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000130375 0247_ $$2doi$$a10.1038/pcan.2016.16
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000130375 1001_ $$0P:(DE-He78)79897f8897ff77676549d9895258a0f2$$aRadtke, Jan Philipp$$b0$$eFirst author$$udkfz
000130375 245__ $$aFurther reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance.
000130375 260__ $$aBasingstoke$$bStockton Press$$c2016
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000130375 520__ $$aActive surveillance (AS) is commonly based on standard 10-12-core prostate biopsies, which misclassify ~50% of cases compared with radical prostatectomy. We assessed the value of multiparametric magnetic resonance imaging (mpMRI)-targeted transperineal fusion-biopsies in men under AS.In all, 149 low-risk prostate cancer (PC) patients were included in AS between 2010 and 2015. Forty-five patients were initially diagnosed by combined 24-core systematic transperineal saturation biopsy (SB) and MRI/transurethral ultrasound (TRUS)-fusion targeted lesion biopsy (TB). A total of 104 patients first underwent 12-core TRUS-biopsy. All patients were followed-up by combined SB and TB for restratification after 1 and 2 years. All mpMRI examinations were analyzed using PIRADS. AS was performed according to PRIAS-criteria and a NIH-nomogram for AS-disqualification was investigated. AS-disqualification rates for men initially diagnosed by standard or fusion biopsy were compared using Kaplan-Meier estimates and log-rank tests. Differences in detection rates of the SB and TB components were evaluated with a paired-sample analysis. Regression analyses were performed to predict AS-disqualification.A total of, 48.1% of patients diagnosed by 12-core TRUS-biopsy were disqualified from AS based on the MRI/TRUS-fusion biopsy results. In the initial fusion-biopsy cohort, upgrading occurred significantly less frequently during 2-year follow-up (20%, P<0.001). TBs alone were significantly superior compared with SBs alone to detect Gleason-score-upgrading. NPV for Gleason-upgrading was 93.5% for PIRADS⩽2. PSA level, PSA density, NIH-nomogram, initial PIRADS score (P<0.001 each) and PIRADS-progression on consecutive MRI (P=0.007) were significant predictors of AS-disqualification.Standard TRUS-biopsies lead to significant underestimation of PC under AS. MRI/TRUS-fusion biopsies, and especially the TB component allow more reliable risk classification, leading to a significantly decreased chance of subsequent AS-disqualification. Cancer detection with mpMRI alone is not yet sensitive enough to omit SB on follow-up after initial 12-core TRUS-biopsy. After MRI/TRUS-fusion biopsy confirmed AS, it may be appropriate to biopsy only those men with suspected progression on MRI.
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000130375 7001_ $$0P:(DE-HGF)0$$aKuru, T. H.$$b1
000130375 7001_ $$0P:(DE-He78)ea098e4d78abeb63afaf8c25ec6d6d93$$aBonekamp, D.$$b2$$udkfz
000130375 7001_ $$0P:(DE-He78)c420f6efccb409e1a287be027501a74c$$aFreitag, Martin$$b3$$udkfz
000130375 7001_ $$0P:(DE-HGF)0$$aWolf, M. B.$$b4
000130375 7001_ $$aAlt, C. D.$$b5
000130375 7001_ $$aHatiboglu, G.$$b6
000130375 7001_ $$aBoxler, S.$$b7
000130375 7001_ $$aPahernik, S.$$b8
000130375 7001_ $$0P:(DE-He78)6c54d919bb3371b6d7f277e2c6262a4a$$aRoth, W.$$b9$$udkfz
000130375 7001_ $$0P:(DE-HGF)0$$aRoethke, M. C.$$b10
000130375 7001_ $$0P:(DE-He78)3d04c8fee58c9ab71f62ff80d06b6fec$$aSchlemmer, H. P.$$b11$$udkfz
000130375 7001_ $$aHohenfellner, M.$$b12
000130375 7001_ $$aHadaschik, B. A.$$b13
000130375 773__ $$0PERI:(DE-600)2008886-3$$a10.1038/pcan.2016.16$$gVol. 19, no. 3, p. 283 - 291$$n3$$p283 - 291$$tProstate cancer and prostatic diseases$$v19$$x1476-5608$$y2016
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