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Best Papers 2009-2016

Best Papers 2009-2016

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Accuracy
The document emphasizes the importance of accurate mapping in transrectal ultrasonographic (TRUS) prostate biopsies for diagnosing and treating prostate cancer. It highlights that using a registration algorithm enhances biopsy localization, with improved operator dexterity over time. The Urostation 3D TRUS system shows high accuracy in targeting lesions with less than 3 mm error, favoring elastic image fusion over rigid techniques.

Comparing Technologies
Studies compare different biopsy techniques, showing that MRI and TRUS soft image fusion techniques have higher success rates in targeted biopsies, improving cancer detection compared to random biopsies. Elastic registration systems are superior to rigid systems as they account for prostate deformation, enhancing biopsy accuracy.

MRI Validation in PCA Management
Multiparametric MRI is validated in prostate cancer management, improving tumor localization. Integrating MRI with TRUS for image registration enhances targeted biopsy accuracy, reducing microfocal cancer detection and increasing high-grade cancer detection.

Efficiency in PCA Detection
Targeted biopsy techniques improve prostate cancer detection efficiency by reducing the number of cores needed and enhancing significant cancer detection. MRI-TRUS fusion techniques offer more precise targeting.

Detection of the Index Tumour
MRI-TRUS fusion targeted biopsy techniques effectively detect the index tumor, crucial for accurate diagnosis and treatment planning.

Status of 3D Mapping in PCA Management
3D mapping techniques improve biopsy accuracy and aid in developing personalized treatment strategies in prostate cancer management.

Conclusion
Advancements in imaging and biopsy techniques, particularly MRI and TRUS fusion, significantly improve prostate cancer diagnosis and management accuracy and efficiency. These technologies support personalized treatment strategies and better cost control.

Objective: The primary aim was to compare prostate cancer detection rates between in-bore guided biopsy (IB-GB) alone and a combination of fusion-guided biopsy (FUS-GB) with transrectal ultrasound-guided biopsy (TRUS-GB) in patients with at least one negative TRUS-GB and a prostate-specific antigen level of ≥4 ng/ml.

Design, Setting, and Participants: Patients were prospectively randomized into two groups after undergoing multiparametric prostate MRI: one group received IB-GB (arm A) and the other received FUS-GB + TRUS-GB (arm B) from November 2011 to July 2014.

Outcome Measurements and Statistical Analysis: The study aimed for an 80% power to demonstrate a PCa detection rate of ≥60% in arm B compared to 40% in arm A. Secondary endpoints included the distribution of highest Gleason scores, detection rate of significant PCa (Gleason ≥7), number of biopsy cores needed to detect one significant PCa, positivity rate for biopsy cores, and tumor involvement per biopsy core.

Results and Limitations: The study was halted early as the primary endpoint was not met. Out of 267 enrolled patients, 210 were analyzed (106 in arm A and 104 in arm B). PCa detection was 37% in arm A and 39% in arm B, with no significant difference (p=0.7). Detection rates for significant PCa and highest tumor involvement per biopsy core were similar between the arms. The mean number of cores was significantly different (5.6 vs 17, p<0.001). A limitation was the limited number of patients due to early cessation.

Conclusions: The trial did not find a significant improvement in detection rates for the combined biopsy approach over MRI-targeted biopsy alone. A prospective comparison between MRI-targeted biopsy alone and systematic TRUS-GB is warranted.

Patient Summary: The study showed similar prostate cancer detection rates between MRI-guided targeted biopsy and the combination of targeted biopsy with systematic TRUS-guided biopsy, excluding a significant improvement with the combined approach.

Additional Findings: The document discusses the value of multiparametric MRI in prostate cancer evaluation, highlighting its potential to more accurately assess tumor burden compared to traditional biopsy protocols. It emphasizes the importance of MRI before biopsy to detect high-grade tumors and improve targeting accuracy through TRUS-MRI image registration.

Figures and Tables: The document includes figures illustrating the process of deformable 3D-TRUS-MRI image fusion and targeted biopsy procedures, as well as tables comparing biopsy protocols.

