2122 can transperineal mapping template prostate biopsy adequately predict prostate cancer localization?

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112122 CAN TRANSPERINEAL MAPPING TEMPLATE PROSTATE BIOPSY ADEQUATELY PREDICT PROSTATE CANCER LOCALIZATION? George R. Schade, Priya Kunju, Chang He, Tudor Borza, Jason Caravalo, Stephanie Meyers, John T. Wei, and David P. Wood George R. SchadeGeorge R. Schade Ann Arbor, MI More articles by this author , Priya KunjuPriya Kunju Ann Arbor, MI More articles by this author , Chang HeChang He Ann Arbor, MI More articles by this author , Tudor BorzaTudor Borza Ann Arbor, MI More articles by this author , Jason CaravaloJason Caravalo Ann Arbor, MI More articles by this author , Stephanie MeyersStephanie Meyers Ann Arbor, MI More articles by this author , John T. WeiJohn T. Wei Ann Arbor, MI More articles by this author , and David P. WoodDavid P. Wood Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2319AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Evidence suggests transperineal mapping template prostate biopsy (TMTPB) changes focal therapy strategies in greater than 65 percent of patients following extended pattern 12 core prostate biopsy due to increased detection of multifocal tumors. However, the ability of TMTPB to adequately localize prostate cancer (CaP) to guide focal therapy is unknown. METHODS Pathologic analysis of 22 patients who underwent TMTPB and subsequent radical prostatectomy (RP) for CaP from 1/2005 – 8/2010 was undertaken. Biopsy and RP tumor data were stratified by laterality, site and lesion size. Positive predictive value (PPV) and negative predictive value (NPV) was used to determine the ability of TMTPB to localize ‘all lesions' and ‘index lesions', defined as the dominant tumor on prostatectomy. RESULTS Patients had a mean prostate volume of 47.3 ± 20.8 cc, with 4.6 ± 3 positive cores out of a total of 58 ± 8.6 TMTPB cores. RRP revealed 4/22 (18.2%) patients had unilateral and 3/22 (13.6%) patients had unifocal disease. Highest biopsy Gleason grade predicted RRP Gleason grade in 14/22 (63.6%) patients. Overall, 40/79 (50.6%) evaluable lesions and all index lesions were detected by TMTPB. Detection rate was significantly different for lesions >8 mm vs 3–8 mm vs <3 mm (95.8% vs 48% vs 16.7%, p<0.0001). When bisecting the prostate into left and right, positive (PPV) and negative (NPV) predictive values were 1.0 and 0.4 for all cancerous lesions and 0.92 and 0.73 for index lesions (see Table 1). Table 1. TMTPB Biopsy Results Detection Rate: Lesion Size >8mm 3–8mm <3mm Number 24 25 30 Detection Rate: 95.8% 48.0% 16.7% p<0.0001 Tumor Localization Sensitivity Specificity PPV NPV All Tumors Left vs Right 0.85 1.00 1.00 0.40 Index Tumors Left vs Right 0.85 0.85 0.92 0.73 CONCLUSIONS Although all index lesions were identified using TMTPB, detection of multifocal tumors is dependent on size. The ability to localize all prostate cancer lesions was limited by a low NPV. Relatively high predictive values are possible when considering only the index lesion, particularly in regards to hemi-ablation, but an acceptable rate of false negative testing remains debatable. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e849 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information George R. Schade Ann Arbor, MI More articles by this author Priya Kunju Ann Arbor, MI More articles by this author Chang He Ann Arbor, MI More articles by this author Tudor Borza Ann Arbor, MI More articles by this author Jason Caravalo Ann Arbor, MI More articles by this author Stephanie Meyers Ann Arbor, MI More articles by this author John T. Wei Ann Arbor, MI More articles by this author David P. Wood Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...