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  • 1
    Online Resource
    Online Resource
    Added value of randomised biopsy to multiparametric magnetic resonance imaging‐targeted biopsy of the prostate in a contemporary cohort
    Wiley ; 2024
    In:  BJU International Vol. 133, No. 5 ( 2024-05), p. 548-554
    Details
    In: BJU International, Wiley, Vol. 133, No. 5 ( 2024-05), p. 548-554
    Abstract: To assess the added value of concurrent systematic randomised ultrasonography‐guided biopsy (SBx) to multiparametric magnetic resonance imaging (mpMRI)‐targeted biopsy and the additional rate of overdiagnosis of clinically insignificant prostate cancer (ciPCa) by SBx in a large contemporary, real‐world cohort. Patients and Methods A total of 1552 patients with positive mpMRI and consecutive mpMRI‐targeted biopsy and SBx were enrolled. Added value and the rate of overdiagnosis by SBx was evaluated. Primary outcome: added value of SBx, defined as detection rate of clinically significant PCa (csPCa; International Society of Urological Pathology [ISUP] Grade ≥2) by SBx, while mpMRI‐targeted biopsy was negative or showed ciPCa (ISUP Grade 1). Secondary outcome: rate of overdiagnosis by SBx, defined as detection of ciPCa in patients with negative mpMRI‐targeted biopsy and PSA level of 〈 10 ng/mL. Results Detection rate of csPCa by mpMRI‐targeted biopsy and/or SBx was 753/1552 (49%). Added value of SBx was 145/944 (15%). Rate of overdiagnosis by SBx was 146/656 (22%). Added value of SBx did not change when comparing patients with previous prostate biopsy and biopsy naïve patients. In multivariable analysis, a Prostate Imaging‐Reporting and Data System (PI‐RADS) 4 index lesion (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.66–6.78; P = 0.001), a PI‐RADS 5 index lesion (OR 2.89, 95% CI 1.39–6.46; P = 0.006) and age (OR 1.05, 95% CI 1.03–1.08; P 〈 0.001) were independently associated with added value of SBx. Conclusions In our real‐world analysis, we saw a significant impact on added value and added rate of overdiagnosis by SBx. Subgroup analysis showed no significant decrease of added value in any evaluated risk group. Therefore, we do not endorse omitting concurrent SBx to mpMRI‐guided biopsy of the prostate.
    Type of Medium: Online Resource
    ISSN: 1464-4096 , 1464-410X
    URL: Issue
    URL: Article
    DOI: 10.1111/bju.v133.5
    DOI: 10.1111/bju.16248
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2019983-1
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  • 2
    Online Resource
    Online Resource
    Sonography of the prostate : Relevance for urologists in daily clinical routine
    Springer Science and Business Media LLC ; 2022
    In:  Der Urologe Vol. 61, No. 4 ( 2022-04), p. 365-373
    Details
    In: Der Urologe, Springer Science and Business Media LLC, Vol. 61, No. 4 ( 2022-04), p. 365-373
    Type of Medium: Online Resource
    ISSN: 0340-2592 , 1433-0563
    URL: Article
    DOI: 10.1007/s00120-022-01767-x
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 3123197-4
    detail.hit.zdb_id: 2925337-8
    detail.hit.zdb_id: 1463249-4
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  • 3
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    Predictive clinical features for negative histopathology of MRI/Ultrasound-fusion-guided prostate biopsy in patients with high likelihood of cancer at prostate MRI: Analysis from a urologic outpatient clinic1
    IOS Press ; 2021
    In:  Clinical Hemorheology and Microcirculation Vol. 76, No. 4 ( 2021-01-11), p. 503-511
    Details
    In: Clinical Hemorheology and Microcirculation, IOS Press, Vol. 76, No. 4 ( 2021-01-11), p. 503-511
    Abstract: OBJECTIVE: The aim of this study was to evaluate clinical features associated with benign histopathology of Prostate Imaging Reporting and Data System (PI-RADS) category 4 and 5 lesions. MATERIALS AND METHODS: Between March 2015 and November 2020, 1161 patients underwent mpMRI/Ultrasound-fusion-guided prostate biopsy (FBx) and concurrent 12-core systematic prostate biopsy (SBx) at the Department of Urology of the Ludwig-Maximilians-University of Munich, Germany. 