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Edison E, Tariq Shah T, Ahmed HU, 2017, Focal Ablation of Early-Stage Prostate Cancer: Candidate Selection, Treatment Guidance, and Assessment of Outcome., Urologic Clinics of North America, Vol: 44, Pages: 575-585, ISSN: 0094-0143
Prostate cancer lesions smaller than 0.5 m3, or Gleason pattern 3, are likely clinically insignificant. Clinically significant disease is often limited to a single index lesion. Focal ablation targets this index lesion, maintains oncological control, and minimizes complications by preserving healthy prostate tissue. Template mapping biopsy or multiparametric MRI-targeted biopsies are used to identify appropriate index lesions. Multiple energy modalities have been tested, including high-intensity frequency ultrasound, cryoablation, laser ablation, photodynamic therapy, focal brachytherapy, radiofrequency ablation, irreversible electroporation. Outcome is assessed by biopsy of the target area, triggered by prostate-specific antigen measurements or MRI imaging, or performed per protocol at 12 months.
Kasivisvanathan V, Ahmed H, Cashman S, et al., 2017, The British Urology Researchers in Surgical Training (BURST) Research Collaborative: an alternative research model for carrying out large scale multi-centre urological studies., BJU International, Vol: 121, Pages: 6-9, ISSN: 1464-4096
Miah S, Ahmed HU, 2017, The death of ink: the value of typing skills as an addition to the medical school curriculum, Advances in Medical Education and Practice, Vol: 8, Pages: 701-702, ISSN: 1179-7258
We read with great interest the article by Malik on the importance of writing skills, which has been highlighted as one of the four competencies that all medical students should possess as future doctors.1 Malik’s article also stated that “first and foremost”writing in a legible manner is imperative for good clinical practice.1While we wholeheartedly agree with these statements, one potentially overlooked skill that we predict will overtake the requirement of legible writing skills within a generation of doctors is typing proficiency. Decades of investment and development of electronic health records (EHRs) have resulted in a greater implementation of this tool globally.2 EHRs have been shown through use of reminders, electronic order sets and other means to improve reliability of performance of many basic tasks in acute, preventive and chronic medical care.2
Faria R, Soares M, Spackman E, et al., 2017, COST-EFFECTIVENESS OF DIAGNOSIS: FROM TESTS TO LONG-TERM OUTCOMES AND COSTS, Publisher: ELSEVIER SCIENCE INC, Pages: A405-A406, ISSN: 1098-3015
Sibley-Allen C, Ahmed H, Johnson S, et al., 2017, Comparison of reporting outcomes for Simultaneous and Sequential perfusion SPECT in VQ SPECT/CT, Publisher: SPRINGER, Pages: S491-S492, ISSN: 1619-7070
De Sousa T, Johnson S, Nunes A, et al., 2017, Half-Time SPECT/CT Acquisition for Post Therapy [177Lu-DOTA, Tyr3] Octreotate Imaging, Publisher: SPRINGER, Pages: S880-S880, ISSN: 1619-7070
Shah TT, To WKL, Ahmed HU, 2017, Magnetic resonance imaging in the early detection of prostate cancer and review of the literature on magnetic resonance imaging-stratified clinical pathways, Expert Review of Anticancer Therapy, Vol: 17, Pages: 1159-1168, ISSN: 1473-7140
INTRODUCTION: With level 1 evidence now available on the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI) we must now utilise this data in developing an MRI-stratified diagnostic pathway for the early detection of prostate cancer. Areas covered: A literature review was conducted and identified seven randomised control trials (RCT's) assessing the diagnostic accuracy of such a pathway against the previously accepted systematic/random trans-rectal ultrasound guided (TRUS) biopsy pathway. The studies were heterogeneous in their design. Five studies assessed the addition of MRI-targeted biopsies to a standard care systematic TRUS biopsy pathway. Three of these studies showed either an increase in their diagnostic accuracy or the potential to remove systematic biopsies. Two studies looked specifically at a targeted biopsy only pathway and although the results were again mixed, there was no decrease in the diagnostic rate and overall significantly fewer biopsy cores were taken in the MRI group. Expert commentary: Results from these RCT's together with multiple retrospective and prospective studies point towards either an improved diagnostic rate for clinically significant cancer and/or a reduction in the need for systematic biopsies with a MRI-stratified pathway. The challenge for the urological community will be to implement pre-biopsy MRI into a routine clinical pathway with likely independent monitoring of standards.
