Comparison of sonoelastography guided biopsy with systematic biopsy: impact on prostate cancer detection

A prospective study was performed to determine the value of sonoelastography (SE) targeted biopsy for prostate cancer (PCa) detection. A series of 230 male screening volunteers was examined. Two independent examiners evaluated each subject. One single investigator performed ≤5 SE targeted biopsies into suspicious regions in the peripheral zone only. The stiffness of the lesion was displayed by SE and color-coded from red (soft) to blue (hard). Hard lesions were considered as malignant and targeted by biopsy. Subsequently, another examiner performed ten systematic biopsies. Cancer detection rates of the two techniques were compared. Cancer was detected in 81 of the 230 patients (35%), including 68 (30%) by SE targeted biopsy and in 58 (25%) by systematic biopsy. Cancer was detected by targeted biopsy alone in 23 patients (10%) and by systematic biopsy alone in 13 patients (6%). The detection rate for SE targeted biopsy cores (12.7% or 135 of 1,109 cores) was significantly better than for systematic biopsy cores (5.6% or 130 of 2,300 cores, P < 0.001). SE targeted biopsy in a patient with cancer was 2.9-fold more likely to detect PCa than systematic biopsy. SE targeted biopsy detected more cases of PCa than systematic biopsy, with fewer than half the number of biopsy cores in this prostate-specific antigen screening population.     

Correlation of power Doppler with microvessel density in assessing prostate needle biopsy

AIM: To correlate hypervascular power Doppler ultrasonography with the histological evaluation of microvasculature in the prostate using trans-rectal ultrasound (TRUS)-guided needle biopsy. MATERIALS AND METHODS: Ninety-six patients with a lower urinary tract symptoms (LUTS) and prostate specific antigen (PSA) value more than 4 ng/ml were evaluated using power Doppler ultrasonography before biopsy. The vascularity of the peripheral zone was graded on a scale of PZ0 to PZ2. Core needle biopsies were immunostained with CD31(DAKO) and counting was performed manually on separate high power fields (HPF; x 400) in areas containing the highest number of vessels. RESULTS: There was a significant correlation between the grading system used for power Doppler and the microvessel density (MVD; PZ0 28.61 +/- 8.97,PZ1 36.00 +/- 12.11 & PZ2 64.008 +/- 15.86; p < 0.001). There was also a significant difference in MVD between benign, malignant and tissue cores with atypia and prostatic intra-epithelial neoplasia (PIN; p < 0.001 and p < 0.018 respectively). There was a significant correlation between malignant tissue having a higher Gleason score and increased MVD (p < 0.001) Furthermore, cancer biopsies having a high flow PZ2 are nearly twice as likely (63.2%) to have a Gleason score of 7 or more when compared those having a Gleason score of less than 7 (36.8%). CONCLUSION: The grading system of assessing the power Doppler flow signals appears to be of value as an indicator of MVD. It also correlates with a higher Gleason score and this may reflect the clinical outcome in prostate cancer. It deserves further study and evaluation as a prognostic indicator.     

PSA与超声引导下穿刺活检诊断前列腺癌对比分析

目的通过测定血清前列腺特异性抗原的变化规律,结合超声引导下经直肠前列腺穿刺活检术,探讨PSA在前列腺癌诊断中的价值。方法男性患者共108例进行血清PSA的测定,并行经直肠超声引导下穿刺活检,将诊断为前列腺癌、前列腺增生、前列腺增生伴炎症伴PIN的患者的结果进行分析。结果前列腺癌组PSA值均显著高于非前列腺癌组,PSA浓度与前列腺癌发生率的关系表明,4-10ng／ml组和〉10ng／ml组前列腺癌的发生率显著高于PSA〈4ng／ml组结论血清PSA在前列腺癌人群筛查中很大价值．实施经直肠超声引导下的组织活检术应作为确诊前列腺癌的主要手段。     