848/ 1161 (73%) patients presented with either PI-RADS 4 or 5 index lesion and were retrospectively evaluated. Multivariate analysis was performed to evaluate clinical parameters associated with a negative outcome of PI-RADS 4 or 5 category lesions after FBx. Area under the receiver operating characteristics (ROC) curve (AUC) was conducted using ROC-analysis. RESULTS: 676/848 (79.7%) patients with either PI-RADS 4 or 5 index lesion were diagnosed with prostate cancer (PCa) by FBx and 172/848 (20.3%) patients had a negative biopsy (including the concurrent systematic prostate biopsy), respectively. Prostate volume (P-Vol) (OR 0.99, 95% CI = 0.98–1.00, p = 0.038), pre-biopsy-status (OR 0.48, 95% CI = 0.29–0.79, p = 0.004) and localization of the lesion in the transitional zone (OR 0.28, 95% CI = 0.13–0.60, p = 0.001) were independent risk factors for a negative outcome of FBx. Age (OR 1.09, 95% CI = 1.05–1.13, p  〈  0.001) and PSA density (PSAD) (OR 75.92, 95% CI = 1.03–5584.61, p = 0.048) increased the risk for PCa diagnosis after FBx. The multivariate logistic regression model combining all clinical characteristics achieved an AUC of 0.802 (95% CI = 0.765–0.835; p  〈  0.001) with a sensitivity and specificity of 66% and 85%. CONCLUSION: Lesions with high or highly likelihood of PCa on multiparametric magnetic resonance imaging (mpMRI) but subsequent negative prostate biopsy occur in a small amount of patients. Localization of the lesion in the transitional zone, prostate volume and prebiopsy were shown to be predictors for benign histopathology of category 4 or 5 lesions on mpMRI. Integration of these features into daily clinical routine could be used for risk-stratification of these patients after negative biopsy of PI-RADS 4 or 5 index lesions.
    Type of Medium: Online Resource
    ISSN: 1386-0291 , 1875-8622
    URL: Article
    DOI: 10.3233/CH-209225
    Language: Unknown
    Publisher: IOS Press
    Publication Date: 2021
    detail.hit.zdb_id: 2026405-7
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  • 4
    Online Resource
    Online Resource
    mpMRI-targeted biopsy of the prostate in men ≥ 75 years. 7-year report from a high-volume referral center
    IOS Press ; 2023
    In:  Clinical Hemorheology and Microcirculation ( 2023-09-08), p. 1-8
    Details
    In: Clinical Hemorheology and Microcirculation, IOS Press, ( 2023-09-08), p. 1-8
    Abstract: OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) –Ultrasound- fusion guided biopsy of the prostate (FBx) is the new gold standard for the detection of prostate cancer. Hallmark studies showing superior detection rates of FBx over randomized biopsies routinely excluded patients≥75 years and information on outcome of FBx on this patient cohort is sparse. As a large referral center, we have performed FBx on a substantial number of patients this age. By evaluating outcome of FBx of patients over the age of 75 years we wanted to close the gap of knowledge on this patient cohort. MATERIALS AND METHODS: Between 2015 –2022, 1577 patients underwent FBx at our department and were considered for analysis. Clinical and histopathological parameters were recorded. Clinical data comprised age at FBx, serum level of Prostate-specific antigen (PSA), prostate volume, PSA-density, history of previous biopsies of the prostate, result of the digital rectal examination (DRE) and assessment of the indexlesion of mpMRI according to the Prostate Imaging and Reporting Data System (PI-RADS). Univariate analysis and multivariable logistic regression was used to identify age barrier of 75 years as a potential risk factor of detection of clinically significant prostate cancer by FBx. RESULTS: 379/1577 patients (24%) were≥75 years and 1198/1577 (76%) patients were  〈  75 years, respectively. Preoperative PSA was significantly higher in patients≥75 years compared to patients  〈  75 years (9.54 vs. 7.8, p  〈  0.001). Patients≥75 years presented significantly more often with mpMRI target lesions classified as PI-RADS 5 compared to patients  〈  75 years (45% vs. 29%, p  〈  0.001). Detection rate of clinically significant prostate cancer was significantly higher in patients≥75 years compared to patients  〈  75 years (63% vs. 43%, p  〈  0.001). Aggressive prostate cancer grade ISUP 5 was significantly more often detected in patients≥75 years compared to patients  〈  75 years (13% vs. 8%, p = 0.03). On multivariable logistic regression model adjusted for PSA and PI-RADS score, age barrier of 75 years was identified as a significant risk factor for the detection of clinically significant prostate cancer by FBx (OR: 1.77, 95% CI: 1.36 –2.31, p  〈  0.001). CONCLUSION: After evaluation of a large patient cohort, we show that age≥75 years represents a significant risk factor for the detection of clinically significant prostate cancer. Further studies on mid- and long term outcome are necessary to draw conclusions for clinical decision making in this patient cohort.
