Targeted biopsy based on cognitive or software magnetic resonance imaging (MRI) to transrectal ultrasound registration seems to increase the detection rate of clinically significant prostate cancer as compared with standard biopsy.
However, these strategies have not been directly compared against an accurate test yet. The aim of this study was to obtain pilot data on the diagnostic ability of visually directed targeted biopsy vs. software-based targeted biopsy, considering transperineal template mapping (TPM) biopsy as the reference test.
Prospective paired cohort study included 50 consecutive men undergoing TPM with one or more visible targets detected on preoperative multiparametric MRI. Targets were contoured on the Biojet software. Patients initially underwent software-based targeted biopsies, then visually directed targeted biopsies, and finally systematic TPM. The detection rate of clinically significant disease (Gleason score ≥3+4 and/or maximum cancer core length ≥4mm) of one strategy against another was compared by 3×3 contingency tables. Secondary analyses were performed using a less stringent threshold of significance (Gleason score ≥4+3 and/or maximum cancer core length ≥6mm).
Median age was 68 (interquartile range: 63-73); median prostate-specific antigen level was 7. 9ng/mL (6. 4-10. 2). A total of 79 targets were detected with a mean of 1. 6 targets per patient. Of these, 27 (34%), 28 (35%), and 24 (31%) were scored 3, 4, and 5, respectively. At a patient level, the detection rate was 32 (64%), 34 (68%), and 38 (76%) for visually directed targeted, software-based biopsy, and TPM, respectively. Combining the 2 targeted strategies would have led to detection rate of 39 (78%). At a patient level and at a target level, software-based targeted biopsy found more clinically significant diseases than did visually directed targeted biopsy, although this was not statistically significant (22% vs. 14%, P = 0. 48; 51. 9% vs. 44. 3%, P = 0. 24). Secondary analysis showed similar results. Based on these findings, a paired cohort study enrolling at least 257 men would verify whether this difference is statistically significant.
The diagnostic ability of software-based targeted biopsy and visually directed targeted biopsy seems almost comparable, although utility and efficiency both seem to be slightly in favor of the software-based strategy. Ongoing trials are sufficiently powered to prove or disprove these findings.
Urologic oncology. 2015 Jul 17 [Epub ahead of print]
Massimo Valerio, Neil McCartan, Alex Freeman, Shonit Punwani, Mark Emberton, Hashim U Ahmed
Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom. , Department of Pathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom. , Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom. , Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom. , Division of Surgery and Interventional Science, University College London, London, United Kingdom; Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.