经会阴前列腺分层饱和穿刺活检在首次前列腺穿刺活检阴性患者中的价值

目的 探讨经会阴前列腺分层饱和穿刺活检在首次前列腺穿刺活检阴性患者中的应用价值。方法84例因直肠指诊、血清前列腺特异性抗原（PSA）和前列腺MRI检查异常而接受经直肠标准12针穿刺活检且结果为良性的患者,行超声引导下经会阴前列腺分层饱和穿刺活检,计算前列腺癌的检出率。结果84例患者行经会阴前列腺分层饱和穿刺活检,诊断为前列腺癌23例（27.4%）,良性前列腺增生61例（72.6%）,其中合并高级别上皮内瘤变3例,慢性前列腺炎5例。结论经会阴前列腺分层饱和穿刺活检可以提高前列腺癌的检出率,对于初次活检阴性,但直肠指诊、前列腺MRI检查异常并且血清前列腺特异性抗原持续升高的患者,可以考虑应用此穿刺活检方法再次穿刺活检予以明确诊断,避免漏诊和延误治疗。     

MR-guided biopsy of the prostate: Comparison of diagnostic specimen quality with 18G and 16G biopsy needles

Purpose

To evaluate specimen quality and diagnostic differences between magnetic resonance (MR) compatible 16G and 18G biopsy needles in MR-guided biopsy (MRGB) of the prostate.

Materials and methods

Semiautomatic MR compatible biopsy needles with a diameter of 16G (Group A) or 18G (Group B) were used to perform MRGB in 88 patients with suspected prostate cancer. After embedding and staining, length and width of all specimens (140 cores in Group A, 143 in Group B) were measured. Fragmentation, squeezing artifacts, and overall evaluability were evaluated using a quality score from 0 (no tissue) to 3 (optimal tissue quality). Groups were statistically compared; p-values <0.05 were regarded as significant.

Results

Demographic data were not significantly different between Group A and B with a mean age of 63 ± 7.3 and 67 ± 5.7 years; and a mean prostate-specific antigen of 12.6 ± 10.3 ng/ml and 13.8 ± 11.6 ng/ml, respectively (p = 0.70). Area of longitudinally sectioned histological specimens was significantly larger in Group A than in Group B with 9.38 mm² (8.74; 10.02) and 7.95 mm² (7.32; 8.59), respectively (p = 0.002). However, there were significantly more cores without prostate tissue with 18 cores (12.9%) versus 3 cores (2.1%) in Groups A and B, respectively (p = 0.004). Fragmentation, squeezing artifacts, and overall evaluability were not statistically different between the two groups. The rate of prostate cancer in the cores was also not significantly different between Groups A and B (22.1% and 24.5%; p = 0.77).

Conclusion

16G biopsy needles do not provide a relevant diagnostic advantage over 18G needles in MRGB. Therefore, use of 18G needles is not discouraged and may even be preferred as it is not expected to result in a relevant degradation of specimen quality or compromise in prostate cancer detection rate.     

A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer

Transrectal ultrasound (TRUS) is an important tool for urologists and radiologists in the detection of prostate cancer. Various TRUS-guided biopsy techniques are applied in clinical practice. Frequently, only the detection rates achieved with these methods are compared. Other diagnostic performance parameters, particularly the specificity and negative predictive value, are seldom compared. After extensive assessment of the available literature, this review describes the methods of TRUS-guided biopsy for prostate cancer detection. A distinction was made between systematic biopsies and biopsies that target a perceived (hypoechoic or Doppler-enhancing) lesion on imaging. Subsequently, the diagnostic performance (sensitivity, specificity, positive and negative predictive values, accuracies) was compared between these techniques. Imaging-guided biopsy showed better diagnostic performance than systematic biopsy with higher sensitivity. The combinations of sensitivity and specificity were highest for colour Doppler and contrast-enhanced targeted biopsy. Studies targeting hypoechoic lesions had relatively high sensitivity, but specificity was low. Presently however, with widespread prostate-specific antigen screening, fewer prostate cancers are hypoechoic, and the value of targeting hypoechoic lesions has diminished. Performing colour or contrast-enhanced Doppler biopsy or adding these techniques to systematic biopsies improves diagnostic performance, particularly by increasing sensitivity.     

Sonoelastography in Distinguishing Benign from Malignant Complex Breast Mass and Making the Decision to Biopsy

Objective

To evaluate the additional effect of sonoelastography on the radiologist''s ability for distinguishing benign from malignant complex breast masses and to decide whether to perform biopsy by B-mode US.

