eprintid: 10053362 rev_number: 46 eprint_status: archive userid: 608 dir: disk0/10/05/33/62 datestamp: 2018-07-27 10:53:28 lastmod: 2021-10-07 21:56:58 status_changed: 2018-07-27 10:53:28 type: article metadata_visibility: show creators_name: Simmons, LAM creators_name: Kanthabalan, A creators_name: Arya, M creators_name: Briggs, T creators_name: Barratt, D creators_name: Charman, SC creators_name: Freeman, A creators_name: Gelister, J creators_name: Hawkes, D creators_name: Hu, Y creators_name: Jameson, C creators_name: McCartan, N creators_name: Moore, CM creators_name: Punwani, S creators_name: van der Muelen, J creators_name: Emberton, M creators_name: Ahmed, HU title: Accuracy of Transperineal Targeted Prostate Biopsies, Visual Estimation and Image Fusion in Men Needing Repeat Biopsy in the PICTURE Trial ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: FI6 divisions: D16 divisions: G88 divisions: B04 divisions: C05 divisions: F42 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: PURPOSE: To evaluate detection of clinically significant prostate cancer (csPCa) using MRI-targeted biopsies, and compare visual-estimation to image-fusion targeting, in patients requiring repeat prostate biopsies. MATERIALS AND METHODS: Prospective, ethics-committee approved, registered PICTURE trial enrolling 249 consecutive patients (11th/January/2012-29th/January/2014). Men underwent an mpMRI and were blinded to its results. All underwent transperineal template prostate mapping (TTPM) biopsies. In 200 with a lesion, this was preceded by visual-estimation and image-fusion targeted biopsies. For the primary endpoint, csPCa was defined as Gleason >/=4+3 and/or any grade of cancer length >/=6mm. Other definitions of csPCa were also evaluated. RESULTS: Mean (SD) age was 62.6 (7) years, median (IQR) PSA 7.17ng/ml (5.25, 10.09), mean primary lesion size 0.37cc (SD1.52), with mean 4.3 (SD2.3) targeted cores per lesion (visual-estimation and image-fusion combined) and mean 48.7 (SD12.3) TTPM-biopsy cores. TTPM-biopsies detected 97 (48.5%) cases of csPCa and 85 (42.5%) insignificant cancers. Overall, mpMRI-targeted biopsies detected 81 (40.5%) csPCa and 63 (31.5%) insignificant cancers. Eighteen (9%) with csPCa on MRI-targeted biopsies were benign or clinically insignificant on TTPM-biopsy. Thirty-four (17%) had csPCa detected on TTPM-biopsy but not on MRI-targeted biopsies; approximately half of these were present in non-targeted areas. csPCa was found with visual-estimation and image-fusion in 53/169 (31.3%) and 48/169 (28.4%) (McNemar's test, p=0.5322). Visual-estimation missed 23 (13.6%) csPCa detected by image-fusion; image-fusion missed 18 (10.8%) csPCa that visual-estimation detected. CONCLUSIONS: MRI-targeted biopsies are accurate at detection of csPCa and reducing over-diagnosis of insignificant cancers. To maximise detection both visual-estimation and image-fusion targeted biopsies are required. date: 2018-12 date_type: published official_url: https://doi.org/10.1016/j.juro.2018.07.001 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1570551 doi: 10.1016/j.juro.2018.07.001 pii: S0022-5347(18)43482-9 lyricists_name: Ahmed, Hashim lyricists_name: Barratt, Dean lyricists_name: Emberton, Mark lyricists_name: Hawkes, David lyricists_name: Hu, Yipeng lyricists_name: McCartan, Neil lyricists_name: Moore, Caroline lyricists_name: Punwani, Shonit lyricists_id: HUAHM90 lyricists_id: DBARR55 lyricists_id: MEMBE52 lyricists_id: DJHAW78 lyricists_id: YHUXX66 lyricists_id: NMCCA09 lyricists_id: CMMOO61 lyricists_id: SPUNW14 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: The Journal of Urology volume: 200 number: 6 pagerange: 1227-1234 event_location: United States issn: 1527-3792 citation: Simmons, LAM; Kanthabalan, A; Arya, M; Briggs, T; Barratt, D; Charman, SC; Freeman, A; ... Ahmed, HU; + view all <#> Simmons, LAM; Kanthabalan, A; Arya, M; Briggs, T; Barratt, D; Charman, SC; Freeman, A; Gelister, J; Hawkes, D; Hu, Y; Jameson, C; McCartan, N; Moore, CM; Punwani, S; van der Muelen, J; Emberton, M; Ahmed, HU; - view fewer <#> (2018) Accuracy of Transperineal Targeted Prostate Biopsies, Visual Estimation and Image Fusion in Men Needing Repeat Biopsy in the PICTURE Trial. The Journal of Urology , 200 (6) pp. 1227-1234. 10.1016/j.juro.2018.07.001 <https://doi.org/10.1016/j.juro.2018.07.001>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10053362/1/Emberton_PICTURE%20Targeted-J-Urol-CLEAN-30-06-2018.pdf