Endorectal power Doppler/grayscale ultrasound‑guided biopsies vs. multiparametric MRI/ultrasound fusion‑guided biopsies 
in males with high risk of prostate cancer: A prospective cohort study

He,Zhizhong; Yuan,Zhifan; Liang,Limei; Xie,Xinx  In; Yuan,Jianjun; He,Wenxu; Chen,Junjun; Kuang,Yongpei

doi:10.3892/etm.2019.8151

Endorectal power Doppler/grayscale ultrasound‑guided biopsies vs. multiparametric MRI/ultrasound fusion‑guided biopsies in males with high risk of prostate cancer: A prospective cohort study

Authors:
- Zhizhong He
- Zhifan Yuan
- Limei Liang
- Xinx In Xie
- Jianjun Yuan
- Wenxu He
- Junjun Chen
- Yongpei Kuang
View Affiliations

Affiliations: Department of Ultrasound, Dongguan People's Hospital Affiliated to Southern Medical University, Dongguan, Guangdong 523000, P.R. China, Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
Published online on: October 31, 2019 https://doi.org/10.3892/etm.2019.8151
Pages: 4765-4773
Copyright: © He et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Multiparametric MRI fusion with transrectal ultrasound (mpMRI/TRUS)‑guided biopsy has the sensitivity of mpMRI with the practicality of TRUS, but males with no cancerous lesion(s) detected on mpMRI have a considerable remaining risk of cancer. Endorectal power Doppler ultrasound improves the sensitivity of grayscale ultrasound‑guided biopsies. The objective of the present study was to evaluate the beneficial effect of endorectal power Doppler/grayscale ultrasound‑guided biopsy over that of mpMRI/TRUS‑guided biopsy for decision‑making regarding prostatectomy in males with a high risk of prostate cancer. Data regarding endorectal power Doppler/grayscale ultrasound‑guided biopsies and mpMRI/TRUS‑guided biopsies of 1,094 males with elevated specific prostate antigen, were included. Radical prostatectomy was performed in males aged <70 years with Gleason scores ≥3+4 in any one of the biopsy reports. The histopathological data of the surgical specimen of 776 males were included in the analysis. Compared to the histopathology of the surgical specimen, endorectal power Doppler/grayscale ultrasound‑guided biopsies had a lower sensitivity (0.930 vs. 1.000; P<0.0001) but mpMRI/TRUS‑guided biopsies had the same sensitivity (0.990 vs. 1.000; P=0.02). The accuracy of mpMRI/TRUS‑guided biopsies was higher than that of endorectal power Doppler/grayscale ultrasound‑guided biopsies (0.944 vs. 0.783). On mpMRI, lesions of 105 subjects (10%) with a Likert scale score of <3 were identified. Among them, 14 subjects (2%) had Gleason scores of ≥3+4 as determined by endorectal power Doppler/grayscale ultrasound‑guided biopsies. In addition, 20 (2%) false‑positive lesions compared to the histopathological analysis of the surgical specimen were identified from mpMRI/TRUS‑guided biopsies. In conclusion, mpMRI/TRUS‑guided biopsy was indicated to have a moderate performance and endorectal power Doppler/grayscale ultrasound‑guided biopsy had a scant performance for decision‑making regarding prostatectomy.