    Type of Medium: Online Resource
    ISSN: 1386-0291 , 1875-8622
    URL: Article
    DOI: 10.3233/CH-238101
    Language: Unknown
    Publisher: IOS Press
    Publication Date: 2023
    detail.hit.zdb_id: 2026405-7
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  • 5
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    Online Resource
    Adverse Pathology after Radical Prostatectomy of Patients Eligible for Active Surveillance—A Summary 7 Years after Introducing mpMRI-Guided Biopsy in a Real-World Setting
    MDPI AG ; 2023
    In:  Bioengineering Vol. 10, No. 2 ( 2023-02-13), p. 247-
    Details
    In: Bioengineering, MDPI AG, Vol. 10, No. 2 ( 2023-02-13), p. 247-
    Abstract: Objective: Over the last decade, active surveillance (AS) of low-risk prostate cancer has been increasing. The mpMRI fusion-guided biopsy of the prostate (FBx) is considered to be the gold standard in preoperative risk stratification. However, the role of FBx remains unclear in terms of risk stratification of low-risk prostate cancer outside high-volume centers. The aim of this study was to evaluate adverse pathology after radical prostatectomy (RP) in a real-world setting, focusing on patients diagnosed with Gleason score (GS) 6 prostate cancer (PCa) and eligible for AS by FBx. Subjects and Methods: Between March 2015 and March 2022, 1297 patients underwent FBx at the Department of Urology, Ludwig-Maximilians-University of Munich, Germany. MpMRI for FBx was performed by 111 different radiology centers. FBx was performed by 14 urologists from our department with different levels of experience. In total, 997/1297 (77%) patients were diagnosed with prostate cancer; 492/997 (49%) of these patients decided to undergo RP in our clinic and were retrospectively included. Univariate and multivariable logistic regression analyses were performed to evaluate clinical and histopathological parameters associated with adverse pathology comparing FBx and RP specimens. To compare FBx and systematic randomized biopsies performed in our clinic before introducing FBx (SBx, n = 2309), we performed a propensity score matching on a 1:1 ratio, adjusting for age, number of positive biopsy cores, and initial PSA (iPSA). Results: A total of 492 patients undergoing FBx or SBx was matched. In total, 55% of patients diagnosed with GS 6 by FBx were upgraded to clinically significant PCa (defined as GS ≥ 7a) after RP, compared to 52% of patients diagnosed by SBx (p = 0.76). A time delay between FBx and RP was identified as the only correlate associated with upgrading. A total of 5.9% of all FBx patients and 6.1% of all SBx patients would have been eligible for AS (p 〉 0.99) but decided to undergo RP. The positive predictive value of AS eligibility (diagnosis of low-risk PCa after biopsy and after RP) was 17% for FBx and 6.7% for SBx (p = 0.39). Conclusions: In this study, we show, in a real-world setting, that introducing FBx did not lead to significant change in ratio of adverse pathology for low-risk PCa patients after RP compared to SBx.
