Multiparametric magnetic resonance (mpMRI)/ultrasound targeted prostate biopsy (TB) is touted as a tool to improve prostate cancer care. Yet, the true clinical utility of TB over transrectal ultrasound-guided prostate biopsy (TRUS-B) has not been systematically analyzed.
We introduce two metrics to better quantify and report the deliverables of TB.
We reviewed our prospective database containing patients who underwent simultaneous TB/TRUS-B. Actionable Intelligence Metric (AIM) was defined as the proportion of patients for whom TB provided actionable information over TRUS-B. Reduction Metric (ReM) was defined as the proportion of men in whom TRUS-B could have been omitted. We compared metrics within our cohort and prior reports.
371 men were included. AIM and ReM were 22.2% and 83.6% for biopsy naïve, 26.7% and 84.2% for prior negative TRUS-B, and 24% and 77.5% for active surveillance patients. No significant differences among groups were observed (p = 0.89 for AIM; p = 0.27 for ReM). AIM was 25.0% for PIRADS 3, 27.5% for PIRADS 4 and 21.7% for PIRADS 5 (p = 0.73) lesions. TRUS-B could have been avoided in more patients with PIRADS 3 compared to PIRADS 4/5 lesions (ReM 92.0% vs. 76.7%, p < 0.01). Our results compare favorably to other reported series.
AIM and ReM are novel, clinically relevant quantification metrics to standardize reporting of TB deliverables. TB affords actionable information (AIM) in ∼25% of men. ReM assessment highlights that TRUS-B may only be omitted after carefully considering the risk of missing clinically significant cancers.
The Journal of urology. 2017 Oct 05 [Epub ahead of print]
Benjamin T Ristau, David Y T Chen, Jeffrey Ellis, Aseem Malhotra, Lyudmilla DeMora, Rosaleen B Parsons, Barton Milestone, Marion Brody, Rosalia Viterbo, Richard Greenberg, Marc Smaldone, Robert Uzzo, Jordan Anaokar, Alexander Kutikov
Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA. Electronic address: ., Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA., Lewis Katz School of Medicine, Temple University, Philadelphia, PA., Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA., Department of Diagnostic Imaging, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA.