Reclassification Rates of Patients Eligible for Active Surveillance After the Addition of Magnetic Resonance Imaging-Ultrasound Fusion Biopsy: An Analysis of 7 Widely Used Eligibility Criteria

Bruno Nahar, Andrew Katims, Marcelo Panizzutti Barboza, Nachiketh Soodana Prakash, Vivek Venkatramani, Bruce Kava, Ramgopal Satyanarayana, Mark L. Gonzalgo, Chad R. Ritch, Dipen J. Parekh, Sanoj Punnen

Research output: Contribution to journalArticle

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Abstract

Objectives: To evaluate the impact of adding magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy cores to standard 12-core biopsy in selecting men for active surveillance (AS). Materials and Methods: Among men undergoing a fusion biopsy for evaluation of prostate cancer, we selected men who were eligible for at least 1 of 7 different AS criteria based on the standard biopsy alone. We assessed each patient's eligibility for each AS criterion with and without the inclusion of fusion biopsy cores. The primary end point was the proportion of men who were initially eligible for AS but became ineligible after addition of the fusion biopsy cores. Results: A total of 100 men were eligible for at least 1 AS criterion. After addition of fusion biopsy cores, the proportion of men who became ineligible for AS varied from 10.3% to 40.7%. Criteria that incorporated an absolute maximum number of cores positive had the highest rates of ineligibility. Using a percentage of cores positive helped to reduce the number of patients who would have been excluded. Combining the targeted biopsy cores into one, or taking the single core with the highest grade or volume did not appear to reduce the proportion of men who became ineligible. Conclusions: The addition of fusion biopsy to standard 12-core biopsy significantly increased the number of men who became ineligible for AS. Using the percent of cores positive, instead of an absolute number, allowed fewer exclusions. AS criteria may need to be updated to prevent the unnecessary exclusion of men due to an oversampling of low-risk disease.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - 2017
Externally publishedYes

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Magnetic Resonance Imaging
Biopsy
Prostatic Neoplasms

ASJC Scopus subject areas

  • Urology

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Reclassification Rates of Patients Eligible for Active Surveillance After the Addition of Magnetic Resonance Imaging-Ultrasound Fusion Biopsy : An Analysis of 7 Widely Used Eligibility Criteria. / Nahar, Bruno; Katims, Andrew; Barboza, Marcelo Panizzutti; Soodana Prakash, Nachiketh; Venkatramani, Vivek; Kava, Bruce; Satyanarayana, Ramgopal; Gonzalgo, Mark L.; Ritch, Chad R.; Parekh, Dipen J.; Punnen, Sanoj.

In: Urology, 2017.

Research output: Contribution to journalArticle

Nahar, Bruno ; Katims, Andrew ; Barboza, Marcelo Panizzutti ; Soodana Prakash, Nachiketh ; Venkatramani, Vivek ; Kava, Bruce ; Satyanarayana, Ramgopal ; Gonzalgo, Mark L. ; Ritch, Chad R. ; Parekh, Dipen J. ; Punnen, Sanoj. / Reclassification Rates of Patients Eligible for Active Surveillance After the Addition of Magnetic Resonance Imaging-Ultrasound Fusion Biopsy : An Analysis of 7 Widely Used Eligibility Criteria. In: Urology. 2017.
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title = "Reclassification Rates of Patients Eligible for Active Surveillance After the Addition of Magnetic Resonance Imaging-Ultrasound Fusion Biopsy: An Analysis of 7 Widely Used Eligibility Criteria",
abstract = "Objectives: To evaluate the impact of adding magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy cores to standard 12-core biopsy in selecting men for active surveillance (AS). Materials and Methods: Among men undergoing a fusion biopsy for evaluation of prostate cancer, we selected men who were eligible for at least 1 of 7 different AS criteria based on the standard biopsy alone. We assessed each patient's eligibility for each AS criterion with and without the inclusion of fusion biopsy cores. The primary end point was the proportion of men who were initially eligible for AS but became ineligible after addition of the fusion biopsy cores. Results: A total of 100 men were eligible for at least 1 AS criterion. After addition of fusion biopsy cores, the proportion of men who became ineligible for AS varied from 10.3{\%} to 40.7{\%}. Criteria that incorporated an absolute maximum number of cores positive had the highest rates of ineligibility. Using a percentage of cores positive helped to reduce the number of patients who would have been excluded. Combining the targeted biopsy cores into one, or taking the single core with the highest grade or volume did not appear to reduce the proportion of men who became ineligible. Conclusions: The addition of fusion biopsy to standard 12-core biopsy significantly increased the number of men who became ineligible for AS. Using the percent of cores positive, instead of an absolute number, allowed fewer exclusions. AS criteria may need to be updated to prevent the unnecessary exclusion of men due to an oversampling of low-risk disease.",
author = "Bruno Nahar and Andrew Katims and Barboza, {Marcelo Panizzutti} and {Soodana Prakash}, Nachiketh and Vivek Venkatramani and Bruce Kava and Ramgopal Satyanarayana and Gonzalgo, {Mark L.} and Ritch, {Chad R.} and Parekh, {Dipen J.} and Sanoj Punnen",
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T2 - An Analysis of 7 Widely Used Eligibility Criteria

