MAN VS. MACHINE: COMPARATIVE EFFECTIVENESS OF COGNITIVE TARGETED AND IMAGE-FUSION TARGETED TRANSPERINEAL PROSTATE BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP56)1 Apr 2020MP56-02 MAN VS. MACHINE: COMPARATIVE EFFECTIVENESS OF COGNITIVE TARGETED AND IMAGE-FUSION TARGETED TRANSPERINEAL PROSTATE BIOPSY Christopher Khoo, David Eldred-Evans, Max Peters, Feargus Hosking-Jervis, Martin Connor*, Deepika Reddy, Mariana Bertoncelli Tanaka, Heather Bhola-Stewart, William Maynard, Edward Bass, Taimur Shah, Jae Lee, Denosshan Sri, Laura Powell, Shahzad Ahmad, Mohamed Noureldin, Suchita Joshi, Elizabeth Pegers, Kathie Wong, Henry Tam, David Hrouda, Mathias Winkler, Steve Gordon, Hasan Qazi, and Hashim Ahmed Christopher KhooChristopher Khoo More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Max PetersMax Peters More articles by this author , Feargus Hosking-JervisFeargus Hosking-Jervis More articles by this author , Martin Connor*Martin Connor* More articles by this author , Deepika ReddyDeepika Reddy More articles by this author , Mariana Bertoncelli TanakaMariana Bertoncelli Tanaka More articles by this author , Heather Bhola-StewartHeather Bhola-Stewart More articles by this author , William MaynardWilliam Maynard More articles by this author , Edward BassEdward Bass More articles by this author , Taimur ShahTaimur Shah More articles by this author , Jae LeeJae Lee More articles by this author , Denosshan SriDenosshan Sri More articles by this author , Laura PowellLaura Powell More articles by this author , Shahzad AhmadShahzad Ahmad More articles by this author , Mohamed NoureldinMohamed Noureldin More articles by this author , Suchita JoshiSuchita Joshi More articles by this author , Elizabeth PegersElizabeth Pegers More articles by this author , Kathie WongKathie Wong More articles by this author , Henry TamHenry Tam More articles by this author , David HroudaDavid Hrouda More articles by this author , Mathias WinklerMathias Winkler More articles by this author , Steve GordonSteve Gordon More articles by this author , Hasan QaziHasan Qazi More articles by this author , and Hashim AhmedHashim Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000925.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Targeted prostate biopsy can be done using visual-estimation (cognitive) targeting or using MRI-ultrasound fusion platforms. We compared cancer detection of these two approaches performed by a large number of surgeons of varying expertise. METHODS: A prospective prostate cancer diagnosis registry identified 603 men who had undergone cognitive or image-fusion targeted transperineal biopsy for PI-RADS v2 score >/=3; a score of 3 required PSA-density >/=0.12ng/mL/mL (April 2017 - July 2019). Elastic registration image-fusion was performed using BiopSee® (Medcom). Propensity score matching (1:1) was performed by age, PSA, PSA-density, prostate volume, number of target lesions, operator grade, PI-RADS score and number of cores (caliper=0.25). Operator experience included senior urologists, trainee urologists or others (e.g. nurse practitioners). We compared detection rates of clinically significant (cs) and insignificant (ci) prostate cancer (PCa) (Fisher’s Exact) and median number of cores taken (Mann-Whitney U). The threshold of csPCa used was Gleason >/=3+4. RESULTS: 845 lesions (cognitive: 261, image-fusion: 584) in 603 patients (cognitive: 185, image-fusion: 418) with median age 66.7 years (IQR: 60.5-72), PSA 7.5ng/mL (IQR: 5.5-10.8), prostate volume 43mL (IQR: 32-59) and PSA-density 0.17 ng/mL/mL (IQR: 0.11–0.28) underwent targeted transperineal biopsy. There was no overall difference in cs or ciPCa detection rates between cognitive and image-fusion targeting (242 pairs; p=1.00). Significantly more cores were taken cognitively (6; IQR: 5-8) than using image-fusion (6; IQR: 4-6) (p<0.0001). Senior urologists detected significantly more csPCa using image-fusion targeted biopsy (cognitive: 27.8%, image-fusion: 55.6%; 54 pairs; p=0.006). There was no significant difference when biopsies were conducted by trainee urologists (143 pairs; p=0.1) or other operators (17 pairs; p=0.73). There was no difference between cognitive and image-fusion for prostates <40mL (107 pairs; p=0.49), 40-80mL (94 pairs; p=1.00) or >80mL (20 pairs; p=0.73). Similarly, there was no difference when there was one target lesion (109 pairs; p=0.54) or >1 target lesions (133 pairs; p=0.54). CONCLUSIONS: We found no difference in overall cancer detection rates between cognitive and image-fusion targeted transperineal biopsy, although more cores were taken using cognitive targeting. Senior urologists detected significantly more csPCa using image-fusion targeting. Choice of biopsy technique should be dependent on operator experience. Source of Funding: na © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e847-e848 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Khoo More articles by this author David Eldred-Evans More articles by this author Max Peters More articles by this author Feargus Hosking-Jervis More articles by this author Martin Connor* More articles by this author Deepika Reddy More articles by this author Mariana Bertoncelli Tanaka More articles by this author Heather Bhola-Stewart More articles by this author William Maynard More articles by this author Edward Bass More articles by this author Taimur Shah More articles by this author Jae Lee More articles by this author Denosshan Sri More articles by this author Laura Powell More articles by this author Shahzad Ahmad More articles by this author Mohamed Noureldin More articles by this author Suchita Joshi More articles by this author Elizabeth Pegers More articles by this author Kathie Wong More articles by this author Henry Tam More articles by this author David Hrouda More articles by this author Mathias Winkler More articles by this author Steve Gordon More articles by this author Hasan Qazi More articles by this author Hashim Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...