Introduction: The document discusses various studies on prostate cancer detection using advanced imaging techniques and biopsy methods. It highlights the effectiveness of multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) fusion in improving cancer detection rates.

PI-RADS and Likert Scoring Systems: The PI-RADS and Likert scoring systems are used to stratify the risk of cancer-positive cores in biopsy-naive men. The study found no significant difference between PI-RADS scores of 9 or greater and Likert scale scores of 3 or greater in detecting cancer in the peripheral zone. Sensitivity, specificity, and predictive values are provided for these scoring systems.

MR Imaging-Transrectal US Fusion: This method is highlighted for its potential to increase the detection of clinically relevant prostate cancer. The study discusses the shortcomings of traditional diagnostic methods and the advantages of targeted biopsies using MR imaging guidance.

3D vs. 2D Biopsy Systems: A comparison between 3D and 2D biopsy systems shows a higher cancer detection rate with the 3D system. The study suggests that 3D-guided biopsies are superior in detecting prostate cancers that might be missed with 2D protocols.

Diffusion-Weighted Imaging (DWI): DWI is shown to be highly sensitive for detecting radiorecurrent prostate cancer. The study emphasizes the importance of targeted biopsies in confirming positive diagnoses and assessing tumor burden.

Conclusions: Advanced imaging techniques and targeted biopsy methods significantly improve the detection and risk stratification of prostate cancer. The studies collectively advocate for the integration of these methods into clinical practice to enhance diagnostic accuracy and patient management.

Introduction: This document presents a series of studies comparing the effectiveness of multiparametric magnetic resonance imaging (mpMRI) targeted biopsies with standard systematic transrectal ultrasound (TRUS) guided biopsies in detecting clinically significant prostate cancer in biopsy-naïve men.

Study 1: MRI-Targeted vs. Systematic Biopsies
Materials and Methods: A prospective study involving 129 biopsy-naïve men with suspected prostate cancer. Participants underwent prebiopsy mpMRI, followed by standard (STD) systematic biopsies and targeted (TAR) biopsies if lesions were detected.
Results: The cancer detection rate for MRI-targeted biopsies was 62.7%, significantly higher than the STD protocol. TAR biopsies showed a higher detection rate of clinically significant cancer (28.9% vs. 9.8% for STD, P < 0.001).
Conclusions: mpMRI-targeted biopsies improve the detection rate of clinically significant prostate cancer with less tissue sampling and higher Gleason scores.

Study 2: MRI/Ultrasound Fusion Biopsies
Purpose: To assess the accuracy of MRI/transrectal ultrasound fusion biopsies in diagnosing prostate cancer based on gland size.
Materials and Methods: A study of 232 men undergoing first-round biopsies with mpMRI and a Likert score of 2 or greater.
Results: The detection rate of clinically significant prostate cancer was 44%. MRI-transrectal ultrasound fusion guided biopsy detection rates varied with prostate size, being highest in smaller glands.
Conclusions: MRI-transrectal ultrasound fusion biopsies increase the yield of first-round prostate biopsies in larger prostate volumes.

Study 3: MRI-Targeted vs. 3D TRUS Biopsies
Objective: To compare detection rates of clinically significant disease in MRI-targeted biopsies versus 3D TRUS-guided biopsies based on prostate size.
Methods: Comparison of 120 men undergoing 3D TRUS-guided biopsy to 120 men undergoing MRI-targeted biopsy.
Results: MRI-targeted biopsies had higher detection rates of clinically significant cancer, especially in larger prostates (volume > 50 cm³).
Conclusion: MRI-targeted biopsies are more effective in detecting significant prostate cancer in enlarged prostates compared to 3D TRUS.

Study 4: MRI/TRUS Fusion Biopsies and Index Tumor Detection
Purpose: To determine the accuracy of MR-TRUS image-fusion biopsy in characterizing index tumors.
Results: High concordance between biopsy and radical prostatectomy specimens for tumor location and Gleason pattern, but limited prediction of cancer volume.
Conclusion: MR-TRUS image fusion reliably identifies the location and aggressiveness of the index tumor.

Study 5: Randomized Controlled Trial of MRI/TRUS vs. Random Biopsy
Objective: To compare detection rates of clinically significant prostate cancer between MRI/TRUS-guided and random biopsies.
Results: Detection rates for clinically significant prostate cancer were similar between the two methods.
Conclusion: MRI/TRUS-targeted biopsy may replace traditional 12-core random biopsy for prostate cancer detection.

Overview: The document discusses advancements in prostate cancer diagnosis and management, focusing on biopsy techniques. It compares traditional systematic biopsies with newer, image-guided methods, emphasizing the importance of accurate lesion mapping for active surveillance and focal therapy.

Key Sections:

1. Purpose of Review: The review highlights the need for improved technologies to support active surveillance and focal therapy as alternatives to radical treatment for low-risk prostate cancer.

2. Recent Findings: The widespread use of PSA testing and extended biopsy practices has increased the diagnosis of low-risk prostate cancer. Emerging technologies such as refined imaging modalities and three-dimensional modeling are crucial for precise targeting of prostate lesions.

3. Summary: Current biopsy technologies are advancing separately, but integration into a comprehensive platform is necessary for improved clinical utility.

4. Contemporary Role of Systematic Prostate Biopsies: This section discusses the indications, techniques, and limitations of current prostate biopsy methods. It emphasizes the need for a balance between detecting high-risk cancers and avoiding overdiagnosis of insignificant cancers.

5. Novel Techniques: The document introduces a 3D-documented biopsy-mapping technology that allows precise re-visiting of prostate cancer foci, achieving high re-sampling accuracy and enabling serial analysis of cell cycle progression gene panels.

6. Bibliography: A comprehensive list of studies and trials related to prostate biopsy techniques, highlighting the evolution and validation of various imaging and biopsy methods.

Conclusion: The integration of advanced imaging and biopsy techniques is essential for improving the detection and management of clinically significant prostate cancer. Prospective studies are needed to validate new approaches against established standards.

Catalog excerpts

KOELIS BEST PAPERS 1st Edition - 2009-2016

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Over the past years KOELIS has been featured in many clinical publications reviewed and accepted by international journals. Within the next document you will find abstracts of the best published results. The consequences of these studies include the potential use of multiparametric MRI exams as first-line diagnostic methods, the implementation of targeted, or at least adapted, biopsies, perhaps as a firstline approach but definitely as a second-line approach, as well as active surveillance protocols based on imaging and mapping. Although the effects are still to be measured, these new practices...

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Mapping of transrectal ultrasonographic prostate biopsies: quality control and learning curve assessment by image processing Mozer P1, Baumann M, Chevreau G, Moreau-Gaudry A, Bart S, Renard-Penna R, Comperat E, Conort P, Bitker MO, Chartier-Kastler E, Richard F, Troccaz J. 1Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris, France J US Med. 2009 PURPOSE: OBJECTIVE: Mapping of transrectal ultrasonographic (TRUS) prostate biopsies is of fundamental importance for either diagnostic purposes or the management and treatment of prostate cancer, but the localization of the cores seems...

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3-Dimensional Elastic Registration System of Prostate Biopsy Location by Real-Time 3-Dimensional Transrectal Ultrasound Guidance With Magnetic Resonance/Transrectal Ultrasound Image Fusion Ukimura O1, Desai MM, Palmer S, Valencerina S, Gross M, Abreu AL, Aron M, Gill IS 1From the Center for Image-Guided Therapy, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California MATERIALS AND METHODS: We used 3 CIRS-053 prostate phantoms containing 3 hypoechoic lesions to perform ultrasound guided biopsy and 3 CIRS066 phantoms...

