OBJECTIVES: To evaluate the ability of Prostate Histoscanning™ to detect, characterise and locally stage prostate cancer, by comparing it with transrectal ultrasound (TRUS)-guided prostate biopsies, transperineal template prostate biopsies (TTB) and whole-mount radical prostatectomy specimens.
SUBJECTS AND METHODS: Study 1: We recruited 24 patients awaiting standard 12-core TRUS-guided biopsies of the prostate to undergo Prostate Histoscanning™ (PHS) immediately beforehand. We compared PHS with the TRUS-guided biopsy results in terms of their ability to detect cancer within the whole prostate, localise it to the correct side and to the correct region of the prostate. Lesions that were suspicious on PHS were biopsied separately. Study 2: 57 patients planned to undergo transperineal template prostate biopsies (TTB) were recruited to have PHS beforehand. We compared PHS to the TTB pathology results in terms of their ability to detect prostate cancer within the whole gland, localise it to the correct side and to the correct sextant of the prostate. Study 3: We recruited 24 patients awaiting radical prostatectomy for localised prostate cancer to undergo pre-operative PHS. We compared PHS to standardised pathologic analysis of the whole-mount prostatectomy specimens in terms of their measurement of total tumour volume within the prostate, tumour volume within prostate sextants and volume of index lesions identified by PHS.
RESULTS: PHS-targeted biopsies had an overall cancer detection rate of 38.1%, compared to 62.5% with standard TRUS-guided biopsies. The sensitivity and specificity of PHS for localising tumour to the correct prostate sextant, compared to standard TRUS-guided biopsies, were 100% and 5.9%, respectively. PHS-targeted biopsies had an overall cancer detection rate of 13.4% compared to 54.4% with standard TTB. PHS had a sensitivity and specificity for cancer detection in the posterior gland of 100% and 13%, respectively, and for the anterior gland, 6% and 82%, respectively. We found no correlation between total tumour volume estimates from PHS and radical prostatectomy pathology (Pearson correlation coefficient -0.099). Sensitivity and specificity of PHS for detecting tumour foci ≥ 0.2ml in volume were 63% and 53%.
CONCLUSIONS: These three independent studies of 105 patients suggest that Prostate Histoscanning™ does not reliably identify and characterise prostate cancer in the routine clinical setting.
Written by:
Javed S, Chadwick E, Edwards AA, Beveridge S, Laing R, Bott S, Eden C, Langley S. Are you the author?
Department of Urology, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, United Kingdom.
Reference: BJU Int. 2013 Nov 13. Epub ahead of print.
doi: 10.1111/bju.12568
PubMed Abstract
PMID: 24224648
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