View Figures

View References

1	Egidi MG, Cochetti G, Serva MR, Guelfi G, Zampini D, Mechelli L and Mearini E: Circulating microRNAs and kallikreins before and after radical prostatectomy: Are they really prostate cancer markers? Biomed Res Int. 2013:2417802013. View Article : Google Scholar : PubMed/NCBI
2	Pan J, Xue W, Sha J, Yang H, Xu F, Xuan H, Li D and Huang Y: Incidental prostate cancer at the time of cystectomy: The incidence and clinicopathological features in Chinese patients. PLoS One. 9:e944902014. View Article : Google Scholar : PubMed/NCBI
3	Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D and Bray F: Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 136:E359–E386. 2015. View Article : Google Scholar : PubMed/NCBI
4	Wong MC, Goggins WB, Wang HH, Fung FD, Leung C, Wong SY, Ng CF and Sung JJ: Global incidence and mortality for prostate cancer: Analysis of temporal patterns and trends in 36 countries. Eur Urol. 70:862–874. 2016. View Article : Google Scholar : PubMed/NCBI
5	Kahraman T, Cubuk R, Sinanoglu O, Tasalı N, Ozarar M and Saydam B: Comparison of power Doppler ultrasound with gray scale transrectal ultrasound in predicting cancer positive prostate biopsy cores. Eurasian J Med. 42:81–85. 2010. View Article : Google Scholar : PubMed/NCBI
6	Guelfi G, Cochetti G, Stefanetti V, Zampini D, Diverio S, Boni A and Mearini E: Next generation sequencing of urine exfoliated cells: An approach of prostate cancer microRNAs research. Sci Rep. 8:71112018. View Article : Google Scholar : PubMed/NCBI
7	Zhang J, Ma M, Nan X and Sheng B: Obesity inversely correlates with prostate-specific antigen levels in a population with normal screening results of prostate cancer in northwestern China. Braz J Med Biol Res. 49(pii): S0100–879X2016000800704. 2016.
8	Kaufmann S, Kruck S, Kramer U, Gatidis S, Stenzl A, Roethke M, Scharpf M and Schilling D: Direct comparison of targeted MRI-guided biopsy with systematic transrectal ultrasound-guided biopsy in patients with previous negative prostate biopsies. Urol Int. 94:319–325. 2015. View Article : Google Scholar : PubMed/NCBI
9	Baco E, Ukimura O, Rud E, Vlatkovic L, Svindland A, Aron M, Palmer S, Matsugasumi T, Marien A, Bernhard JC, et al: Magnetic resonance imaging-transectal ultrasound image-fusion biopsies accurately characterize the index tumor: Correlation with step-sectioned radical prostatectomy specimens in 135 patients. Eur Urol. 67:787–794. 2015. View Article : Google Scholar : PubMed/NCBI
10	Cochetti G, Poli G, Guelfi G, Boni A, Egidi MG and Mearini E: Different levels of serum microRNAs in prostate cancer and benign prostatic hyperplasia: Evaluation of potential diagnostic and prognostic role. Onco Targets Ther. 9:7545–7553. 2016. View Article : Google Scholar : PubMed/NCBI
11	Zhang Q, Wang W, Zhang B, Shi J, Fu Y, Li D, Guo S, Zhang S, Huang H, Jiang X, et al: Comparison of free-hand transperineal mpMRI/TRUS fusion-guided biopsy with transperineal 12-core systematic biopsy for the diagnosis of prostate cancer: A single-center prospective study in China. Int Urol Nephrol. 49:439–448. 2017. View Article : Google Scholar : PubMed/NCBI
12	Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, Okoro C, Raskolnikov D, Parnes HL, Linehan WM, et al: Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 313:390–397. 2015. View Article : Google Scholar : PubMed/NCBI
13	Borkowetz A, Platzek I, Toma M, Laniado M, Baretton G, Froehner M, Koch R, Wirth M and Zastrow S: Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ultrasound-fusion biopsy for the diagnosis of prostate cance. BJU Int. 116:873–879. 2015. View Article : Google Scholar : PubMed/NCBI
14	Pepe P, Garufi A, Priolo G and Pennisi M: Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance? World J Urol. 34:1249–1253. 2016. View Article : Google Scholar : PubMed/NCBI
15	Lian H, Zhuang J, Wang W, Zhang B, Shi J, Li D, Fu Y, Jiang X, Zhou W and Guo H: Assessment of free-hand transperineal targeted prostate biopsy using multiparametric magnetic resonance imaging-transrectal ultrasound fusion in Chinese men with prior negative biopsy and elevated prostate-specific antigen. BMC Urol. 17:522017. View Article : Google Scholar : PubMed/NCBI
16	Ezquer A, Ortega Hrescak MC, Sanagua C, Roggia-Rebullida P, López R, Cenice F, Veglia FH, Veglia F and Fernández A: Transrectal doppler ultrasound during prostate biopsy: Clinical utility and limitations. Actas Urol Esp. 39:13–19. 2015.(In English, Spanish). View Article : Google Scholar : PubMed/NCBI
