RossumPeter S. N. van Rossum Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands More articles by this author , Martin J. ConnorMartin J. Connor Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom More articles by this author , Feargus Hosking-JervisFeargus Hosking-Jervis Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom More articles by this author , Mariana Bertoncelli TanakaMariana Bertoncelli Tanaka Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , Deepika ReddyDeepika Reddy Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Financial interest and/or other relationship with Prostate Cancer UK and Sonacare Inc. More articles by this author , Edward BassEdward Bass Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom More articles by this author , Laura PowellLaura Powell Department of Urology, St. George’s Hospital NHS Foundation Trust, London, United Kingdom More articles by this author , Shahzad AhmadShahzad Ahmad Department of Urology, Epsom and St. Helier’s University Hospital Trust, Surrey, United Kingdom More articles by this author , Elizabeth PegersElizabeth Pegers RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom More articles by this author , Suchita JoshiSuchita Joshi RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom More articles by this author , Denosshan SriDenosshan Sri Department of Urology, St. George’s Hospital NHS Foundation Trust, London, United Kingdom More articles by this author , Kathie WongKathie Wong Department of Urology, Epsom and St. Helier’s University Hospital Trust, Surrey, United Kingdom More articles by this author , Henry TamHenry Tam Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , David HroudaDavid Hrouda Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , Hasan QaziHasan Qazi Department of Urology, St. George’s Hospital NHS Foundation Trust, London, United Kingdom More articles by this author , Stephen GordonStephen Gordon Department of Urology, Epsom and St. Helier’s University Hospital Trust, Surrey, United Kingdom More articles by this author , Stuart McCrackenStuart McCracken Department of Urology, South Tyneside and Sunderland NHS Trust, Sunderland Royal Hospital, Sunderland, United Kingdom More articles by this author , Mathias WinklerMathias Winkler Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author , and Hashim U. AhmedHashim U. Ahmed Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom Financial interest and/or other relationship with Sophiris Bio, Sonacare and Boston Scientific. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001476AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared clinically significant prostate cancer detection by visual estimation and image fusion targeted transperineal prostate biopsy. Materials and Methods: This multicenter study included patients with multiparametric magnetic resonance imaging lesions undergoing visual estimation or image fusion targeted transperineal biopsy (April 2017–March 2020). Propensity score matching was performed using demographics (age and ethnicity), clinical features (prostate specific antigen, prostate volume, prostate specific antigen density and digital rectal examination), multiparametric magnetic resonance imaging variables (number of lesions, PI-RADS® score, index lesion diameter, whether the lesion was diffuse and radiological T stage) and biopsy factors (number of cores, operator experience and anesthetic type). Matched groups were compared overall and by operator grade, PI-RADS score, lesion multiplicity, prostate volume and anesthetic type using targeted-only and targeted plus systematic histology. Multiple clinically significant prostate cancer thresholds were evaluated (primary: Gleason ≥3+4). Results: A total of 1,071 patients with a median age of 67.3 years (IQR 61.3–72.4), median prostate specific antigen of 7.5 ng/ml (IQR 5.3–11.2) and 1,430 total lesions underwent targeted-only biopsies (visual estimation: 372 patients, 494 lesions; image fusion: 699 patients, 936 lesions). A total of 770 patients with a median age of 67.4 years (IQR 61–72.1), median prostate specific antigen of 7.1 ng/ml (IQR 5.2–10.6) and 919 total lesions underwent targeted plus systematic biopsies (visual estimation: 271 patients, 322 lesions; image fusion: 499 patients, 597 lesions). Matched comparisons demonstrated no overall difference in clinically significant prostate cancer detection between visual estimation and image fusion (primary: targeted-only 54% vs 57.4%, p=0.302; targeted plus systematic 51.2% vs 58.2%, p=0.123). Senior urologists had significantly higher detection rates using image fusion (primary: targeted-only 45.4% vs 63.7%, p=0.001; targeted plus systematic 39.4% vs 64.5%, p <0.001). Conclusions: We found no overall difference in clinically significant prostate cancer detection, although image fusion may be superior in experienced hands. References 1. : Magnetic resonance imaging cognitive fusion biopsy—is near enough good enough?BJU Int 2018; 121: 324. Google Scholar 2. : MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018; 378: 1767. Google Scholar 3. National Institute for Health and Care Excellence: Prostate Cancer: Diagnosis and Management. 2019. Available at https://www.nice.org.uk/guidance/ng131. Google Scholar 4. : EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer. 2020. Available at https://uroweb.org/wp-content/uploads/EAU-EANM-ESTRO-ESUR-SIOG-Pocket-Guidelines-on-Prostate-Cancer-2020.pdf. 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Prostate Cancer Prostatic Dis 2017; 20: 436. Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 205, NO. 4, (951-952), Online publication date: 1-Apr-2021. Volume 205Issue 4April 2021Page: 1075-1081Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsmultiparametric magnetic resonance imagingbiopsyprostatic neoplasmsMetricsAuthor Information Christopher C. Khoo Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom *Correspondence: E-mail Address: [email protected]. More articles by this author David Eldred-Evans Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Max Peters Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands More articles by this author Marieke van Son Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands More articles by this author Peter S. N. van Rossum Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands More articles by this author Martin J. Connor Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom More articles by this author Feargus Hosking-Jervis Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom More articles by this author Mariana Bertoncelli Tanaka Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Deepika Reddy Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Financial interest and/or other relationship with Prostate Cancer UK and Sonacare Inc. More articles by this author Edward Bass Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom More articles by this author Laura Powell Department of Urology, St. George’s Hospital NHS Foundation Trust, London, United Kingdom More articles by this author Shahzad Ahmad Department of Urology, Epsom and St. Helier’s University Hospital Trust, Surrey, United Kingdom More articles by this author Elizabeth Pegers RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom More articles by this author Suchita Joshi RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom More articles by this author Denosshan Sri Department of Urology, St. George’s Hospital NHS Foundation Trust, London, United Kingdom More articles by this author Kathie Wong Department of Urology, Epsom and St. Helier’s University Hospital Trust, Surrey, United Kingdom More articles by this author Henry Tam Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author David Hrouda Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Hasan Qazi Department of Urology, St. George’s Hospital NHS Foundation Trust, London, United Kingdom More articles by this author Stephen Gordon Department of Urology, Epsom and St. Helier’s University Hospital Trust, Surrey, United Kingdom More articles by this author Stuart McCracken Department of Urology, South Tyneside and Sunderland NHS Trust, Sunderland Royal Hospital, Sunderland, United Kingdom More articles by this author Mathias Winkler Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom More articles by this author Hashim U. Ahmed Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom Financial interest and/or other relationship with Sophiris Bio, Sonacare and Boston Scientific. More articles by this author Expand All Advertisement PDF DownloadLoading ...