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MP86-18 MRI TARGETED BIOPSY MAY ENHANCE DIAGNOSTIC PERFORMANCE OF SIGNIFICANT PROSTATE CANCER DETECTION COMPARED TO STANDARD TRANSRECTAL ULTRASOUND GUIDED BIOPSY: A SYSTEMATIC REVIEW AND META-ANALYSIS
THE JOURNAL OF UROLOGYâ
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either upgrade or upstage on subsequent prostate biopsy while 45% of them showed acute inflammation in the subsequent biopsy without any upgrading or upstaging. The positive predicting value for PCA3 > 100 was only 62%. CONCLUSIONS: Despite prior evidence suggesting that inflammation does not cause elevated PCA3, our data indicates that some men with extremely high PCA3 levels do have significant inflammation in their prostate biopsy. Clinicians can reassure patients with very high PCA3 levels that cancer is not inevitable and that inflammation may explain this abnormal result. Furthermore, among patients on AS, only a minority of patients with a highly abnormal PCA3 reclassify. Source of Funding: Princess Margaret Cancer Research Centre
MP86-17 CLINICALLY SIGNIFICANT INCIDENTAL PROSTATE CANCER DETECTED IN RADICAL CYSTOPROSTATECTOMY SPECIMENS Swar Shah*, Soroush Bazaragani, Gus Miranda, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand, Los Angeles, CA INTRODUCTION AND OBJECTIVES: While the focus of radical cystoprostatectomy (RC) is usually a bladder-primary malignancy, incidental prostate cancer is a common finding during pathological examination of the surgical specimen. While mostly clinically insignificant and generally minimally monitored, we sought to characterize clinically significant prostate cancer (csPCA), which may require closer monitoring. Herein, we evaluate the role of prostate specific antigen (PSA) in monitoring csPCA diagnosed at the time of RC. METHODS: Using and IRB approved prospective database, we identified 1451 patients who underwent RC between 2003 and 2014 at our institution. Clinically significant prostate cancer was defined as Gleason score 7, extra prostatic extension, seminal vesicle involvement, positive surgical margin, and lymph node involvement. PSA values were recorded. In patients with evidence of a biochemical recurrence, complete follow up was obtained. Patients were diagnosed with recurrence based on PSA values or findings on cross sectional imaging. RESULTS: We identified a total of 107 patients with csPCA diagnosed at the time of RC, of whom 42 had PSA followup. Average age at the time of RC in these patients was 72.24 9.52 years, with a median follow up of 2.18 years. Mean baseline PSA prior to surgery was 4.457.49. Two (4.7%) patients developed a recurrence of their prostate cancer, aged 66 and 65 at the time of surgery, and diagnosed 6.8 and 6.1 years after RC. Both had Gleason grade 3þ4 on RC pathology, with no capsule penetration, bladder extension, seminal vesicle involvement, or nodal extension. PSA at the time of recurrence was 0.12 and 43.6 each. PSA peaks were 0.52 and 80.6, respectively. The first was diagnosed based on an enlarged lymph node on routine postoperative cross sectional imaging followed by a steady rise in PSA, which was ultimately biopsy proven PCA. He was unable to undergo radiotherapy because his neobladder would not tolerate the doses of radiation required for prostate cancer and refused ADT. The second was diagnosed based on a markedly elevated PSA, and underwent ADT with a normalization of his markers. He had a marker relapse 3 years after cessation of ADT. Both were alive at last follow up, 6.9 and 9.5 years post-surgery. CONCLUSIONS: Less than 5% of patients develop a relapse after diagnosis of csPCA on RC pathology. The relative paucity of recurrence makes it difficult to establish parameters for monitoring, however time to diagnosis (>6 years) suggests long term-follow up in these patients may be necessary to monitor for recurrence. Source of Funding: None
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
MP86-18 MRI TARGETED BIOPSY MAY ENHANCE DIAGNOSTIC PERFORMANCE OF SIGNIFICANT PROSTATE CANCER DETECTION COMPARED TO STANDARD TRANSRECTAL ULTRASOUND GUIDED BIOPSY: A SYSTEMATIC REVIEW AND META-ANALYSIS Ivo Schoots, Monique Roobol*, Arnout Alberts, Daan Nieboer, Chris Bangma, Ewout Steyerberg, Myriam Hunink, Rotterdam, Netherlands INTRODUCTION AND OBJECTIVES: A major limitation of prostate cancer detection by transrectal ultrasound guided biopsy (TRUS-Bx) is undersampling of significant tumours and oversampling of potentially insignificant tumours. Prostate MRI may improve diagnostic performance of prostate cancer detection by enabling targeted biopsy (MRI-TBx). OBJECTIVE: To systematically review and