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Paper Sessions 8 Table of Contents BAUS Annual Meeting, 17–20 BJUI June 2013, Manchester Central Paper Sessions Tuesday 18 June Paper Session A 1400–1530 Charter 1 PROSTATE CANCER DIAGNOSIS Chairs: Professor Martin Gleave & Mr William Cross Papers A1–A9 Wednesday 19 June Paper Session B 1330–1430 Charter 1 GENERAL UROLOGY Chairmen: Mr Peter Malone & Mr Toby Page Papers B1–B7 © 2013 The Authors 8 BJU International © 2013 BJU International | 111, Supplement 3, 8 Papers Abstracts 9 Tuesday 18 June BJUI Paper Session A 1400–1530 Charter 1 PROSTATE CANCER DIAGNOSIS Chairs: Professor Martin Gleave & Mr William Cross Papers A1–A9 A1 We then compared cancer yield in 50 Conclusion : Visualisation of each biopsy 3 D Visualisation of biopsy consecutive cases of positive prostate trajectory signifi cantly increases cancer trajectory and its clinical impact biopsies in the 2D vs. the 3D group (Part 2 detection rates and allows for a more in routine diagnostic TRUS guided of the study) through sampling of the prostate. Not only prostate biopsy Results : Th e results are tabulated as does this have a role in targeted biopsies K Narahari, A Peltier, R Van Velthoven follows but also in routine diagnostic biopsies. University Hospital of Wales, United Kingdom Introduction and Aims : Transrectal ultrasound (TRUS) guided biopsy remains Part 1 the gold standard in prostate cancer Parameter 2D USS * 3D USS *** P value diagnosis however prostate remains n = 110 n = 110 Student ’s t test perhaps the only solid organ where biopsy Age in years 64 (46–90) 65 (46–84) NS is “blind”. Traditionally the surgeon would Mean (Range) prepare a “mental image” of the prostate PSA ng/ml 9 (0.5–70) 10 (0.5–59) NS and target his biopsy cores evenly to map Mean (Range) out the prostate as best as possible. Th is Prostate volume, cc 47 (16–160) 51 (20–145) NS method is not only random but also open Mean (Range) to signifi cant operator bias and no real way DRE positive 33 36 of checking for accuracy. Family history positive 10 13 In contrast, a 3D USS reconstruction of the Cancer detection rate 3450 0.04 prostate allows for visualisation of each biopsy core trajectory ensuring accuracy, *BK Medical systems, *** Sonoace X8, Medison/ Koelis completeness and most importantly brings quality control to the biopsy protocol. Th e aim of our study was to assess the P a r t 2 A2 impact of 3D USS in routine diagnostic Repeat prostate biopsy strategies prostate biopsy and its eff ect on cancer Parameter 2D USS 3D USS P after initial negative biopsy: detection rates. n = 55 n = 55 value meta-regression comparing Methods : We compared a case matched Gleason NS cancer detection of transperineal, cohort of all consecutive patients attending grade transrectal saturation and MRI for diagnostic prostate biopsies before and ≤ 6 61 56 guided biopsy aft er the introduction of the 3D USS 72832 AW Nelson, RC Harvey, RA Parker, A Doble, system (Part 1 of the study). All biopsies ≥ 8 11 12 C Kastner, VJ Gnanapragasam were performed by a single experienced % Of cores 8.6 35.66 0.03 Addenbrooke ’ s Hospital, United Kingdom surgeon using the exactly the same involved standard 16 core biopsy protocol in both Introduction : Th ere is no consensus on cohorts. how to investigate men with negative © 2013 The Authors BJU International © 2013 BJU International | 111, Supplement 3, 9–16 9 10 Papers Abstracts transrectal ultrasound guided prostate A3 A4 biopsy (TRUS-B) but ongoing suspicion of Repeat prostate biopsy after initial Could use of MRI in men referred cancer. Th ree strategies used are benign standard biopsies – for risk of prostate cancer result in transperineal (TP-B), transrectal saturation comparison of 3 advanced a reduction of biopsy related (TS-B) and MRI-guided biopsy (MRI-B). techniques; MRI / TRUS fusion morbidity when compared to the We compared cancer yields of these transperineal, transperineal sector, ERSPC and PCPT risk calculators strategies. extensive transrectal prostate for decision to biopsy? Methods : Systematic literature search biopsies ( MD A nderson protocol) J Dockray, J Coe, V Abu, A Freeman, C Allen, identifi ed studies investigating biopsy RL Lombardo, AC Cantiani, THK Kuru, M Emberton, C Moore Royal Hampshire County Hospital, United diagnostic yield in men with at least one KSB Saeb-Parsy, AN Nelson, BK Koo, VG Gnanapragasam, AW Warren, AD Doble, Kingdom negative TRUS-B and ongoing suspicion of BH Hadaschik, CK Kastner cancer. Age, PSA, number of previous Addenbrooke ’ s Hospital, Cambridge, United Introduction : Th e widespread use of PSA biopsy episodes, number of cores at Kingdom testing has increased referrals for suspected re-biopsy, cancer yield, and Gleason score prostate cancer with numerous strategies of detected cancers were extracted. Introduction : Large cohorts of men are proposed