Skip to main content
SpringerLink
Log in

One-Stop MRI and MRI/transrectal ultrasound fusion-guided biopsy: an expedited pathway for prostate cancer diagnosis

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 16 September 2019

Abstract

Purpose

To assess the feasibility, safety, and outcomes of an expedited One-Stop prostate cancer (PCa) diagnostic pathway.

Patients and methods

We identified 370 consecutive patients who underwent multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound fusion prostate biopsy (MRI/TRUS-PBx) from our institutional review board-approved database. Patients were divided according to diagnostic pathway: One-Stop (n = 74), with mpMRI and same-day PBx, or Standard (n = 296), with mpMRI followed by a second visit for PBx. mpMRIs were performed and interpreted according to Prostate Imaging-Reporting and Data System (PI-RADS v2). Grade group ≥ 2 PCa defined clinically significant PCa (csPCa). Statistical significance was considered when p < 0.05.

Results

Age (66 vs 66 years, p = 0.59) and PSA density (0.1 vs 0.1 ng/mL2, p = 0.26) were not different between One-Stop vs Standard pathway, respectively. One-Stop patients lived further away from the hospital than Standard patients (163 vs 31 km; p < 0.01), and experienced shorter time from mpMRI to PBx (0 vs 7 days; p < 0.01). The number (p = 0.56) and distribution of PI-RADS lesions (p = 0.67) were not different between the groups. All procedures were completed successfully with similar perioperative complications rate (p = 0.24). For patients with PI-RADS 3–5 lesions, the csPCa detection rate (49% vs 41%, p = 0.55) was similar for One-Stop vs Standard, respectively. The negative predictive value of mpMRI (PI-RADS 1–2) for csPCa was 78% for One-Stop vs 83% for Standard (p = 0.99). On multivariate analysis, age, prostate volume and PI-RADS score (p < 0.01), but not diagnostic pathway, predicted csPCa detection.

Conclusion

A One-Stop PCa diagnostic pathway is feasible, safe, and provides similar outcomes in a shorter time compared to the Standard two-visit diagnostic pathway.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

AS:

Active surveillance

CI:

Confidence interval

csPCa:

Clinically significant prostate cancer

DCE:

Dynamic contrast-enhanced

DRE:

Digital rectal examination

DWI:

Diffusion-weighted images

IQR:

Interquartile range

ISUP:

International Society of Urological Pathology

mpMRI:

Multiparametric magnetic resonance imaging

MRI/TRUS-PBx:

Magnetic resonance imaging transrectal ultrasound fusion-guided prostate biopsy

NPV:

Negative predictive value

OR:

Odds ratio

PBx:

Prostate biopsy

PCa:

Prostate cancer

PI-RADS v.2:

Prostate Imaging-Reporting and Data System Version 2

PPV:

Positive predictive value

PSA:

Prostatic specific antigen

UTI:

Urinary tract infection

References

  1. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378(19):1767–1777

    Article  Google Scholar 

  2. Singh M, Maheu C, Brady T, Farah R (2017) The psychological impact of the rapid diagnostic centres in cancer screening: a systematic review. Can Oncol Nurs J 27(4):348–355

    Article  Google Scholar 

  3. Berg WT, Danzig MR, Pak JS, Korets R, RoyChoudhury A, Hruby G et al (2015) Delay from biopsy to radical prostatectomy influences the rate of adverse pathologic outcomes. Prostate 75(10):1085–1091

    Article  Google Scholar 

  4. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ et al (2016) PI-RADS prostate imaging-reporting and data system: 2015, version 2. Eur Urol 69(1):16–40

    Article  Google Scholar 

  5. Oishi M, Shin T, Ohe C, Nassiri N, Palmer SL, Aron M, Ashrafi AN, Cacciamani GE, Chen F, Duddalwar V, Stern MC, Ukimura O, Gill IS, Luis de Castro Abreu A (2019) Which patients with negative magnetic resonance imaging can safely avoid biopsy for prostate cancer? J Urol 201(2):268–277. https://doi.org/10.1016/j.juro.2018.08.046

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liss MA, Ehdaie B, Loeb S, Meng MV, Raman JD, Spears V et al (2017) An update of the American Urological Association white paper on the prevention and treatment of the more common complications related to prostate biopsy. J Urol 198(2):329–334

    Article  Google Scholar 

  7. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, The 2014 International Society of Urological Pathology (ISUP) (2016) Consensus conference on gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40(2):244–252

    PubMed  Google Scholar 

  8. Ahmed HU, Bosaily AE-S, Brown LC, Gabe R, Kaplan R, Parmar MK et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389(10071):815–822

    Article  Google Scholar 

  9. Wegelin O, Exterkate L, van der Leest M, Kummer JA, Vreuls W, de Bruin PC, Bosch JLHR, Barentsz JO, Somford DM, van Melick HHE (2019) The FUTURE trial: a multicenter randomised controlled trial on target biopsy techniques based on magnetic resonance imaging in the diagnosis of prostate cancer in patients with prior negative biopsies. Eur Urol 75(4):582–590. https://doi.org/10.1016/j.eururo.2018.11.040

    Article  PubMed  Google Scholar 

  10. Bass EJ, Freeman A, Jameson C, Punwani S, Moore CM, Arya M et al (2018) Prostate cancer diagnostic pathway: is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK. BMJ Open 8(10):e024941

    Article  Google Scholar 

  11. Oberlin DT, Casalino DD, Miller FH, Meeks JJ (2017) Dramatic increase in the utilization of multiparametric magnetic resonance imaging for detection and management of prostate cancer. Abdom Radiol (N Y) 42(4):1255–1258

