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MP-11.15: Comparison study between ten core extended and saturation prostate biopsy in a repeat prostate biopsy population
MODERATED POSTER SESSIONS
RALPs were performed from July, 2005 to June, 2006. Data pertaining to cost details and outcome metrics were analyzed. Average direct and total cost per case for room and board, operating room services, medical and surgical supplies, medications and investigations was determined and the sensitivity of total average cost to each of these parameters was studied. The cost of the robot was estimated to be $1,300,000 from published literature, along with a yearly maintenance contract of $100,000 depreciated over a projected life of ten years. Results: Average direct cost of a procedure was found to be $4,971 and the average total cost $9,536 (this includes indirect costs); excluding the capital cost of the robot, assigned from published literature, to each case, these costs would be $4,314 and $8,879, respectively. Based on the analyzed data, it was found that the cost of medical and surgical supplies, including the cost of instruments accounted for 45% of total average direct cost and approximately one-third of average total cost. Operating room services and therefore, duration of OR utilization accounted for almost 30% of total average direct cost and 35% of the total cost per procedure. Projecting an increase in the number of procedures performed per year from 100 to 400 reduced costs by around 18%, based on the cost of the robot and maximal change in costs were seen in increasing volumes from 100 to 200 cases per year. Conclusions: Total cost of a procedure was found to be sensitive to and dependent upon a number of variables: increasing the number of RALP procedures per year, reducing OR time per case and decreasing the cost of medical and surgical supplies are the most important parameters that ultimately reduce total cost of the procedure. MP-11.14 Diagnosis of anterior prostate cancer by dynamic contrast-enhanced combined with T2W MR imaging Villers A1, Lemaitre L2, Puech P2, Poncelet E2, Leroy X1, Biserte J1 1 Urology, 2Radiology, Centre Hospitalier Re´gional Universitaire de Lille, France Introduction: To relate the imaging features of suspicious areas in the anterior compartment of the prostate, as given by Dynamic Contrast Enhanced Magnetic Resonance Imaging, with a pelvic phased array coil (PPA-DCE-MRI), to histopathology findings. Methods: The institutional review board
98
approved this prospective study and waived the informed consent requirement. The location of suspicious areas in the anterior prostate on prospective prebiopsy PPA-DCE-MRI in 250 patients was determined relative to the transition zone (TZ) and anterior fibromuscular stroma (AFMS) boundary. A malignancy score including features of early and intense enhancement was assigned to each area. Largest surface area and volume were determined. Ultrasound-guided systematic and targeted biopsies to suspicious anterior areas were performed. Results: DCE-MRI was suspicious in TZ or AFMS in 45/250 patients. Biopsies revealed adenocarcinoma in 33/45 patients (median PSA 13.4 ng/mL). Tumors were classified according to their location and outline relative to the TZ and AFMS boundaries: Type I: tumor confined to one TZ lobe; Type II: tumor in one TZ lobe but crossing the anterior TZ-AFMS boundary; Type IIIa: tumor in AFMS (midgland or base level); Type IIIb: tumor in AFMS anterior to the urethra (apex level). Type IV: tumors in the anterior PZ. MRI median tumor volume was 2.78 cc (0.279.6). In 10/23 (43%) patients who had targeted biopsies, targeted and/or random apex biopsies were the only positive biopsies and their median total tumor length was significantly higher than for random base and mid-gland biopsies, 9 mm (2-22) versus 2 mm (0-6) respectively (p⬍0.0001). Conclusion: High-resolution PPA-DCEMRI is useful in detecting anterior prostate tumors and targeting biopsies to suspicious areas especially in AFMS.
biopsy. The aim of this study is to compare ten cores biopsy or saturation biopsy in patients with repeat biopsy. Material & Methods: We retrospectively reviewed 854 patients, with first ten core extended negative biopsy, between January 1999 and November 2006. Extended biopsy scheme included ten cores and saturation scheme included 20-26 cores. Second biopsy was performed in 686 (80.3%) patients and third biopsy in 186 (19.7%). Saturation prostate biopsy was performed as second biopsy in 18 (2.3%) and 56 (28%) as third. Clinical baseline variables were age, rectal examination, total PSA, free PSA, f/t %PSA, prostate volume and PSA density we compare and analyze variables with Mann-Whitney and Chi-square tests. Results: In the second and third biopsy group, there is no statistical differences in baseline variables. At second biopsy, there are no statistical differences on prostate cancer findings between extended and saturation prostate biopsy schemes (20.8% vs. 22.2%, p⫽0.776; OR⫽1.09, 95% CI: 0.35-3.35). In the third biopsy group, there are also no statistical differences among the two schemes groups (22.5% vs. 23.2%, p⫽0.913; OR⫽1.04, 95% CI: 0.49-2.18). Conclusions: Extended ten core biopsy scheme may be adequate to follow up patients with repeated biopsies. Our data does not suggest significant differences between ten core extended and saturation prostate biopsy scheme in the repeat biopsy population since their first ten core extended negative biopsy.
