Prostate biopsy cancer risk profile of the impacts of the method -
By Joanna Lyford first medwireNews Reporter
prostate cancers that are classified as "low risk" based on the classic prostate biopsy and histology are often found to be at higher risk when assessed using the targeted biopsy newer method, US researchers have warned.
The results are important because men suspected of indolent cancers are often managed using active surveillance rather than definitive treatment, potentially allowing aggressive tumors more time to grow and metastasize.
"In men initially diagnosed with cancer at low risk for prostate imaging multiparametric magnetic resonance [mpMRI] Ultrasound Biopsy confirmation, including the targeting of suspicious lesions seen on MRI , resulted in the frequent detection of tumors exceeding the Epstein criteria, "write Leonard Marks and co-authors from the University of California, Los Angeles in the Journal of Urology .
"These data suggest that the Epstein criteria to be reassessed in men enrolled in the active surveillance to take account of inflation risks seen with targeted biopsy of the prostate."
Marks et al identified 113 men with prostate cancer who were enrolled in an active surveillance program because they met in 1994 Epstein histological criteria indolent tumors (Gleason score of 6 or less, 2 or less positive cores and ≤50% of all drivers), and were therefore considered to have a very low risk or low-risk disease.
An average of 10 months after diagnosis, men have been targeted biopsy using mpMRI. This technique assigns a "picture quality" of 1 to 5 areas of interest, with higher scores indicating a higher degree of suspicion. Four cores were taken to the targeted biopsy and 12 cores were taken to the repetition of routine biopsy.
On the confirmation biopsy, 38 men (33.6%) have been found free of prostate cancer, 35 (31.0%) had prostate cancer who met the Epstein criteria and 41 (36.3%) were reclassified as having prostate cancer that exceeded Epstein criteria.
Among the latter group, 26 men (23.0%) have been reclassified due to having a Gleason score of 7 or more, and 15 (13.3%) had a Gleason score 6, but a higher volume of the disease.
The proportion of men who were reclassified after confirmation of biopsy was 27.0% among those with a picture mpMRI year 0-3, 46.9% among grade 4 and at 100% those with grade 5.
Two reference factors predicted subsequent reclassification: mpMRI the 4 picture quality 5 instead of 2 or 3, and 0.10 U increase in antigen density prostate specific, with odds ratios of 3.2 and 2.41, respectively.
Note that the results of standard and new biopsy techniques were consistent only in 50% of cases. targeted biopsy detected cancer in a significant three (3.0%), men considered by systematic biopsy without cancer, while the systematic biopsy detected cancer in a significant 10 (11.0%) men who target the biopsy has found no cancer.
The authors conclude: "The active surveillance criteria need to be reassessed when mpMRI-ultrasound fusion prostate guided biopsy is used"
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