    Article  Google Scholar 

  12. Fossati N, Rossi MS, Cucchiara V, Gandaglia G, Dell'Oglio P, Moschini M, Suardi N, Dehò F, Montorsi F, Schiavina R, Mottrie A, Briganti A (2017) Evaluating the effect of time from prostate cancer diagnosis to radical prostatectomy on cancer control: can surgery be postponed safely? Urol Oncol 35(4):150.e9–150.e15. https://doi.org/10.1016/j.urolonc.2016.11.010

    Article  Google Scholar 

  13. Korets R, Seager CM, Pitman MS, Hruby GW, Benson MC, McKiernan JM (2012) Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis. BJU Int 110(2):211–216

    Article  Google Scholar 

  14. Morini MA, Muller RL, de Castro Junior PCB, de Souza RJ, Faria EF (2018) Time between diagnosis and surgical treatment on pathological and clinical outcomes in prostate cancer: does it matter? World J Urol 36(8):1225–1231

    Article  Google Scholar 

  15. Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S et al (2014) Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open 4(3):e003901

    Article  Google Scholar 

  16. Jiang P, Liss MA, Szabo RJ (2018) Targeted antimicrobial prophylaxis does not always prevent sepsis after transrectal prostate biopsy. J Urol 200(2):361–368

    Article  Google Scholar 

  17. Xiang J, Yan H, Li J, Wang X, Chen H, Zheng X (2019) Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis. World J Surg Oncol 17(1):31

    Article  Google Scholar 

  18. Grummet JP, Weerakoon M, Huang S, Lawrentschuk N, Frydenberg M, Moon DA et al (2014) Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy? BJU Int 114(3):384–388

    PubMed  Google Scholar 

  19. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R et al (2013) Systematic review of complications of prostate biopsy. Eur Urol 64(6):876–892

    Article  Google Scholar 

  20. Borghesi M, Ahmed H, Nam R, Schaeffer E, Schiavina R, Taneja S et al (2017) Complications after systematic, random, and image-guided prostate biopsy. Eur Urol 71(3):353–365

    Article  Google Scholar 

  21. Pinkhasov GI, Lin YK, Palmerola R, Smith P, Mahon F, Kaag MG et al (2012) Complications following prostate needle biopsy requiring hospital admission or emergency department visits—experience from 1000 consecutive cases. BJU Int 110(3):369–374

    Article  Google Scholar 

  22. Nilbert M, Bläckberg M, Ceberg J, Hagberg O, Stenhoff R, Liedberg F (2018) Diagnostic pathway efficacy for urinary tract cancer: population-based outcome of standardized evaluation for macroscopic haematuria. Scand J Urol 52(4):237–243. https://doi.org/10.1080/21681805.2018.1498124

    Article  CAS  PubMed  Google Scholar 

  23. Safir IJ, Gabale S, David SA, Huang JH, Gerhard RS, Pearl J et al (2016) Implementation of a tele-urology program for outpatient hematuria referrals: initial results and patient satisfaction. Urology 97:33–39

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by the R01 Grant CA205058-01 from the National Institutes of Health/National Cancer Institute (M. C. S, I. S. G. and A. L. D. C. A.) and in part by the Australasian Urological Foundation Scholarship (A. N. A).

Author information

Author notes

  1. Alessandro Tafuri and Akbar N. Ashrafi contributed equally to this manuscript.

Authors and Affiliations

  1. USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Alessandro Tafuri, Akbar N. Ashrafi, Aliasger Shakir, Giovanni E. Cacciamani, Atsuko Iwata, Tsuyoshi Iwata, Jie Cai, Akash Sali, Chhavi Gupta, Luis G. Medina, Mariana C. Stern, Inderbir S. Gill & Andre Abreu

  2. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Alessandro Tafuri

  3. Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Suzanne Palmer & Vinay Duddalwar

  4. Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Akash Sali, Chhavi Gupta & Manju Aron

  5. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Mariana C. Stern

  6. USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA

    Andre Abreu

Authors
  1. Alessandro Tafuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akbar N. Ashrafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suzanne Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aliasger Shakir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni E. Cacciamani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsuko Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tsuyoshi Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jie Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akash Sali
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chhavi Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Luis G. Medina
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mariana C. Stern
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Vinay Duddalwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Manju Aron
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Inderbir S. Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Andre Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AA, AT, ANA, SP: project development, analysis interpretation, manuscript writing. AS: data collection, manuscript writing and language revision. JC: statistical analysis. AI, TI, AS, CG, LGM: data collection. GEC: data collection and analysis interpretation. MCS, VD, MA, ISG: other (supervision and critical revision).

Corresponding author

Correspondence to Andre Abreu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. This study was funded by the R01 Grant CA205058-01 from the National Institutes of Health/National Cancer Institute (M. C. S, I. S. G. and A. A.) and in part by the Australasian Urological Foundation Scholarship (A. N. A). Dr. Vinay Duddalwar is a consultant for Intuitive Surgical and Radmetrix, sits on the advisory board for DeepTek, and received grant support from Samsung Healthcare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tafuri, A., Ashrafi, A.N., Palmer, S. et al. One-Stop MRI and MRI/transrectal ultrasound fusion-guided biopsy: an expedited pathway for prostate cancer diagnosis. World J Urol 38, 949–956 (2020). https://doi.org/10.1007/s00345-019-02835-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-02835-2

Keywords

Search

Navigation