MP-11.15 Comparison study between ten core extended and saturation prostate biopsy in a repeat prostate biopsy population Ponce J1 Veiga F1, Romero E1, Pe´rtega S2 Janeiro J1, Casas P1, Martı´nez S1, Lopez D1, Rodrı´guez I1, Ferna´ndez E1, Gonza´lez Martı´n M1 1 Department of Urology, 2Statistics, Juan Canalejo Hospital, La Corun ˜ a, Spain
MP-11.16 Prostate cancer predictive model for patients candidates to first extended prostate biopsy with PSA 2.5 - 10 ng/ml Ponce J1, Veiga FG1, Romero E1, Pe´rtega S2, Casas P1, Janeiro J1, Lo ´ pez D1, Martı´nez S1, Rosado EF1, Go ´ mez IR1, 1 Gonza´lez Martı´n M 1 Department of Urology, 2Statistics, Juan Canalejo Hospital. La Corun ˜ a. Spain
Introduction: A significant percentage of candidates to prostate biopsy are initially negative but some of them continue with increased PSA level or abnormal DRE. There exists controversy about management in patients with first negative biopsy and persistent suspicion of prostate cancer, and which biopsy model is optimal. Recently saturation biopsy schemes (20-26 cores) appear more effective to detect prostate cancer in patients with repeat
Introduction & Objectives: There exists controversy on prostate biopsy with total PSA level ⬍4ng/mL. A percentage of tumours may be insignificant. We aim with this predictive model to diagnose prostate cancer in patients with total PSA 2.5 – 10 ng/mL. and candidates of first ten core extended prostate biopsy. Material & Methods: We retrospectively reviewed 1806 patients in which first ten core extended prostate biopsy were performed, from January 2002 to
UROLOGY 70 (Supplment 3A), September 2007
RALPs were performed from July, 2005 to June, 2006. Data pertaining to cost details and outcome metrics were analyzed. Average direct and total cost per case for room and board, operating room services, medical and surgical supplies, medications and investigations was determined and the sensitivity of total average cost to each of these parameters was studied. The cost of the robot was estimated to be $1,300,000 from published literature, along with a yearly maintenance contract of $100,000 depreciated over a projected life of ten years. Results: Average direct cost of a procedure was found to be $4,971 and the average total cost $9,536 (this includes indirect costs); excluding the capital cost of the robot, assigned from published literature, to each case, these costs would be $4,314 and $8,879, respectively. Based on the analyzed data, it was found that the cost of medical and surgical supplies, including the cost of instruments accounted for 45% of total average direct cost and approximately one-third of average total cost. Operating room services and therefore, duration of OR utilization accounted for almost 30% of total average direct cost and 35% of the total cost per procedure. Projecting an increase in the number of procedures performed per year from 100 to 400 reduced costs by around 18%, based on the cost of the robot and maximal change in costs were seen in increasing volumes from 100 to 200 cases per year. Conclusions: Total cost of a procedure was found to be sensitive to and dependent upon a number of variables: increasing the number of RALP procedures per year, reducing OR time per case and decreasing the cost of medical and surgical supplies are the most important parameters that ultimately reduce total cost of the procedure. MP-11.14 Diagnosis of anterior prostate cancer by dynamic contrast-enhanced combined with T2W MR imaging Villers A1, Lemaitre L2, Puech P2, Poncelet E2, Leroy X1, Biserte J1 1 Urology, 2Radiology, Centre Hospitalier Re´gional Universitaire de Lille, France Introduction: To relate the imaging features of suspicious areas in the anterior compartment of the prostate, as given by Dynamic Contrast Enhanced Magnetic Resonance Imaging, with a pelvic phased array coil (PPA-DCE-MRI), to histopathology findings. Methods: The institutional review board
98
approved this prospective study and waived the informed consent requirement. The location of suspicious areas in the anterior prostate on prospective prebiopsy PPA-DCE-MRI in 250 patients was determined relative to the transition zone (TZ) and anterior fibromuscular stroma (AFMS) boundary. A malignancy score including features of early and intense enhancement was assigned to each area. Largest surface area and volume were determined. Ultrasound-guided systematic and targeted biopsies to suspicious anterior areas were performed. Results: DCE-MRI was suspicious in TZ or AFMS in 45/250 patients. Biopsies revealed adenocarcinoma in 33/45 patients (median PSA 13.4 ng/mL). Tumors were classified according to their location and outline relative to the TZ and AFMS boundaries: Type I: tumor confined to one TZ lobe; Type II: tumor in one TZ lobe but crossing the anterior TZ-AFMS boundary; Type IIIa: tumor in AFMS (midgland or base level); Type IIIb: tumor in AFMS anterior to the urethra (apex level). Type IV: tumors in the anterior PZ. MRI median tumor volume was 2.78 cc (0.279.6). In 10/23 (43%) patients who had targeted biopsies, targeted and/or random apex biopsies were the only positive biopsies and their median total tumor length was significantly higher than for random base and mid-gland biopsies, 9 mm (2-22) versus 2 mm (0-6) respectively (p⬍0.0001). Conclusion: High-resolution PPA-DCEMRI is useful in detecting anterior prostate tumors and targeting biopsies to suspicious areas especially in AFMS.