Davda R, Prentice M, Sarova A, et al., 2017, Late Toxicity and Patient Reported Outcomes in Patients Treated With Salvage Radiation Following Primary High Intensity Focal Ultrasound for Localized Prostate Cancer, 59th Annual Meeting of the American-Society-for-Radiation-Oncology (ASTRO), Publisher: ELSEVIER SCIENCE INC, Pages: E226-E226, ISSN: 0360-3016
Faria R, Soares MO, Spackman E, et al., 2017, Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS)., European Urology, Vol: 73, Pages: 23-30, ISSN: 0302-2838
BACKGROUND: The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI). OBJECTIVE: To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS). INTERVENTION: Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs. RESULTS AND LIMITATIONS: The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92-0.98] vs 0.91 [95% CI 0.86-0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer. CONCLUSIONS: An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines. PATIENT SUMMARY: We found that, under certain assumptions, the use of multiparametri
Peters M, Kanthabalan A, Shah TT, et al., 2017, Development and internal validation of prediction models for biochemical failure and composite failure after focal salvage high intensity focused ultrasound for local radiorecurrent prostate cancer: Presentation of risk scores for individual patient prognoses., Urologic Oncology: Seminars and Original Investigations, Vol: 36, Pages: 13.e1-13.e10, ISSN: 1078-1439
PURPOSE: Patient selection for focal salvage remains difficult. Therefore, we developed and internally validated prediction models for biochemical failure (BF) and a composite endpoint (CE) following focal salvage high intensity focused ultrasound (HIFU) for radiorecurrent prostate cancer. MATERIALS AND METHODS: A prospective HIFU registry identified 150 cases (November 2006-August 2015). Recurrence was assessed with multiparametric magnetic resonance imaging (MRI) combined with template prostate mapping biopsies, targeted biopsies, or systematic transrectal ultrasound-guided biopsies. Metastatic disease was ruled out with a positron emission tomography-computed tomography and a bone scan. Focal salvage HIFU consisted of quadrant-ablation, hemi-ablation, or index-lesion ablation. Cox-regression was used for BF (Phoenix-definition) and CE (BF/MRI+/biopsies+/local or systemic treatment/metastases+/prostate cancer specific mortality+). Internal validation was performed using bootstrap resampling (500 datasets) after which C-statistic and hazard ratios were adjusted. Models were calibrated and risk scores created. RESULTS: Median follow-up was 35 months (interquartile range: 22-52). Median biochemical disease-free survival (DFS) was 33 months (95% CI: 23-45). Median CE-free survival was 24 months (95% CI: 21-35). After multivariable analysis, DFS interval after primary radiotherapy, presalvage prostate-specific antigen (PSA), PSA-doubling time, prostatic volume, and T-stage (both MRI based) predicted BF. For the CE, PSA-doubling time was not predictive but additionally, primary Gleason score was. The adjusted C-statistics were 0.68 and 0.64 for BF and CE, respectively. Calibration was accurate until 48 months. The risk scores showed 3 groups, with biochemical DFS of 60%, 35%, and 7% and CE-free survival of 40%, 24%, and 0% at 4 years. CONCLUSION: Our model, once externally validated, could allow for better selection of patients for focal salvage HIFU.