to more accurately predict clini- Meta-regression analyses compared these faced with uncertainty following previous cally signifi cant cancer. We compared the data. benign biopsy with ongoing concern due European Randomised Study of Screening Results : Forty-six studies were included rising PSA or changes suspicious for cancer for Prostate Cancer (ERSPC) and Prostate (4,657 patients). Th ere were no signifi cant in previous biopsies. We compared detec- Cancer Prevention Trial (PCPT) risk calcu- diff erences in PSA or number of previous tion rate of 3 prostate biopsy techniques lators with the use of MRI to aid the biopsy biopsy episodes. Th e mean number of performed in 2 centers: MRI/TRUS fusion decision. biopsy cores obtained by TP-B and TS-B transperineal prostate (MTTP), transperi- Methods : 217 men referred via the ‘2 were signifi cantly greater than MRI-B. neal sector (STP) and extensive transrectal week wait’ pathway were off ered a Cancer detection rates were 29·8%, 35·7%, prostate biopsies (MD Anderson protocol; multi-parametric MRI prior to a discussion and 37·6% for TS-B, TP-B, and MRI-B MDA) regarding biopsy. Th e ERSPC and PCPT respectively. Meta-regression analysis Materials and Methods : 738 patients were risk calculators were applied to compare showed that TP-B and MRI-B had similar identifi ed retrospectively: 201 patients how many patients would have undergone cancer detection but both performed better underwent MTTP biopsies, 188 patients biopsy using a calculator. Th e predicted than TS-B. In a sensitivity analysis STP biopsies and 349 MDA biopsies. biopsy-related morbidity was calculated incorporating previous biopsy episodes (36 Patients undergoing MTTP biopsies had a using data from the ProtecT study (Rosario studies) this was not maintained, resulting multiparametric MRI prior to the biopsy: et al, 2012.) in no diff erence in cancer detection suspicious lesions on MRI were contoured Results : Data for formal risk calculation between the groups. Th ere were no and the image was fused to a live was available for 167 men. Of these, signifi cant diff erences in median Gleason transrectal ultrasound image for guidance 104(52.2%) chose biopsy aft er a discussion scores detected. of lesion biopsies using BiopSeeTM; STP incorporating MR fi ndings into prostate Conclusions : In the re-biopsy setting, it is biopsies were taken dividing the prostate cancer risk assessment. 70/104(67.3%) had not clear which strategy off ers the highest into six sectors for guidance. MDA biopsy cancer, of which 49/70(70%) was clinically cancer detection rate. TP-B and MRI-B involved sampling of peripheral and signifi cant. Use of the PCPT or ERSPC may detect more cancers than TS-B. transition zones as well as standard sextant calculator to inform the biopsy decision MRI-B achieves this with fewer cores than biopsies. Low grade disease was defi ned as would have resulted in 166(99.4%) and ≤ + TP-B. Well–designed prospective cohorts Gleason 7(3 4) and high grade disease 147(88%) of men having a biopsy. ≥ + with standardised outcome measures are as Gleason 7(4 3). Use of MRI to inform the decision to needed to compare these three modalities Results : Th ere was no statistical diff erence biopsy resulted in fewer biopsies than and defi ne an optimum re-biopsy between the groups in relation to mean would have been suggested by either approach. age, mean PSA and mean prostate volume. calculator. Th e mean number of cores for MTTP was Th e reduction in biopsies using an MRI ± ± 27 5 and for STP 34 16. Cancer based approach is predicted to have detection rate in the MTTP group was avoided biopsy-related morbidity by the 107/201(53%), 79/188(42%) in the STP absolute numbers in the table below. group and 106/243(30%) in the MDA group (p = 0.0005). Detection rate of high grade disease was 40/107(37%), 22/106(21%) and 20/79(25%) respectively(p = 0.031). Conclusions : Our data suggests MTTP has a higher cancer detection rate and higher proportion of high grade disease compared to transrectal and transperineal biopsy techniques without MRI guidance. © 2013 The Authors 10 BJU International © 2013 BJU International | 111, Supplement 3, 9–16 Papers Abstracts 11 Table (for A4) Patients & Methods : Patients who underwent anterior lobe prostate biopsies PCPT ERSPC following previous negative standard or Present Moderate/Severe Present Moderate/Severe saturation biopsies and multi-parametric Pain 27.0 4.5 18.7 3.1 MRI scans were identifi ed and their results Fever 10.9 3.4 7.5 2.4 analysed to determine detection rate of Haematuria 40.8 3.8 28.3 2.7 prostate cancer using these techniques. Haematospermia 57.4 16.5 39.8 11.4 Results : 35 patients who had anterior lobe Haematochezia 22.8 1.6 15.8 1.1 prostate biopsies and subsequently underwent multi-parametric MRI scans were identifi ed.
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