Materials and Methods

One hundred eighteen complex breast masses (15 malignant lesions, 103 benign lesions) were included. Five blinded readers independently assessed the likelihood of the malignancy score from 1 to 5 for two data sets (B-mode ultrasound alone and B-mode ultrasound with sonoelastography). Elasticity scores were categorized as 0, 1, or 2 based on the degree and distribution of strain of the echogenic component within complex masses. The readers were asked to downgrade the likelihood of the malignancy score when an elasticity score of 0 was assigned and to upgrade the likelihood of the malignancy score when an elasticity score of 2 was assigned. The likelihood of the malignancy score was maintained as it was for the lesions with an elasticity score of 1. The Az values, sensitivities, and specificities were compared.

Results

The Az value of B-mode ultrasound with sonoelastography (mean, 0.863) was greater than that of B-mode ultrasound alone (mean, 0.731; p = 0.001-0.007) for all authors. The specificity of B-mode ultrasound with sonoelastography (mean, 37.1%) was greater than that of B-mode ultrasound alone (mean, 3.8%; p < 0.001) for all readers. The addition of sonoelastography led to changes in decisions. A mean of 33.6% of benign masses were recommended for follow-up instead of biopsy.

Conclusion

For complex breast masses, sonoelastography allows increase in both the accuracy in distinguishing benign from malignant lesions and the specificity in deciding whether to perform biopsy.     

HDR brachytherapy as monotherapy for prostate cancer: A systematic review with meta-analysis

PurposeThe effectiveness and safety of high dose brachytherapy as monotherapy (HDR-BRT-M) in prostate cancer is limited to retrospective studies. We performed a meta-analysis to summarize existing data and identify trends in biochemical recurrence-free survival (bRFS) and toxicity after HDR-BRT-M in patients with prostate cancer.Methods and MaterialsRetrospective, prospective, or randomized clinical trials were identified on electronical databases through June 2020. We followed the PRISMA and MOOSE guidelines. A meta-regression analysis was performed to assess if there is a relationship between moderator variables and bRFS. A p-value < 0.05 was considered significant.ResultsFourteen studies with a total of 3534 patients treated were included. The cumulative size of the bRFS at 5 years was 0.92 (95% confidence interval (CI) 0.48–0.61). The five-year bRFS for low, intermediate, and high risk was 97.5% (95% CI 96–98%), 93.5% (95% CI 91–96%), and 91% (95% CI 88–93%), respectively. The total biological effective dose (BED) (p = 0.02), the BED per fraction (p = 0.001), androgen deprivation therapy usage (p = 0.04), and the number of fractions of HDR-BRT-M (p = 0.024) were significantly associated with bRFS rate. The rate of late Grade 2/3 or > genitourinary and gastrointestinal toxicity was 22.4% (95% CI 9–35,2%)/1.4% (95% CI 0.8–2.1%) and 2.7% (95% CI 0–6.8%) and 0.2% (95% CI 0.1%–0.4%), respectively.ConclusionsHDR-BRT-M is safe with excellent rates of bRFS for all risk groups. The total BED, the BED per fraction, and number of fractions were the key factors associated with the biochemical control. These data can be useful to choose the size and number of BRT fractionation.     

Schwannoma of the prostate: ultrasonographic features

A noteworthy case of a benign schwannoma of the prostate in a 65-year-old man not in connection with genetic neurofibromatoses is reported. A 12-mm nodular hypoechoic lesion in the peripheral gland was seen at transrectal ultrasound, but diagnosis could be achieved only by transrectal echo-guided biopsy.     

经直肠超声引导10点前列腺穿刺活检诊断前列腺癌临床分析

目的:探讨经直肠彩色多普勒超声引导10点前列腺穿刺活检诊断前列腺癌的临床价值。方法:对71例血清PSA升高和直肠指诊阳性、彩色多普勒出现局部血流增加异常者,行经直肠彩色多普勒超声引导10点前列腺穿刺活检术。结果:71例患者中确诊为前列腺癌者24例(33.8%);前列腺增生28例(39.4%);前列腺炎14例(19.7%);前列腺炎性肉芽肿4例(5.6%);前列腺结核1例。71例患者接受10点前列腺穿刺活检术,有12例(16.9%)术后出现血尿;2例出现血便;1例出现血精,未出现严重的并发症。结论:经直肠彩色多普勒超声引导10点前列腺穿刺活检术是一种安全的方法,有助于提高前列腺癌的早期诊断及前列腺疾病的鉴别诊断。     

Dosimetric outcomes in prostate brachytherapy: Is downsizing the prostate with androgen deprivation necessary?