meta-analyse evidence regarding the diagnostic performance of MRI-TBx (index test) versus TRUS-Bx (current reference standard) in detection of overall prostate cancer, and significant and insignificant prostate cancer. METHODS: A systematic review of the literature (i.e. Embase, Medline, PubMed) was performed according to the PRISMA statement. Identified reports were critically appraised according to the QUADAS criteria. Only studies applying a sequential sampling design of the two biopsy tests, MRI-TBx and TRUS-Bx, in the same man, were selected. MRI-TBx was performed by visual estimation, software-registered fusion between MRI and US, or ‘in-bore’ targeted biopsy. TRUS-Bx was performed by transrectal systematic 10-12 core biopsies. RESULTS: Included reports (16) used both MRI-TBx and TRUS-Bx for prostate cancer detection. A cumulative total of 1926 men with positive MRI were included, with prostate cancer prevalence of 59%. - MRI-TBx and TRUS-Bx did not show significant differences in overall prostate cancer detection (sensitivity 0.85 [CI 0.80, 0.89] and 0.81 [0.70, 0.88], respectively). - MRI-TBx showed increased significant prostate cancer detection (sensitivity 0.91 [0.87, 0.94] and 0.76 [0.64, 0.84], respectively). - MRI-TBx showed decreased insignificant prostate cancer detection (sensitivity 0.44 [0.26, 0.64] and 0.83 [0.77, 0.87] respectively). - Subgroup analysis showed improvement of significant prostate cancer detection by MRI-TBx in men with previous negative biopsy, rather than in men with initial biopsy (relative sensitivity of 1.54 [1.05, 2.57] and 1.10 [1.00, 1.22]). CONCLUSIONS: In men with a clinical suspicion of prostate cancer and a subsequent positive MRI, MRI targeted biopsy and TRUS guided biopsy did not differ in overall prostate cancer detection. However, MRI-TBx resulted in a higher detection rate of significant prostate cancer and a lower detection rate of insignificant prostate cancer, compared with TRUS-guided biopsy. Source of Funding: none
MP86-19 IN-BORE MRI-GUIDED TARGETED PROSTATE BIOPSY (MRGTBX): PI RADS BASED PROSTATE CANCER DETECTION AND GLEASON UPGRADING ON 3T COMPARED TO TRUS BIOPSY IN MEN WITH ELEVATED PSA Wei Chan Lin*, Los Angeles, CA; Nelly Tan, Pooria Khoshnoodi, Daniel Margolis, David Lu, Steven Raman, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Introduction:Systemic transrectal biopsy has suffered from high false negative rate. MRgTBx,on the other hand,has better detection accuracy&requires
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either upgrade or upstage on subsequent prostate biopsy while 45% of them showed acute inflammation in the subsequent biopsy without any upgrading or upstaging. The positive predicting value for PCA3 > 100 was only 62%. CONCLUSIONS: Despite prior evidence suggesting that inflammation does not cause elevated PCA3, our data indicates that some men with extremely high PCA3 levels do have significant inflammation in their prostate biopsy. Clinicians can reassure patients with very high PCA3 levels that cancer is not inevitable and that inflammation may explain this abnormal result. Furthermore, among patients on AS, only a minority of patients with a highly abnormal PCA3 reclassify. Source of Funding: Princess Margaret Cancer Research Centre
MP86-17 CLINICALLY SIGNIFICANT INCIDENTAL PROSTATE CANCER DETECTED IN RADICAL CYSTOPROSTATECTOMY SPECIMENS Swar Shah*, Soroush Bazaragani, Gus Miranda, Hooman Djaladat, Anne Schuckman, Siamak Daneshmand, Los Angeles, CA INTRODUCTION AND OBJECTIVES: While the focus of radical cystoprostatectomy (RC) is usually a bladder-primary malignancy, incidental prostate cancer is a common finding during pathological examination of the surgical specimen. While mostly clinically insignificant and generally minimally monitored, we sought to characterize clinically significant prostate cancer (csPCA), which may require closer monitoring. Herein, we evaluate the role of prostate specific antigen (PSA) in monitoring csPCA diagnosed at the time of RC. METHODS: Using and IRB approved prospective database, we identified 1451 patients who underwent RC between 2003 and 2014 at our institution. Clinically significant prostate cancer was defined as Gleason score 7, extra prostatic extension, seminal vesicle involvement, positive surgical margin, and lymph node involvement. PSA values were recorded. In patients with evidence of a biochemical recurrence, complete follow up was obtained. Patients were diagnosed with recurrence based on PSA values or findings on cross sectional imaging. RESULTS: We identified a total of 107 patients with csPCA diagnosed at the time of RC, of whom 42 had PSA followup. Average age