“The use of multi-parametric magnetic resonance imaging (mpMRI) could help avoid a repeat prostate biopsy in some men, according to a new study. The imaging test has a high sensitivity for clinically significant cancers, but could miss some and overdiagnose insignificant cancers as well.
” ‘The prostate cancer diagnostic pathway is very different to that of almost all other solid organ cancers, in that it is calibrated to detect subclinical disease but often misses clinically important disease,’ wrote study authors led by Lucy A. M. Simmons, MBBS, MRCS, of University College London. That imprecision arises from the use of transrectal ultrasound-guided (TRUS) biopsy, which is considered standard in men with elevated prostate-specific antigen (PSA) levels.”
“Incorporating scores from two urine-based biomarker assays may reduce the number of biopsies men with clinically localized prostate cancer need to undergo without greatly affecting 10-year survival rates, according to the results of a decision analysis.
“ ‘Results from recent studies have demonstrated the potential clinical utility of the urine-based PROGENSA prostate cancer antigen 3 (PCA3) assay (Gen-Probe, Inc.) to predict repeat biopsy outcomes in men with elevated serum PSA levels and previous negative biopsy findings,’ Brian T. Denton, PhD, associate professor of industrial and operations engineering at University of Michigan, and colleagues wrote. ‘A recent literature review reported current evidence suggesting that the PCA3 test is clinically useful for selecting which patients should undergo repeat biopsy. Several studies have determined that urine assessment of [T2:ERG] is also associated with biopsy outcome and may be better at discriminating between low-grade and high-grade cancers.‘ “
“Denton and colleagues performed a decision analysis using a decision tree to evaluate the clinical value of using PCA3 and T2:ERG scores to determine the need for repeat biopsy in men with clinically localized prostate cancer who had at least one prior negative biopsy. Researchers estimated the probability for cancer by using the Prostate Cancer Prevention Trial Risk Calculator.”
“Among a group of men with an initial negative prostate biopsy, clinically significant cancer is still found in subsequent repeat sampling rounds, according to a study published in the April issue of The Journal of Urology.
“Nitya E. Abraham, M.D., from the New York University School of Medicine in New York City, and colleagues collected data on 1,837 men who underwent prostate biopsy (Jan. 1, 1995, to Jan. 1, 2010). The authors sought to determine characteristics of repeat biopsy (indication for biopsy, the number of repeat biopsies performed, the number of cores obtained, and total prostate-specific antigen before biopsy), as well as features of prostate cancer diagnosed on repeat biopsy (including Gleason score, number of positive cores, percent of tumor and treatment choice).
“The researchers found that 1,213 men had negative initial biopsies, but that 798 repeat biopsies were performed in 255 men. Gleason score was ≤6 in 33 of 63 men diagnosed with prostate cancer, 7 in 22, and 8 to 9 in eight. Using Epstein criteria, the rate of clinically insignificant cancer diagnosis decreased substantially by the third and fourth repeat biopsies. An increased likelihood of prostate cancer diagnosis was seen in men ≥70 years with repeat biopsies, biopsies including more than 20 cores, and the fourth repeat biopsy.”
“Prostate cancer is the second leading cause of cancer death in men in the United States. Active surveillance offers low-risk prostate cancer patients a means to avoid the potentially harmful side effects from treatment. Pathologists help determine patient eligibility for active surveillance and today a multi-specialty team published their recommendations for making such determinations in a special on-line posting from the Archives of Pathology & Laboratory Medicine.
“With active surveillance, patients undergo regular visits with prostate-specific antigen (PSA) tests and repeated prostate biopsies rather than aggressive treatment. It is distinguished from watchful waiting, in which treatment for localized disease is withheld and palliative treatment for systemic disease is initiated.
” ‘Active surveillance is an important management option for men with low-risk prostate cancer,’ says lead author Mahul Amin, MD, FCAP, Chair, Department of Pathology Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. ‘Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance.'”
“A commercial test designed to rule out the presence of genetic biomarkers of prostate cancer may be accurate enough to exclude the need for repeat prostate biopsies in many — if not most — men, a new article reports. ‘Often, one biopsy is not enough to definitively rule out prostate cancer, says a study researcher. ‘Our research finds that by looking for the presence or absence of cancer in a different way, we may be able to offer many men peace of mind without putting them through the pain, bleeding and risk of infection that can come with a repeat biopsy.’ “