ObjectivesA large prostate volume has historically been a relative contraindication to prostate brachytherapy (PB) because of concerns of toxicity and potential pubic arch interference. Common practice has been to downsize large prostates with androgen deprivation therapy (ADT) before proceeding with brachytherapy. The present study compares postimplant dosimetry in patients with prostate volumes >50 cc with those with prostate volumes ≤50 cc.MethodsA review of all patients who underwent PB at our institution from 2001 to 2006 was performed. Postimplant dosimetry was obtained approximately 4 weeks after brachytherapy.ResultsOne-hundred forty-five out of a total of 148 patients had available dosimetry. In the 113 patients with prostate volumes ≤50 cc (mean, 35.4 cc, range, 14.2–49.7 cc); the mean D₉₀ (dose which covers 90% of the prostate), V₁₀₀ (volume of prostate receiving 100% of the prescribed dose), V₁₅₀ (volume of prostate receiving 150% of the prescribed dose), and V₂₀₀ (volume of prostate receiving 200% of the prescribed dose) was 128.9%, 95.6%, 73.9%, and 51.2%, respectively. In the 32 patients with prostate volumes >50 cc (mean 58.1 cc, range 50.2–86.0 cc); the mean D₉₀, V₁₀₀, V₁₅₀, and V₂₀₀ was 125.1%, 95.2%, 68.2%, and 41.7%, respectively. The rectal V₁₀₀ was 1.0 cc for both cohorts. There was no statistically significant difference between the cohorts with respect to postimplant dosimetry for D₉₀, V₁₀₀, and V₁₅₀. The V₂₀₀ for prostate volumes >50 cc was significantly lower (p < 0.05).ConclusionsIn the present study, patients with prostate volumes >50 cc have postimplant dosimetry parameters similar to patients with prostate volumes ≤50 cc for D₉₀, V₁₀₀, and V₁₅₀; and significantly lower values for V₂₀₀. These results suggest that patients with large prostate volumes may not need to be routinely placed on hormonal therapy; sparing patients the side effects of hormonal therapy, and sparing the health care system the costs of luteinizing hormone-releasing hormone agonist injections.     

Transperineal mapping biopsy improves selection of brachytherapy boost for men with localized prostate cancer

PURPOSETo determine if transperineal mapping biopsy (TPMB) can improve the selection of brachytherapy alone (BT) or brachytherapy boost (BTB) in men with localized prostate cancer.Methods and MaterialsTwo hundred and eighteen men underwent TPMB with a mean of 48.6 cores retrieved. Comparisons were made between prebiopsy risk features and biopsy results to treatment choice with associations tested with ANOVA (bootstrap), χ² test (Pearson), and linear regression. Survival estimates were tested by the Kaplan–Meier method with comparisons by log rank.ResultsMean age, prostate specific antigen (PSA), prostate specific antigen density (PSAD), and prostate volume were 67.2 years, 8.1 ng/mL, 0.19, and 50.3 cc, respectively. 105 (48.2%) biopsies were positive for Gleason Group (GG) 1: 34 (32.4%), 2: 21 (20%), 3: 31 (29.5%), 4: 7 (6.7%), and 5: 12 (11.4%). The mean number of positive cores (PCs) was 7.3 (median 6, range 1–37). Men with six or more PCs had higher PSA (11.3 vs. 6.0 ng/mL, p = 0.025) and PSAD (0.34 vs. 0.13, p = 0.013). Overall brachytherapy was used in 74 (70.5%) as either monotherapy or boost therapy. Men with BTB had higher PSA (9.7 vs. 6.7 ng/mL, p = 0.029), PSAD (0.27 vs. 0.16, p = 0.007), GG (3.3 vs. 1.8, p < 0.001), more bilateral disease (75.9% vs. 55.6%, odds ratio 3.9, p = 0.008), and PCs (10.9 vs. 4.4, p < 0.001). On linear regression, only GG (p = 0.008) and PCs (p = 0.044) were associated with BTB. Biochemical-free failure at 5 years was 92.7%.ConclusionsTPMB improves the selection of patients for BTB. Men with more PCs are more likely to have BTB. Restricting the need for BTB to those with greater volume prostate cancer may reduce radiation side effects.     