biopsy. The aim of this study is to compare ten cores biopsy or saturation biopsy in patients with repeat biopsy. Material & Methods: We retrospectively reviewed 854 patients, with first ten core extended negative biopsy, between January 1999 and November 2006. Extended biopsy scheme included ten cores and saturation scheme included 20-26 cores. Second biopsy was performed in 686 (80.3%) patients and third biopsy in 186 (19.7%). Saturation prostate biopsy was performed as second biopsy in 18 (2.3%) and 56 (28%) as third. Clinical baseline variables were age, rectal examination, total PSA, free PSA, f/t %PSA, prostate volume and PSA density we compare and analyze variables with Mann-Whitney and Chi-square tests. Results: In the second and third biopsy group, there is no statistical differences in baseline variables. At second biopsy, there are no statistical differences on prostate cancer findings between extended and saturation prostate biopsy schemes (20.8% vs. 22.2%, p⫽0.776; OR⫽1.09, 95% CI: 0.35-3.35). In the third biopsy group, there are also no statistical differences among the two schemes groups (22.5% vs. 23.2%, p⫽0.913; OR⫽1.04, 95% CI: 0.49-2.18). Conclusions: Extended ten core biopsy scheme may be adequate to follow up patients with repeated biopsies. Our data does not suggest significant differences between ten core extended and saturation prostate biopsy scheme in the repeat biopsy population since their first ten core extended negative biopsy.
MP-11.15 Comparison study between ten core extended and saturation prostate biopsy in a repeat prostate biopsy population Ponce J1 Veiga F1, Romero E1, Pe´rtega S2 Janeiro J1, Casas P1, Martı´nez S1, Lopez D1, Rodrı´guez I1, Ferna´ndez E1, Gonza´lez Martı´n M1 1 Department of Urology, 2Statistics, Juan Canalejo Hospital, La Corun ˜ a, Spain
MP-11.16 Prostate cancer predictive model for patients candidates to first extended prostate biopsy with PSA 2.5 - 10 ng/ml Ponce J1, Veiga FG1, Romero E1, Pe´rtega S2, Casas P1, Janeiro J1, Lo ´ pez D1, Martı´nez S1, Rosado EF1, Go ´ mez IR1, 1 Gonza´lez Martı´n M 1 Department of Urology, 2Statistics, Juan Canalejo Hospital. La Corun ˜ a. Spain
Introduction: A significant percentage of candidates to prostate biopsy are initially negative but some of them continue with increased PSA level or abnormal DRE. There exists controversy about management in patients with first negative biopsy and persistent suspicion of prostate cancer, and which biopsy model is optimal. Recently saturation biopsy schemes (20-26 cores) appear more effective to detect prostate cancer in patients with repeat
Introduction & Objectives: There exists controversy on prostate biopsy with total PSA level ⬍4ng/mL. A percentage of tumours may be insignificant. We aim with this predictive model to diagnose prostate cancer in patients with total PSA 2.5 – 10 ng/mL. and candidates of first ten core extended prostate biopsy. Material & Methods: We retrospectively reviewed 1806 patients in which first ten core extended prostate biopsy were performed, from January 2002 to
UROLOGY 70 (Supplment 3A), September 2007