at the time of RC in these patients was 72.24 9.52 years, with a median follow up of 2.18 years. Mean baseline PSA prior to surgery was 4.457.49. Two (4.7%) patients developed a recurrence of their prostate cancer, aged 66 and 65 at the time of surgery, and diagnosed 6.8 and 6.1 years after RC. Both had Gleason grade 3þ4 on RC pathology, with no capsule penetration, bladder extension, seminal vesicle involvement, or nodal extension. PSA at the time of recurrence was 0.12 and 43.6 each. PSA peaks were 0.52 and 80.6, respectively. The first was diagnosed based on an enlarged lymph node on routine postoperative cross sectional imaging followed by a steady rise in PSA, which was ultimately biopsy proven PCA. He was unable to undergo radiotherapy because his neobladder would not tolerate the doses of radiation required for prostate cancer and refused ADT. The second was diagnosed based on a markedly elevated PSA, and underwent ADT with a normalization of his markers. He had a marker relapse 3 years after cessation of ADT. Both were alive at last follow up, 6.9 and 9.5 years post-surgery. CONCLUSIONS: Less than 5% of patients develop a relapse after diagnosis of csPCA on RC pathology. The relative paucity of recurrence makes it difficult to establish parameters for monitoring, however time to diagnosis (>6 years) suggests long term-follow up in these patients may be necessary to monitor for recurrence. Source of Funding: None
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
MP86-18 MRI TARGETED BIOPSY MAY ENHANCE DIAGNOSTIC PERFORMANCE OF SIGNIFICANT PROSTATE CANCER DETECTION COMPARED TO STANDARD TRANSRECTAL ULTRASOUND GUIDED BIOPSY: A SYSTEMATIC REVIEW AND META-ANALYSIS Ivo Schoots, Monique Roobol*, Arnout Alberts, Daan Nieboer, Chris Bangma, Ewout Steyerberg, Myriam Hunink, Rotterdam, Netherlands INTRODUCTION AND OBJECTIVES: A major limitation of prostate cancer detection by transrectal ultrasound guided biopsy (TRUS-Bx) is undersampling of significant tumours and oversampling of potentially insignificant tumours. Prostate MRI may improve diagnostic performance of prostate cancer detection by enabling targeted biopsy (MRI-TBx). OBJECTIVE: To systematically review and meta-analyse evidence regarding the diagnostic performance of MRI-TBx (index test) versus TRUS-Bx (current reference standard) in detection of overall prostate cancer, and significant and insignificant prostate cancer. METHODS: A systematic review of the literature (i.e. Embase, Medline, PubMed) was performed according to the PRISMA statement. Identified reports were critically appraised according to the QUADAS criteria. Only studies applying a sequential sampling design of the two biopsy tests, MRI-TBx and TRUS-Bx, in the same man, were selected. MRI-TBx was performed by visual estimation, software-registered fusion between MRI and US, or ‘in-bore’ targeted biopsy. TRUS-Bx was performed by transrectal systematic 10-12 core biopsies. RESULTS: Included reports (16) used both MRI-TBx and TRUS-Bx for prostate cancer detection. A cumulative total of 1926 men with positive MRI were included, with prostate cancer prevalence of 59%. - MRI-TBx and TRUS-Bx did not show significant differences in overall prostate cancer detection (sensitivity 0.85 [CI 0.80, 0.89] and 0.81 [0.70, 0.88], respectively). - MRI-TBx showed increased significant prostate cancer detection (sensitivity 0.91 [0.87, 0.94] and 0.76 [0.64, 0.84], respectively). - MRI-TBx showed decreased insignificant prostate cancer detection (sensitivity 0.44 [0.26, 0.64] and 0.83 [0.77, 0.87] respectively). - Subgroup analysis showed improvement of significant prostate cancer detection by MRI-TBx in men with previous negative biopsy, rather than in men with initial biopsy (relative sensitivity of 1.54 [1.05, 2.57] and 1.10 [1.00, 1.22]). CONCLUSIONS: In men with a clinical suspicion of prostate cancer and a subsequent positive MRI, MRI targeted biopsy and TRUS guided biopsy did not differ in overall prostate cancer detection. However, MRI-TBx resulted in a higher detection rate of significant prostate cancer and a lower detection rate of insignificant prostate cancer, compared with TRUS-guided biopsy. Source of Funding: none
MP86-19 IN-BORE MRI-GUIDED TARGETED PROSTATE BIOPSY (MRGTBX): PI RADS BASED PROSTATE CANCER DETECTION AND GLEASON UPGRADING ON 3T COMPARED TO TRUS BIOPSY IN MEN WITH ELEVATED PSA Wei Chan Lin*, Los Angeles, CA; Nelly Tan, Pooria Khoshnoodi, Daniel Margolis, David Lu, Steven Raman, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Introduction:Systemic transrectal biopsy has suffered from high false negative rate. MRgTBx,on the other hand,has better detection accuracy&requires