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| 024 | 7 | _ | |a 10.1038/pcan.2016.16 |2 doi |
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| 100 | 1 | _ | |a Radtke, Jan Philipp |0 P:(DE-He78)79897f8897ff77676549d9895258a0f2 |b 0 |e First author |u dkfz |
| 245 | _ | _ | |a Further 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. |
| 260 | _ | _ | |a Basingstoke |c 2016 |b Stockton Press |
| 336 | 7 | _ | |a article |2 DRIVER |
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| 336 | 7 | _ | |a Journal Article |b journal |m journal |0 PUB:(DE-HGF)16 |s 1525696345_2126 |2 PUB:(DE-HGF) |
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| 520 | _ | _ | |a 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 PIRADSā©½2. 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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| 700 | 1 | _ | |a Kuru, T. H. |0 P:(DE-HGF)0 |b 1 |
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| 700 | 1 | _ | |a Freitag, Martin |0 P:(DE-He78)c420f6efccb409e1a287be027501a74c |b 3 |u dkfz |
| 700 | 1 | _ | |a Wolf, M. B. |0 P:(DE-HGF)0 |b 4 |
| 700 | 1 | _ | |a Alt, C. D. |b 5 |
| 700 | 1 | _ | |a Hatiboglu, G. |b 6 |
| 700 | 1 | _ | |a Boxler, S. |b 7 |
| 700 | 1 | _ | |a Pahernik, S. |b 8 |
| 700 | 1 | _ | |a Roth, W. |0 P:(DE-He78)6c54d919bb3371b6d7f277e2c6262a4a |b 9 |u dkfz |
| 700 | 1 | _ | |a Roethke, M. C. |0 P:(DE-HGF)0 |b 10 |
| 700 | 1 | _ | |a Schlemmer, H. P. |0 P:(DE-He78)3d04c8fee58c9ab71f62ff80d06b6fec |b 11 |u dkfz |
| 700 | 1 | _ | |a Hohenfellner, M. |b 12 |
| 700 | 1 | _ | |a Hadaschik, B. A. |b 13 |
| 773 | _ | _ | |a 10.1038/pcan.2016.16 |g Vol. 19, no. 3, p. 283 - 291 |0 PERI:(DE-600)2008886-3 |n 3 |p 283 - 291 |t Prostate cancer and prostatic diseases |v 19 |y 2016 |x 1476-5608 |
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