AU - Nahar, Bruno

AU - Katims, Andrew

AU - Barboza, Marcelo Panizzutti

AU - Soodana Prakash, Nachiketh

AU - Venkatramani, Vivek

AU - Kava, Bruce

AU - Satyanarayana, Ramgopal

AU - Gonzalgo, Mark L.

AU - Ritch, Chad R.

AU - Parekh, Dipen J.

AU - Punnen, Sanoj

PY - 2017

Y1 - 2017

N2 - Objectives: To evaluate the impact of adding magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy cores to standard 12-core biopsy in selecting men for active surveillance (AS). Materials and Methods: Among men undergoing a fusion biopsy for evaluation of prostate cancer, we selected men who were eligible for at least 1 of 7 different AS criteria based on the standard biopsy alone. We assessed each patient's eligibility for each AS criterion with and without the inclusion of fusion biopsy cores. The primary end point was the proportion of men who were initially eligible for AS but became ineligible after addition of the fusion biopsy cores. Results: A total of 100 men were eligible for at least 1 AS criterion. After addition of fusion biopsy cores, the proportion of men who became ineligible for AS varied from 10.3% to 40.7%. Criteria that incorporated an absolute maximum number of cores positive had the highest rates of ineligibility. Using a percentage of cores positive helped to reduce the number of patients who would have been excluded. Combining the targeted biopsy cores into one, or taking the single core with the highest grade or volume did not appear to reduce the proportion of men who became ineligible. Conclusions: The addition of fusion biopsy to standard 12-core biopsy significantly increased the number of men who became ineligible for AS. Using the percent of cores positive, instead of an absolute number, allowed fewer exclusions. AS criteria may need to be updated to prevent the unnecessary exclusion of men due to an oversampling of low-risk disease.

AB - Objectives: To evaluate the impact of adding magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy cores to standard 12-core biopsy in selecting men for active surveillance (AS). Materials and Methods: Among men undergoing a fusion biopsy for evaluation of prostate cancer, we selected men who were eligible for at least 1 of 7 different AS criteria based on the standard biopsy alone. We assessed each patient's eligibility for each AS criterion with and without the inclusion of fusion biopsy cores. The primary end point was the proportion of men who were initially eligible for AS but became ineligible after addition of the fusion biopsy cores. Results: A total of 100 men were eligible for at least 1 AS criterion. After addition of fusion biopsy cores, the proportion of men who became ineligible for AS varied from 10.3% to 40.7%. Criteria that incorporated an absolute maximum number of cores positive had the highest rates of ineligibility. Using a percentage of cores positive helped to reduce the number of patients who would have been excluded. Combining the targeted biopsy cores into one, or taking the single core with the highest grade or volume did not appear to reduce the proportion of men who became ineligible. Conclusions: The addition of fusion biopsy to standard 12-core biopsy significantly increased the number of men who became ineligible for AS. Using the percent of cores positive, instead of an absolute number, allowed fewer exclusions. AS criteria may need to be updated to prevent the unnecessary exclusion of men due to an oversampling of low-risk disease.

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