Segaran SV, Emara AM, Mahesan T, et al., 2017, The ability of free to total prostate-specific antigen and prostate-specific antigen density to detect clinically significant prostate cancer in men undergoing transperineal template biopsy, JOURNAL OF CLINICAL UROLOGY, Vol: 10, Pages: 529-534, ISSN: 2051-4158
The ability of free to total prostate-specific antigen and prostate-specific antigen density to detect clinically significant prostate cancer in men undergoing transperineal template biopsyShow all authorsSurayne V Segaran, Amr M Emara, Tharani Mahesan, ...First Published September 12, 2017 Research ArticleDownload PDFPDF download for The ability of free to total prostate-specific antigen and prostate-specific antigen density to detect clinically significant prostate cancer in men undergoing transperineal template biopsy Article information Full AccessArticle InformationVolume: 10 issue: 6, page(s): 529-534Article first published online: September 12, 2017; Issue published: November 1, 2017Received: May 04, 2017; Accepted: August 08, 2017https://doi.org/10.1177/2051415817730494Surayne V Segaran1, Amr M Emara1, 2, Tharani Mahesan3, Joshua Silverman1, Hashim U Ahmed4, Simon RJ Bott3, Richard G Hindley11Urology Department, North Hampshire Hospitals NHS Trust, UK2Urology Department, Ain Shams University, Egypt3Urology Department, Frimley Park Hospital, UK4Imperial College London, UKCorresponding Author: Surayne V Segaran, Urology Department, North Hampshire Hospitals NHS Trust, Aldermaston Road, Basingstoke, RG24 9NA, UK. Email: surayne.segaran@fhft.nhs.ukAbstractObjective:The purpose of this study was to determine the ability of the ratio of free to total prostate-specific antigen and prostate-specific antigen density to predict the presence of clinically significant prostate cancer on template biopsies. The value of these tests may be underestimated as they were previously validated against sextant transrectal biopsy of the prostate, which has been proved to miss a large proportion of significant prostate cancers. The ability of these tests to specifically detect clinically significant cancers has not previously been studied.Patients and methods:A retrospective analysis was performed of patients undergoing transperineal template biopsy who also had free to total pros
Afaq A, Alahmed S, Chen S-H, et al., 2017, (68)Ga-PSMA PET/CT impact on prostate cancer management., Journal of Nuclear Medicine, ISSN: 1535-5667
Aim: To assess the impact of (68)Ga-Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography/ Computed Tomography (PET/CT) on management of prostate cancer in patients with biochemical recurrence (BCR). Methods: Documented management plans were retrospectively reviewed before and after (68)Ga-PSMA PET/CT in 100 patients with BCR and change in plans recorded. Results: Management changed after (68)Ga-PSMA PET/CT in 39 patients (39%). These occurred in 23/68 (33.8%) of patients with radical prostatectomy (RP) and 16/32 (50%) of patients previously treated with radical radiotherapy. Positive scan (P < 0.001) and higher Prostate Specific Antigen (PSA) (P = 0.024) were associated with management changes. No significant association with management change was found with Gleason grade, stage, presence of metastatic disease, PSA velocity or doubling time. Conclusion:(68)Ga-PSMA PET/CT altered management in 39% of patients with BCR, and occurred more often in patients with radical radiotherapy treatment, a positive (68)Ga-PSMA scan and higher PSA level.
Ahmed HU, Brown LC, Kaplan R, et al., 2017, Diagnostic accuracy of the PROMIS study Reply, LANCET, Vol: 390, Pages: 362-362, ISSN: 0140-6736
Linch M, Goh G, Hiley C, et al., 2017, Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters, ANNALS OF ONCOLOGY, Vol: 28, Pages: 2472-2480, ISSN: 0923-7534
BackgroundIntratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies.Patients and methodsForty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification.ResultsWe demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion.ConclusionsThe PROGENY (PROstate cancer GENomic heterogeneitY) s
