PD44-06 CONFIDENCE IN BIOPSY FINDINGS IN THE ERA OF MRI-TARGETED PROSTATE SAMPLING (2015)

You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 2015PD44-06 CONFIDENCE IN BIOPSY FINDINGS IN THE ERA OF MRI-TARGETED PROSTATE SAMPLING Arvin George, Nabeel Shakir, M. Minhaj Siddiqui, Soroush Rais-Bahrami, Thomas Frye, Steven Abboud, Michele Fascelli, Richard Ho, Raju Chelluri, Peter L. Choyke, Baris Turkbey, Bradford J. Wood, and Peter A. Pinto Arvin GeorgeArvin George More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , M. Minhaj SiddiquiM. Minhaj Siddiqui More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author , Thomas FryeThomas Frye More articles by this author , Steven AbboudSteven Abboud More articles by this author , Michele FascelliMichele Fascelli More articles by this author , Richard HoRichard Ho More articles by this author , Raju ChelluriRaju Chelluri More articles by this author , Peter L. ChoykePeter L. Choyke More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford J. WoodBradford J. Wood More articles by this author , and Peter A. PintoPeter A. Pinto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2552AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging-ultrasound fusion (“targeted”) biopsy of the prostate is being increasingly adopted as a diagnostic modality for detecting prostate cancer (PCa). While targeted biopsy demonstrates improved performance in cancer detection and grading compared to template 12-core biopsy, the finding of low-grade or no cancer by either method presents a dilemma for patients clinically suspected to have higher risk PCa. We evaluated the likelihood of harboring clinically-significant (CS) PCa in spite of negative or equivocal biopsy using Bayesian analysis. METHODS Patients enrolled in a prospective trial undergoing multiparametric magnetic resonance imaging (MP-MRI) of the prostate followed by both 12-core and targeted biopsy in the same session were reviewed. Men upgrading to CS PCa were defined as patients with a greatest Gleason sum of ≥4+3 found by only one biopsy method. The probability of upgrading to CS PCa was modeled by logistic regression using prebiopsy variables found to be predictive of this outcome on univariate analysis. R 3.1.0 was used for all analyses. RESULTS From 2007-2014, 1003 men enrolled in the trial, of whom 564 were diagnosed with PCa and 192 were classified with CS PCa. The sensitivity of targeted biopsy for CS PCa was estimated to be 0.85 (95% confidence interval: 0.78-0.91); in contrast, that of 12-core biopsy was 0.60 (95% confidence interval: 0.52-0.67). The prior probability of CS PCa was computed using the sensitivity estimates. For an index patient with prostate-specific antigen (PSA) >10 ng/mL, the prebiopsy posterior probability of CS PCa was 68%. If only 12-core biopsy was performed in this patient and revealed low-grade or no PCa, the likelihood of still harboring CS PCa was 46%. If targeted and 12-core biopsy both revealed low-grade or no PCa, the likelihood of CS PCa decreased to 11%. Results for index patients across a range of PSA values are presented in Table 1. CONCLUSIONS In men with high-risk features and unrevealing 12-core biopsy, targeted biopsy adds certainty to the diagnosis and appropriate grading of PCa. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e899 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arvin George More articles by this author Nabeel Shakir More articles by this author M. Minhaj Siddiqui More articles by this author Soroush Rais-Bahrami More articles by this author Thomas Frye More articles by this author Steven Abboud More articles by this author Michele Fascelli More articles by this author Richard Ho More articles by this author Raju Chelluri More articles by this author Peter L. Choyke More articles by this author Baris Turkbey More articles by this author Bradford J. Wood More articles by this author Peter A. Pinto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...