    Type of Medium: Online Resource
    ISSN: 2306-5354
    URL: Article
    DOI: 10.3390/bioengineering10020247
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2746191-9
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  • 6
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    Online Resource
    Multiparametrische Magnetresonanztomographie (mpMRT) und mpMRT-gesteuerte Biopsie bei der Diagnostik des Prostatakarzinoms
    Springer Science and Business Media LLC ; 2020
    In:  Der Radiologe Vol. 60, No. S1 ( 2020-11), p. 63-69
    Details
    In: Der Radiologe, Springer Science and Business Media LLC, Vol. 60, No. S1 ( 2020-11), p. 63-69
    Type of Medium: Online Resource
    ISSN: 0033-832X , 1432-2102
    URL: Article
    DOI: 10.1007/s00117-020-00716-z
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 3120921-X
    detail.hit.zdb_id: 1463036-9
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  • 7
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    Online Resource
    Sonography of the prostate : Relevance for urologists in daily clinical routine
    Springer Science and Business Media LLC ; 2022
    In:  Journal für Urologie und Urogynäkologie/Österreich Vol. 29, No. 4 ( 2022-12), p. 123-131
    Details
    In: Journal für Urologie und Urogynäkologie/Österreich, Springer Science and Business Media LLC, Vol. 29, No. 4 ( 2022-12), p. 123-131
    Type of Medium: Online Resource
    ISSN: 1023-6090 , 1680-9424
    URL: Article
    DOI: 10.1007/s41972-022-00180-y
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2051806-7
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  • 8
    Online Resource
    Online Resource
    Sonography of the genitourinary system
    Springer Science and Business Media LLC ; 2022
    In:  MMW - Fortschritte der Medizin Vol. 164, No. 21-22 ( 2022-12), p. 54-63
    Details
    In: MMW - Fortschritte der Medizin, Springer Science and Business Media LLC, Vol. 164, No. 21-22 ( 2022-12), p. 54-63
    Type of Medium: Online Resource
    ISSN: 1438-3276 , 1613-3560
    URL: Article
    DOI: 10.1007/s15006-022-2073-7
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2173071-4
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  • 9
    Online Resource
    Online Resource
    Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature
    S. Karger AG ; 2021
    In:  Urologia Internationalis Vol. 105, No. 5-6 ( 2021), p. 520-524
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 105, No. 5-6 ( 2021), p. 520-524
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy. 〈 b 〉 〈 i 〉 Case Description: 〈 /i 〉 〈 /b 〉 We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000512378
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1464417-4
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  • 10
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    Online Resource
    The Impact of Prostate Volume on the Prostate Imaging and Reporting Data System (PI-RADS) in a Real-World Setting
    MDPI AG ; 2023
    In:  Diagnostics Vol. 13, No. 16 ( 2023-08-15), p. 2677-
    Details
    In: Diagnostics, MDPI AG, Vol. 13, No. 16 ( 2023-08-15), p. 2677-
    Abstract: Multiparametric magnetic resonance imaging (mpMRI) has emerged as a new cornerstone in the diagnostic pathway of prostate cancer. However, mpMRI is not devoid of factors influencing its detection rate of clinically significant prostate cancer (csPCa). Amongst others, prostate volume has been demonstrated to influence the detection rates of csPCa. Particularly, increasing volume has been linked to a reduced cancer detection rate. However, information about the linkage between PI-RADS, prostate volume and detection rate is relatively sparse. Therefore, the current study aims to assess the association between prostate volume, PI-RADS score and detection rate of csP-Ca, representing daily practice and contemporary mpMRI expertise. Thus, 1039 consecutive patients with 1151 PI-RADS targets, who underwent mpMRI-guided prostate biopsy at our tertiary referral center, were included. Prior mpMRI had been assessed by a plethora of 111 radiology offices, including academic centers and private practices. mpMRI was not secondarily reviewed in house before biopsy. mpMRI-targeted biopsy was performed by a small group of a total of ten urologists, who had performed at least 100 previous biopsies. Using ROC analysis, we defined cut-off values of prostate volume for each PI-RADS score, where the detection rate drops significantly. For PI-RADS 4 lesions, we found a volume 〉 61.5 ccm significantly reduced the cancer detection rate (OR 0.24; 95% CI 0.16–0.38; p 〈 0.001). For PI-RADS 5 lesions, we found a volume 〉 51.5 ccm to significantly reduce the cancer detection rate (OR 0.39; 95% CI 0.25–0.62; p 〈 0.001). For PI-RADS 3 lesions, none of the evaluated clinical parameters had a significant impact on the detection rate of csPCa. In conclusion, we show that enlarged prostate volume represents a major limitation in the daily practice of mpMRI-targeted biopsy. This study is the first to define exact cut-off values of prostate volume to significantly impair the validity of PI-RADS assessed in a real-world setting. Therefore, the results of mpMRI-targeted biopsy should be interpreted carefully, especially in patients with prostate volumes above our defined thresholds.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics13162677
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662336-5
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