Kanthabalan A, Peters M, Van Vulpen M, et al., 2017, Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer, BJU International, Vol: 120, Pages: 246-256, ISSN: 1464-4096
ObjectiveTo assess short- to medium-term cancer control rates and side effects of focal salvage high- intensity focused ultrasound (HIFU).Materials and MethodsA retrospective registry analysis identified 150 men who underwent focal salvage HIFU (FS-HIFU) (Sonablate 500) between November 2006 and August 2015. Metastatic disease was excluded by nodal assessment on the pelvic MRI, a radioisotope bone scan and positron-emission tomography (PET) imaging (choline-18F-fluorodeoxyglucose PET or choline PET-CT). In our current clinical practice, metastatic disease must be excluded by both choline PET and bone scan. Localization of cancer was carried out using multiparametric MRI of the prostate (T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging) with systematic or template prostate mapping biopsies. The primary outcome was a composite failure incorporating biochemical failure (BCF) and/or positive localized or distant imaging results and/or positive biopsy and/or systemic therapy and/or metastases/prostate cancer-specific death. The secondary outcome was BCF using the Phoenix-ASTRO definition (prostate-specific antigen [PSA] nadir + 2 ng/mL). We used Kaplan–Meier analysis and Cox proportional hazards regression to quantify the effect of the determinants on the endpoints.ResultsThe mean (standard deviation [sd]) patient age at focal salvage HIFU was 69.8 (6.1) years and the median (interquartile range [IQR]) PSA pre-focal salvage HIFU was 5.5 (3.6–7.9) ng/mL. The median (IQR) follow-up was 35 (22–52) months. Patients were classified as having low- 2.7% (4/150), intermediate- 39.3% (59/150) and high-risk disease 41.3% (62/150) according to D'Amico classification, prior to focal salvage HIFU. Composite failure occurred in 61% of patients (91/150) and BCF occurred in 51.3% (77/150). The Kaplan–Meier composite endpoint-free survival (CEFS) rate at 3 years was 40% (95% confidence interval [CI] 31–50) for the entire group. Kaplan&nd
Hindley RG, Mistry K, Ahmed HU, 2017, The PROMIS of a New Diagnostic Pathway for Men with Suspected Prostate Cancer, CLINICAL ONCOLOGY, Vol: 29, Pages: 397-400, ISSN: 0936-6555
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Bass EJ, Donaldson IA, Freeman A, et al., 2017, Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach, Prostate Cancer and Prostatic Diseases, Vol: 20, Pages: 311-317, ISSN: 1365-7852
Background:Despite high rates of disease misclassification and sepsis, the use of transrectal biopsy remains commonplace. Transperineal mapping biopsies mitigate these problems but carry increased cost and patient burden. Local anaesthetic, multiparametric magnetic resonance imaging (MRI)-targeted transperineal biopsy may offer an alternative. Here, we aim to determine the feasibility, tolerability and detection rates of clinically significant prostate cancer using a local anaesthetic, transperineal, MRI-targeted biopsy technique.Methods:Tertiary referral centre in which 181 consecutive men underwent local anaesthetic, transperineal MRI-targeted prostate biopsy (September 2014 to January 2016). A standardized local anaesthetic technique was used to obtain targeted biopsies using visual estimation with the number of targeted cores determined by each of a number of users. We assessed adverse events, patient visual analogue pain scores and detection rates of clinically significant cancer (defined by University College London (UCL) definitions one and two and separately by the presence of dominant and non-dominant Gleason pattern 4). We secondarily assessed detection of any cancer, rates of detection by MRI (Likert) score and by presenting PSA. Differences were assessed using Chi-squared tests (P<0.05).Results:One hundred eighty-one men with 243 lesions were included. There were no episodes of sepsis or re-admissions and one procedure was abandoned owing to patient discomfort. Twenty-three out of 25 (92%) men would recommend the procedure to another. Median visual analogue pain score was 1.0 (interquartile range: 0.0–2.4). A total 104/181 (57%) had UCL definition 1 disease (Gleason ⩾4+3 and/or maximum cancer length ⩾6 mm) and 129/181 (71%) had UCL definition 2 cancer (Gleason ⩾3+4 and/or maximum cancer length ⩾4 mm). Fifty-four out of 181 (30%) and 124/181 (69%) had dominant and non-dominant pattern 4 disease or greater
