학술논문
Transperineal template saturation and conventional biopsy for stage prediction in prostate cancer.
Document Type
Article
Source
Subject
*ENDORECTAL ultrasonography
*PROSTATE cancer
*MAGNETIC resonance imaging
*DECISION making
*BIOPSY
*RADICAL prostatectomy
*LYMPH nodes
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Language
ISSN
1464-4096
Abstract
Objective: To evaluate the performance of risk calculators (RCs) predicting lymph node invasion (LNI) and extraprostatic extension (EPE) in men undergoing transperineal magnetic resonance imaging/transrectal ultrasound (TRUS)‐fusion template saturation biopsy (TTSB) and conventional systematic TRUS‐guided biopsy (SB). Patients and Methods: The RCs were tested in a consecutive cohort of 645 men undergoing radical prostatectomy with extended pelvic LN dissection between 2005 and 2019. TTSB was performed in 230 (35.7%) and SB in 415 (64.3%) men. Risk of LNI and EPE was calculated using the available RCs. Discrimination, calibration, and clinical usefulness stratified by different biopsy techniques were assessed. Results: Lymph node invasion was observed in 23 (10%) and EPE in 73 (31.8%) of cases with TTSB and 53 (12.8%) and 158 (38%) with SB, respectively. RCs showed an excellent discrimination and acceptable calibration for prediction of LNI based on TTSB (area under the curve [AUC]/risk estimation: Memorial Sloan Kettering Cancer Center [MSKCC]‐RC 0.79/−4%, Briganti (2012)‐RC 0.82/−4%, Gandaglia‐RC 0.81/+6%). These were comparable in SB (MSKCC‐RC 0.78/+2%; Briganti (2012)‐RC 0.77/−3%). Decision curve analysis (DCA) revealed a net benefit at threshold probabilities between 3% and 6% when TTSB was used. For prediction of EPE based on TTSB an inferior discrimination and variable calibration were observed (AUC/risk estimation: MSKCC‐RC 0.71/+8% and Martini (2018)‐RC 0.69/+2%) achieving a net benefit on DCA only at risk thresholds of >17%. Performance of RCs for prediction of LNI and EPE based on SB showed comparable results with a better performance in the DCA for LNI (risk thresholds 1–2%) and poorer performance for EPE (risk threshold >20%). This study is limited by its retrospective single‐institution design. Conclusions: The potentially more accurate grading ability of TTSB did not result in improved performance of preoperative RCs. Prediction tools for LNI proved clinical usefulness while RCs for EPE did not. [ABSTRACT FROM AUTHOR]