17	Cochetti G, Boni A, Barillaro F, Pohja S, Cirocchi R and Mearini E: Full neurovascular sparing extraperitoneal robotic radical prostatectomy: Our experience with PERUSIA technique. J Endourol. 31:32–37. 2017. View Article : Google Scholar : PubMed/NCBI
18	Boni A, Cochetti G, Del Zingaro M, Paladini A, Turco M, Rossi de Vermandois JA and Mearini E: Uroflow stop test with electromyography: A novel index of urinary continence recovery after RARP. Int Urol Nephrol. 51:609–615. 2019. View Article : Google Scholar : PubMed/NCBI
19	Zhu G and Wang Q: Comparisons between magnetic resonance/ultrasound fusion-guided biopsy and standard biopsy in the diagnosis of prostate cancer: A prospective cohort study. Medicine (Baltimore). 97:e119622018. View Article : Google Scholar : PubMed/NCBI
20	Huang M, Lin Y, Xu A, Uhlman M, Deng X, Lin X, Wu S, Diao P, Xie K and Tang P: Percent free prostate-specific antigen does not improve the effectiveness of prostate cancer detection in Chinese men with a prostate-specific antigen of 2.5–20.0 ng/ml: A multicenter study. Med Oncol. 31:9252014. View Article : Google Scholar : PubMed/NCBI
21	Mariotti GC, Falsarella PM, Garcia RG, Queiroz MRG, Lemos GC and Baroni RH: Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: A prospective controlled study. Eur Radiol. 28:11–16. 2018. View Article : Google Scholar : PubMed/NCBI
22	Equator Network, . The Standards for Reporting of Diagnostic accuracy studies guidelines. http://www.equator-network.org/reporting-guidelines/stard/September 6–2019
23	Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, Rouviere O, Logager V and Fütterer JJ; European Society of Urogenital Radiology, : ESUR prostate MR guidelines 2012. Eur Radiol. 22:746–757. 2012. View Article : Google Scholar : PubMed/NCBI
24	Rosenkrantz AB, Kim S, Lim RP, Hindman N, Deng FM, Babb JS and Taneja SS: Prostate cancer localization using multiparametric MR imaging: Comparison of prostate imaging reporting and data system (PI-RADS) and Likert scales. Radiology. 269:482–492. 2013. View Article : Google Scholar : PubMed/NCBI
25	Costa DN, Lotan Y, Rofsky NM, Roehrborn C, Liu A, Hornberger B, Xi Y, Francis F and Pedrosa I: Assessment of prospectively assigned Likert scores for targeted magnetic resonance imaging-transrectal ultrasound fusion biopsies in patients with suspected prostate cancer. J Urol. 195:80–87. 2016. View Article : Google Scholar : PubMed/NCBI
26	Moore CM, Kasivisvanathan V, Eggener S, Emberton M, Fütterer JJ, Gill IS, Grubb Iii RL, Hadaschik B, Klotz L, Margolis DJ, et al: Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: Recommendations from an International working group. Eur Urol. 64:544–552. 2013. View Article : Google Scholar : PubMed/NCBI
27	Dell'atti L: Prostatic abscess after transrectal ultrasound-guided prostate biopsy. Case report. G Chir. 39:260–262. 2013.
28	Ozok HU, Sagnak L, Tuygun C, Oktay M, Karakoyunlu N, Ersoy H and Alper M: Will the modification of the Gleason grading system affect the urology practice? Int J Surg Pathol. 18:248–254. 2010. View Article : Google Scholar : PubMed/NCBI
29	Labanaris AP, Witt JH and Zugor V: Robotic-assisted radical prostatectomy in men ≥75 years of age. Surgical, oncological and functional outcomes. Anticancer Res. 32:2085–2089. 2012.PubMed/NCBI
30	Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R and Orgill DP; STROCSS Group, : The STROCSS statement: Strengthening the reporting of Cohort studies in surgery. Int J Surg. 46:198–202. 2017. View Article : Google Scholar : PubMed/NCBI
31	Fitzgerald M, Saville BR and Lewis RJ: Decision curve analysis. JAMA. 13:409–410. 2015. View Article : Google Scholar
32	Bjurlin MA, Mendhiratta N, Wysock JS and Taneja SS: Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment. Cent European J Urol. 69:9–18. 2016.PubMed/NCBI
33	Tan CH, Hobbs BP, Wei W and Kundra V: Dynamic contrast-enhanced MRI for the detection of prostate cancer: Meta-analysis. Am J Roentgenol. 204:W439–W448. 2015. View Article : Google Scholar
34	Sohail SK, Sarfraz R, Imran M, Khan NA and Yusuf NW: Power doppler ultrasonography guided and random prostate biopsy in prostate cancer diagnosis-a comparative study. J Pak Med Assoc. 65:65–68. 2015.PubMed/NCBI
35	Delgado Oliva F, Arlandis Guzman S, Bonillo García M, Broseta Rico E and Boronat Tormo F: Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy? Eur J Radiol. 85:1778–1785. 2016. View Article : Google Scholar : PubMed/NCBI
36	Na YQ, Ye ZQ, Sun YH and Sun G: Chinese Guidelines on Urologic DiseasesPR China Helath Department. People's Medical Publishing House; Beijing: 2015, (In Chinese).