Ahmed HU, 2017, Opening our eyes to multiparametric magnetic resonance imaging before prostate biopsy, European Urology, Vol: 73, Pages: 361-362, ISSN: 1421-993X
MacLennan S, Williamson PR, Bekema H, et al., 2017, A core outcome set for localised prostate cancer effectiveness trials., BJU International, Vol: 120, Pages: E64-E79, ISSN: 1464-4096
OBJECTIVE: To develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer. Many treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio; which is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials. PATIENTS, SUBJECTS AND METHODS: A list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 patients with prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs; cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and eight patients. RESULTS: The final COS included 19 outcomes. In all, 12 apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, and sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side-effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere. CONCLUSION: We have established a COS for trials of effectiveness in localised prostate
Donaldson I, Hamid S, Barratt D, et al., 2017, THE SMARTTARGET BIOPSY TRIAL: A PROSPECTIVE PAIRED BLINDED TRIAL WITH RANDOMISATION TO COMPARE VISUAL-ESTIMATION AND IMAGE-FUSION TARGETED PROSTATE BIOPSIES, JOURNAL OF UROLOGY, Vol: 197, Pages: E425-E425, ISSN: 0022-5347
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Hu Y, Kasivisvanathan V, Simmons LAM, et al., 2017, Development and Phantom Validation of a 3-D-Ultrasound-Guided System for Targeting MRI-Visible Lesions During Transrectal Prostate Biopsy, IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, Vol: 64, Pages: 946-958, ISSN: 0018-9294
Olivier J, Kay J, Stravinides V, et al., 2017, USING MP-MRI GUIDED PROSTATE NEEDLE BIOPSY SAMPLES TO IMPROVE PROSTATE CANCER DIAGNOSIS, JOURNAL OF UROLOGY, Vol: 197, Pages: E1270-E1270, ISSN: 0022-5347
Kasivisvanathan V, Nehikhare O, Renshaw S, et al., 2017, A MULTIVARIATE LOGISTIC REGRESSION INVESTIGATING WHICH FACTORS INFLUENCE DETECTION OF CLINICALLY SIGNIFICANT CANCER BY MRI-TARGETED PROSTATE BIOPSY, JOURNAL OF UROLOGY, Vol: 197, Pages: E819-E820, ISSN: 0022-5347
Bass E, Shanmugabavan Y, Hulme A, et al., 2017, INTRA-PROSTATIC PRX302 FOCAL THERAPY IN TREATING CLINICALLY SIGNIFICANT LOW-INTERMEDIATE PROSTATE CANCER: AN OPEN LABEL, PROOF-OF-CONCEPT STUDY, JOURNAL OF UROLOGY, Vol: 197, Pages: E940-E941, ISSN: 0022-5347
Orczyk C, Brew-graves C, Williams N, et al., 2017, PROSTATE RADIOFREQUENCY ABLATION FOCAL TREATMENT (PRORAFT): INTERIM RESULTS OF A PROSPECTIVE DEVELOPMENT STUDY, Annual Meeting of the American-Urological-Association (AUA), Publisher: ELSEVIER SCIENCE INC, Pages: E942-E942, ISSN: 0022-5347
Leslie T, Davies L, Elliott D, et al., 2017, THE PART TRIAL - A PHASE III STUDY COMPARING PARTIAL PROSTATE ABLATION VERSUS RADICAL PROSTATECTOMY (PART) IN INTERMEDIATE RISK PROSTATE CANCER - EARLY DATA FROM THE FEASIBILITY STUDY, JOURNAL OF UROLOGY, Vol: 197, Pages: E1118-E1119, ISSN: 0022-5347
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Orczyk C, Hu YP, Bosaily AE-S, et al., 2017, CORRELATION OF MPMRI CONTOURS WITH 3-DIMENSIONAL 5MM TRANSPERINEAL PROSTATE MAPPING BIOPSY WITHIN THE PROMIS TRIAL PILOT: WHAT MARGINS ARE REQUIRED?, Annual Meeting of the American-Urological-Association (AUA), Publisher: ELSEVIER SCIENCE INC, Pages: E935-E935, ISSN: 0022-5347
Orczyk C, Hu YP, Gibson E, et al., 2017, SHOULD WE AIM FOR THE CENTRE OF AN MRI PROSTATE LESION? CORRELATION BETWEEN MPMRI AND 3-DIMENSIONAL 5MM TRANSPERINEAL PROSTATE MAPPING BIOPSIES FROM THE PROMIS TRIAL, Annual Meeting of the American-Urological-Association (AUA), Publisher: ELSEVIER SCIENCE INC, Pages: E486-E486, ISSN: 0022-5347