前列腺癌患者癌组织中miR-21表达水平及与预后的关系分析

目的 分析前列腺癌患者癌组织中miRNA-21（miR-21）表达水平及与预后的关系。方法 回顾性分析2011年1月—2012年6月四川大学华西医院76例前列腺癌行手术切除患者资料,采用特异性TaqMan探针实时定量PCR法检测患者切除前列腺癌组织及癌旁前列腺组织miR-21表达水平,分析其与患者预后的关系。结果 miR-21在前列腺癌组织中相对表达量为（2.68±0.54）,明显高于癌旁组织的（1.14±0.42）（t=19.62,P<0.05）;前列腺癌患者miR-21高表达者57例（75%）,低表达者19例（25%）,2组TNM分期、Gleason评分、复发转移比较,差异均有统计学意义（P<0.05）,而年龄、前列腺体积、血清前列腺特异抗原水平比较,差异无统计学意义（P>0.05）;miR-21表达量低组平均生存期32.5个月,miR-21表达量高组平均生存期24.8个月,经Kaplan-Meier生存分析显示,2组差异有统计学意义（P=0.019）。结论 miR-21在前列腺癌患者癌组织中具有高表达现象,对前列腺癌的诊断及预后评价具有指导意义。     

超声引导下前列腺穿刺择点研究进展

前列腺癌是西方发达国家老年男性最常见的恶性肿瘤之一,近年来,我国前列腺癌发病率呈明显上升趋势。目前经直肠超声（transrectal ultrasound ,TRUS）引导下前列腺穿刺活检术是诊断前列腺癌的主要手段。本文主要就穿刺点的选择及几种先进的技术等作一综述。     

经直肠超声引导前列腺穿刺活检术患者的舒适护理

目的:探讨舒适护理在经直肠超声引导前列腺穿刺活检术患者围手术期的作用。方法:通过实施舒适护理减轻或消除患者的焦虑、恐惧心理,增加患者对手术的了解及信心。结果:66例患者均配合手术顺利完成。术后排尿疼痛15例,尿潴留2例,血尿6例,血便3例,发热10例。患者满意度95.0%。结论:舒适护理应用于前列腺穿刺活检术围手术期可有效提高患者在心理上和生理上的舒适度,对提高护理质量具有重要意义。     

Predictive power of the ESUR scoring system for prostate cancer diagnosis verified with targeted MR-guided in-bore biopsy

PurposeThis study evaluates the diagnostic value of the ESUR scoring system (PI-RADS) regarding prostate cancer detection using MR-guided in-bore biopsies (IB-GB) as the reference standard.Methods566 lesions in 235 consecutive patients (65.7 ± 7.9 years, PSA 9.9 ± 8.5 ng/ml) with a multiparametric (mp)-MRI (T2WI, DWI, DCE) of the prostate at 3 T were scored using the PI-RADS scoring system. PI-RADS single (PS_single), summed (PS_sum), and overall (PS_overall) scores were determined. All lesions were histologically verified by IB-GB.ResultsLesions with a PS_sum below 9 contained no prostate cancer (PCa) with Gleason score (GS) ≥ 4 + 3 = 7. A PS_sum of 13–15 (PS_overall V) resulted in 87.8% (n = 108) in PCa and in 42.3% (n = 52) in GS ≥ 4 + 3 = 7. Transition zone (TZ) lesions with a PS_sum of 13–15 (PS_overall V) resulted in 76.3% (n = 36) in PCa and in 26.3% (n = 10) in GS ≥ 4 + 3 = 7, whereas for peripheral zone (PZ) lesions cancer detection rate at this score was 92.9% (n = 79) and 49.4% (n = 42) for GS ≥ 4 + 3 = 7. Using a threshold of PS_sum ≥ 10, sensitivity was 86.0%, and negative predictive value (NPV) was 86.2%. For higher grade PCa sensitivity was 98.6%, and NPV was 99.5%.ConclusionA PS_sum below 9 excluded a higher grade PCa, whereas lesions with a PS_sum ≥ 13 (PS_overall V) represented in 88% PCa, and in 42% higher grade PCa. The PS_sum or PS_overall demonstrated a better diagnostic value for PZ lesions with higher detection rates for higher grade PCa compared to TZ lesions.     

