Transperineal template prostate-mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer.

Details

Serval ID
serval:BIB_4973EEDBFA00
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transperineal template prostate-mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer.
Journal
Bju International
Author(s)
Valerio M., Anele C., Charman S.C., van der Meulen J., Freeman A., Jameson C., Singh P.B., Emberton M., Ahmed H.U.
ISSN
1464-410X (Electronic)
ISSN-L
1464-4096
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
118
Number
3
Pages
384-390
Language
english
Abstract
OBJECTIVES: To determine whether modified transperineal template prostate-mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value (NPV) equal to full 5-mm TTPM.
PATIENTS AND METHODS: Retrospective analysis of an institutional registry including treatment-naïve men undergoing 5-mm TTPM biopsy analysed in a 20-zone fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5-mm TTPM. Strategy 1, did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was used to calculate reliable estimates of sensitivity and NPV of these three strategies for the detection of clinically significant disease (maximum cancer core length ≥4 mm and/or Gleason score ≥3 + 4).
RESULTS: In all, 391 men with a median (interquartile range, IQR) age of 62 (58-67) years were included. The median (IQR) PSA level and PSA density were 6.9 (4.8-10) ng/mL and 0.17 (IQR 0.12-0.25) ng/mL/mL, respectively. A median (IQR) of 6 (2-9) cores out of 48 (33-63) taken per man were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low-, intermediate- and high-risk disease was identified in 78 (20%), 80 (21%), and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% [95% confidence interval (CI) 73-84%], 85% (95% CI 80-90%) and 84% (95% CI 79-89%), respectively. The NPVs of the three strategies were 73% (95% CI 67-80%), 80% (95% CI 74-86%) and 79% (95% CI 72-84%), respectively.
CONCLUSION: Altering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM biopsy to exclude clinically significant disease. This should be considered when modified TTPM biopsy strategies are used to select men for tissue-preserving approaches, and when modified TTPM are used to validate new diagnostic tests.
Pubmed
Web of science
Create date
04/10/2016 18:30
Last modification date
20/08/2019 13:56
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