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Ristau BT, Chen DY, Ellis J, Malhotra A, DeMora L, Parsons RB, Milestone B, Brody M, Viterbo R, Greenberg R, Smaldone M, Uzzo R, Anaokar J, Kutikov A
Defining Novel and Practical Metrics to Assess the Deliverables of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy
J Urol (2018) 199:969-975.
PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 371 men were included. AIM and ReM were 22.2% and 83.6% for biopsy naive, 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. CONCLUSIONS: AIM and ReM are novel, clinically relevant quantification metrics to standardize reporting of TB deliverables. TB affords actionable information (AIM) in approximately 25% of men. ReM assessment highlights that TRUS-B may only be omitted after carefully considering the risk of missing clinically significant cancers.
Publication Date: 2018-10-05.
Last updated on Wednesday, May 02, 2018