Ultrasound of prostate cancer: recent advances

Prostate cancer is the most common cancer in men. In the future, a significant further increase in the incidence of prostate cancer is expected. Therefore, improvement of prostate cancer diagnosis is a main topic of diagnostic imaging. The systematic prostate biopsy (“ten-core biopsy”) is now the “gold standard” of prostate cancer diagnosis but may miss prostate cancer. Contrast-enhanced colour Doppler ultrasound (US) and elastography are evolving methods that may dramatically change the role of US for prostate cancer diagnosis. Contrast-enhanced colour Doppler US allows for investigations of the prostate blood flow and consequently for prostate cancer visualization and therefore for targeted biopsies. Comparisons between systematic and contrast-enhanced targeted biopsies have shown that the targeted approach detects more cancers and cancers with higher Gleason scores with a reduced number of biopsy cores. Furthermore, elastography, a new US technique for the assessment of tissue elasticity has been demonstrated to be useful for the detection of prostate cancer, and may further improve prostate cancer staging. Therefore, contrast-enhanced colour Doppler US and elastography may have the potential to improve prostate cancer detection, grading and staging. However, further clinical trials will be needed to determine the promise of these new US advances.     

Prostate biopsy after ano-rectal resection: value of CT-guided trans-gluteal biopsy

We describe our single-institutional experience with computed tomography (CT)-guided percutaneous transgluteal biopsy of the prostate in patients in whom transrectal ultrasound-guided biopsy is precluded by prior ano-rectal resection. Between March 1995 and April 2007, 22 patients had 34 prostate biopsies (mean age 68; mean PSA 29 ng/ml; mean follow-up 6.1 years). The charts of patients who had transgluteal biopsy were reviewed for demographic, complications and pathology. Ninety-five percent (21/22) of primary biopsies were diagnostic. Of the 21 diagnostic biopsies, 11 were positive for prostate cancer and ten were definitive benign samples. Seventy-three percent (8/11) of the patients had progressive PSA elevation that mandated 11 further prostate biopsies. Six patients had a second biopsy, one patient had a third and one patient had a fourth biopsy. Among patients who had serial biopsies, 38% (3/8) had prostate cancer. No complications or death occurred. A malignant biopsy was not significantly associated with core number (P = 0.58) or a high PSA level (P = 0.15). CT-guided transgluteal biopsy of the prostate is safe and effective.     

Evaluation of T2-weighted and dynamic contrast-enhanced MRI in localizing prostate cancer before repeat biopsy

We assessed the accuracy of T2-weighted (T2w) and dynamic contrast-enhanced (DCE) 1.5-T magnetic resonance imaging (MRI) in localizing prostate cancer before transrectal ultrasound-guided repeat biopsy. Ninety-three patients with abnormal PSA level and negative prostate biopsy underwent T2w and DCE prostate MRI using pelvic coil before repeat biopsy. T2w and DCE images were interpreted using visual criteria only. MR results were correlated with repeat biopsy findings in ten prostate sectors. Repeat biopsy found prostate cancer in 23 patients (24.7%) and 44 sectors (6.6%). At per patient analysis, the sensitivity, specificity, positive and negative predictive values were 47.8%, 44.3%, 20.4% and 79.5% for T2w imaging and 82.6%, 20%, 24.4% and 93.3% for DCE imaging. When all suspicious areas (on T2w or DCE imaging) were taken into account, a sensitivity of 82.6% and a negative predictive value of 100% could be achieved. At per sector analysis, DCE imaging was significantly less specific (83.5% vs. 89.7%, p < 0.002) than T2w imaging; it was more sensitive (52.4% vs. 32.1%), but the difference was hardly significant (p = 0.09). T2w and DCE MRI using pelvic coil and visual diagnostic criteria can guide prostate repeat biopsy, with a good sensitivity and NPV.