Systematic and mri-targeted biopsy strategies for the detection of radiorecurrent prostate cancer: an analysis from the focal recurrent assessment and salvage treatment (forecast) trial

You have accessJournal of UrologyCME1 Apr 2023MP44-02 SYSTEMATIC AND MRI-TARGETED BIOPSY STRATEGIES FOR THE DETECTION OF RADIORECURRENT PROSTATE CANCER: AN ANALYSIS FROM THE FOCAL RECURRENT ASSESSMENT AND SALVAGE TREATMENT (FORECAST) TRIAL Alexander Light, Abi Kanthabalan, Menelaos Pavlou, Rumana Omar, Sola Adeleke, Francesco Giganti, Chris Brew-Graves, Amr Emara, Athar Haroon, Arash Latifoltojar, Harbir Sidhu, Alex Freeman, Ashok Nikapota, Tim Dudderidge, Richard G. Hindley, Heather Payne, Anita Mitra, Jamshed Bomanji, Mathias Winkler, Gail Horan, Shonit Punwani, Hashim U. Ahmed, and Taimur T. Shah Alexander LightAlexander Light More articles by this author , Abi KanthabalanAbi Kanthabalan More articles by this author , Menelaos PavlouMenelaos Pavlou More articles by this author , Rumana OmarRumana Omar More articles by this author , Sola AdelekeSola Adeleke More articles by this author , Francesco GigantiFrancesco Giganti More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , Amr EmaraAmr Emara More articles by this author , Athar HaroonAthar Haroon More articles by this author , Arash LatifoltojarArash Latifoltojar More articles by this author , Harbir SidhuHarbir Sidhu More articles by this author , Alex FreemanAlex Freeman More articles by this author , Ashok NikapotaAshok Nikapota More articles by this author , Tim DudderidgeTim Dudderidge More articles by this author , Richard G. HindleyRichard G. Hindley More articles by this author , Heather PayneHeather Payne More articles by this author , Anita MitraAnita Mitra More articles by this author , Jamshed BomanjiJamshed Bomanji More articles by this author , Mathias WinklerMathias Winkler More articles by this author , Gail HoranGail Horan More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Hashim U. AhmedHashim U. Ahmed More articles by this author , and Taimur T. ShahTaimur T. Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Planning salvage focal therapy for radiorecurrent prostate cancer requires localization of any intra-prostatic disease. Whilst saturation biopsies maximize cancer detection, they increase operative time and morbidity. Using the paired validation FORECAST trial, we tested 5 alternative biopsy strategies. Here, men with radiorecurrence underwent multiparametric MRI followed by transperineal template mapping (TPM) and MRI-targeted biopsies (MRI-TB). METHODS: FORECAST (NCT01883128) enrolled 181 men from 6 UK centers. The prostate was divided into quadrants (right/left; posterior/anterior). Strategies evaluated were: 1) MRI-TB only; 2) MRI-TB and systematic biopsy of the other ipsilateral quadrant; 3) MRI-TB and systematic biopsy of the contralateral posterior quadrant; 4) MRI-TB and systematic biopsy of the other ipsilateral and contralateral posterior quadrants; 5) MRI-TB and contralateral hemi-gland systematic biopsy. The number of missed cancers per strategy was compared against whole-gland MRI-TB and TPM biopsy. RESULTS: 84 men underwent MRI-TB and TPM biopsy, and 73 (87%) had recurrent cancer. Strategy 1 missed 6 cancers (8%). Strategies 4 and 5 missed 2 (3%) and 3 (4%) cancers, respectively, not significantly different to strategy 1 (p=0.3 and 0.5, respectively). Strategies 2 and 3 missed 2 (3%) and 5 (7%) cancers. For cancer defined as Grade Group (GG) ≥2 and/or maximum cancer core length (MCCL) ≥4mm (n=73), strategy 1 missed 9 cancers (12%), and strategies 4 and 5 missed 2 (3%) and 4 (5%) cancers, respectively (p=0.06 and 0.7, respectively). Strategies 2 and 3 missed 3 (4%) and 7 (10%) cancers, respectively. For cancer defined as GG ≥3 and/or MCCL ≥6mm (n=67), strategy 1 missed significantly more cancers (8, 12%) than strategy 4 (1, 1%; p=0.03) but not strategy 5 (4, 6%; p=0.4). Strategies 2 and 3 missed 3 (4%) and 6 (9%) cancers, respectively. CONCLUSIONS: Strategies 2-5, which systematically sampled additional quadrants outside of the MRI target did not significantly increase cancer detection of any definition compared to MRI-TB alone, which missed <10% of recurrent cancer. However, for cancer defined as GG ≥3 and/or MCCL ≥6mm, MRI-TB alone missed significantly more cancer than strategy 3. Depending on cancer definition, it may therefore be possible to omit whole gland biopsy for shorter biopsy protocols whilst maintaining high diagnostic yield. Source of Funding: Funded by the Pelican Cancer Foundation, the US National Institutes of Health, and the UK Medical Research Council © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e610 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Light More articles by this author Abi Kanthabalan More articles by this author Menelaos Pavlou More articles by this author Rumana Omar More articles by this author Sola Adeleke More articles by this author Francesco Giganti More articles by this author Chris Brew-Graves More articles by this author Amr Emara More articles by this author Athar Haroon More articles by this author Arash Latifoltojar More articles by this author Harbir Sidhu More articles by this author Alex Freeman More articles by this author Ashok Nikapota More articles by this author Tim Dudderidge More articles by this author Richard G. Hindley More articles by this author Heather Payne More articles by this author Anita Mitra More articles by this author Jamshed Bomanji More articles by this author Mathias Winkler More articles by this author Gail Horan More articles by this author Shonit Punwani More articles by this author Hashim U. Ahmed More articles by this author Taimur T. Shah More articles by this author Expand All Advertisement PDF downloadLoading ...