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MRI and ultrasound-guided prostate biopsy using soft image fusion Rud E1, Baco E, Eggesbø HB. 1Division of Diagnostics and Intervention, Department of Radiology and Nuclear Medicine, Oslo University Hospital Anti cancer. 2012 OBJECTIVES: Transrectal ultrasound (TRUS)-guided random biopsies is the gold standard when diagnosing prostate cancer. A new 3D system with organ tracking, allows accurate targeted biopsies using magnetic resonance imaging (MRI) and TRUS soft image fusion. The aim of the study was to evaluate the accuracy of targeted biopsies. MATERIALS AND METHODS: Retrospective study of...

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Prebiopsy Magnetic Resonance Imaging and Prostate Cancer Detection: Comparison of Random and Targeted Biopsies Nicolas Barry Delongchamps,* Michaël Peyromaure, Alexandre Schull, Frédéric Beuvon, Naïm Bouazza, Thierry Flam, Marc Zerbib, Naira Muradyan, Paul Legman and François Cornud From the Departments of Urology (NBD, MP, TF, MZ), Radiology (AS, PL, FC) and Pathology (FB), Assistance Publique-Hôpitaux de Paris, Cochin Hospital and Department of Clinical Research, Assistance Publique-Hôpitaux de Paris, Tarnier Hospital (NB), Paris Descartes University, Sorbonne Paris Cité and Tourville Imaging...

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TRUS-MRI image registration: a paradigm shift in the diagnosis of significant prostate cancer Cornud F1, Brolis L, Delongchamps NB, Portalez D, Malavaud B, Renard-Penna R, Mozer P. 1Department of Radiology, Hôpital Cochin, Paris, France COMPARING TECHNOLOGIES ABSTRACT: Accuracy of multiparametric MRI has greatly improved the ability of localizing tumor foci of prostate cancer. This property can be used to perform a TRUS–MR image registration, new technological advance, which allows for an overlay of an MRI onto a TRUS image to target a prostate biopsy toward a suspicious area Three types of registration...

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Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies Arsov C1, Rabenalt R, Blondin D, Quentin M, Hiester A, Godehardt E, Gabbert HE, Becker N, Antoch G, Albers P, Schimmöller L. 1Department of Urology, Heinrich-Heine University, Düsseldorf, Germany. Eur Urol. 2015 BACKGROUND: A significant proportion of prostate cancers (PCas) are missed by conventional transrectal ultrasound-guided biopsy (TRUS-GB). It remains unclear whether the combined...

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Value of multiparametric MRI in the work-up of prostate cancer Cornud F¹, Delongchamps NB, Mozer P, Beuvon F, Schull A, Muradyan N, Peyromaure M. ¹Service de Radiologie, Hôpital Cochin, Paris, France. Curr Urol. 2011 ABSTRACT: The role of magnetic resonance imaging (MRI) in prostate cancer evaluation is controversial and likely underestimated. Technological advances over the past 5 years have demonstrated that multiparametric MRI, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI, can evaluate the actual tumor burden of a newly diagnosed prostate cancer more accurately...

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Targeted MRI-guided prostate biopsies for the detection of prostate cancer: initial clinical experience with real-time 3-dimensional transrectal ultrasound guidance and magnetic resonance/transrectal ultrasound image fusion Fiard G¹, Hohn N, Descotes JL, Rambeaud JJ, Troccaz J, Long JA. ¹Urology Department, Grenoble University Hospital, Grenoble, France. METHODS: We prospectively included 30 patients for suspicion of prostate cancer from November 2011 to August 2012. All patients were previously evaluated by a multiparametric MRI, interpreted by a single radiologist who attributed a Prostate...

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Validation of the European Society of Urogenital Radiology scoring system for prostate cancer diagnosis on multiparametric magnetic resonance imaging in a cohort of repeat biopsy patients Portalez D¹, Mozer P, Cornud F, Renard-Penna R, Misrai V, Thoulouzan M, Malavaud B. ¹Department of Radiology, Clinique Pasteur, Toulouse, France. Eur Urol. 2012 BACKGROUND: Wide variations in acquisition protocols and the lack of robust diagnostic criteria make magnetic resonance imaging (MRI) detection of prostate cancer (PCa) one of the most challenging fields in radiology and urology. OBJECTIVE: To validate...

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