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@ARTICLE{Radtke:130375,
      author       = {J. P. Radtke$^*$ and T. H. Kuru$^*$ and D. Bonekamp$^*$ and
                      M. Freitag$^*$ and M. B. Wolf$^*$ and C. D. Alt and G.
                      Hatiboglu and S. Boxler and S. Pahernik and W. Roth$^*$ and
                      M. C. Roethke$^*$ and H. P. Schlemmer$^*$ and M.
                      Hohenfellner and B. A. Hadaschik},
      title        = {{F}urther 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.},
      journal      = {Prostate cancer and prostatic diseases},
      volume       = {19},
      number       = {3},
      issn         = {1476-5608},
      address      = {Basingstoke},
      publisher    = {Stockton Press},
      reportid     = {DKFZ-2017-05454},
      pages        = {283 - 291},
      year         = {2016},
      abstract     = {Active 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.},
      cin          = {E010 / G150},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)G150-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:27184812},
      doi          = {10.1038/pcan.2016.16},
      url          = {https://inrepo02.dkfz.de/record/130375},
}