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Simmons LAM, Kanthabalan A, Arya M, et al., 2017, The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy, British Journal of Cancer, Vol: 116, Pages: 1159-1165, ISSN: 0007-0920
background: Transrectal prostate biopsy has limited diagnostic accuracy. Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE) was a paired-cohort confirmatory study designed to assess diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in men requiring a repeat biopsy.methods: All underwent 3 T mpMRI and transperineal template prostate mapping biopsies (TTPM biopsies). Multiparametric MRI was reported using Likert scores and radiologists were blinded to initial biopsies. Men were blinded to mpMRI results. Clinically significant prostate cancer was defined as Gleason greater than or equal to4+3 and/or cancer core length greater than or equal to6 mm.results: Two hundred and forty-nine had both tests with mean (s.d.) age was 62 (7) years, median (IQR) PSA 6.8 ng ml (4.98–9.50), median (IQR) number of previous biopsies 1 (1–2) and mean (s.d.) gland size 37 ml (15.5). On TTPM biopsies, 103 (41%) had clinically significant prostate cancer. Two hundred and fourteen (86%) had a positive prostate mpMRI using Likert score greater than or equal to3; sensitivity was 97.1% (95% confidence interval (CI): 92–99), specificity 21.9% (15.5–29.5), negative predictive value (NPV) 91.4% (76.9–98.1) and positive predictive value (PPV) 46.7% (35.2–47.8). One hundred and twenty-nine (51.8%) had a positive mpMRI using Likert score greater than or equal to4; sensitivity was 80.6% (71.6–87.7), specificity 68.5% (60.3–75.9), NPV 83.3% (75.4–89.5) and PPV 64.3% (55.4–72.6).conclusions: In men advised to have a repeat prostate biopsy, prostate mpMRI could be used to safely avoid a repeat biopsy with high sensitivity for clinically significant cancers. However, such a strategy can miss some significant cancers and overdiagnose insignificant cancers depending on the mpMRI score threshold used to define whic
Tay KJ, Scheltema MJ, Ahmed HU, et al., 2017, Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project, Prostate Cancer and Prostatic Diseases, Vol: 20, Pages: 294-299, ISSN: 1365-7852
Background:Whole-gland extirpation or irradiation is considered the gold standard for curative oncological treatment for localized prostate cancer, but is often associated with sexual and urinary impairment that adversely affects quality of life. This has led to increased interest in developing therapies with effective cancer control but less morbidity. We aimed to provide details of physician consensus on patient selection for prostate focal therapy (FT) in the era of contemporary prostate cancer management.Methods:We undertook a four-stage Delphi consensus project among a panel of 47 international experts in prostate FT. Data on three main domains (role of biopsy/imaging, disease and patient factors) were collected in three iterative rounds of online questionnaires and feedback. Consensus was defined as agreement in ⩾80% of physicians. Finally, an in-person meeting was attended by a core group of 16 experts to review the data and formulate the consensus statement.Results:Consensus was obtained in 16 of 18 subdomains. Multiparametric magnetic resonance imaging (mpMRI) is a standard imaging tool for patient selection for FT. In the presence of an mpMRI-suspicious lesion, histological confirmation is necessary prior to FT. In addition, systematic biopsy remains necessary to assess mpMRI-negative areas. However, adequate criteria for systematic biopsy remains indeterminate. FT can be recommended in D’Amico low-/intermediate-risk cancer including Gleason 4+3. Gleason 3+4 cancer, where localized, discrete and of favorable size represents the ideal case for FT. Tumor foci <1.5 ml on mpMRI or <20% of the prostate are suitable for FT, or up to 3 ml or 25% if localized to one hemi-gland. Gleason 3+3 at one core 1mm is acceptable in the untreated area. Preservation of sexual function is an important goal, but lack of erectile function should not exclude a patient from FT.Conclusions:This consensus provides a contemporary insight into expert opinion
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