Volume 2, Number 2Review ArticlesUreteroscopic Management of Upper Urinary Tract Urothelial MalignanciesTechniques and TechnologyMichael GrassoUreteroscopyBiopsyCarcinoma, transitional cellLaserSurgery, urologicTherapy, topicalUrinary tract
Volume 7, Supplement 3Review ArticlesProstatic Intraepithelial Neoplasia: An OverviewMichael K BrawerProstate cancerAndrogen deprivation therapyBiopsyChemopreventionRepeat biopsyProstatic intraepithelial neoplasia (PIN)High-grade PINEpidemiology
Volume 8, Number 4Review ArticlesProstate Biopsy: Targeting Cancer for Detection and TherapyTechnology UpdateSamir S TanejaDespite improvements in cancer detection, prostate biopsy still lacks the ability to accurately map locations of cancer within the prostate. Improvements in prostate imaging may allow more accurate mapping of overall disease volume. Magnetic resonance (MR) spectroscopy allows improved specificity in detecting even small foci of disease within the peripheral zone. Improvements in MR-guided biopsy techniques may allow this technology to be adapted to therapeutics as well. Computer modeling of individual prostates serves as a means of designing optimized plans for prostate biopsy. The use of novel targeted biopsy schemes may allow an integration of available technologies in detection and localization of prostate cancer. Computer-directed needle biopsies based on anatomic landmarks within the prostate and computerized three-dimensional reconstruction of the gland may allow a highly reproducible means of identifying small foci of cancer, targeting them for therapy, and monitoring for recurrence. The TargetScan® system (Envisioneering Medical Technologies, St. Louis, MO) is the first technology to integrate available targeting methodologies in a systematic fashion. [Rev Urol. 2006;8(4):173-182]Prostate cancerBiopsyTransrectal ultrasound3D mapping
Volume 10, Number 4Review ArticlesUsing Biopsy to Detect Prostate CancerDiagnostic ReviewClaus G RoehrbornShahrokh F ShariatTransrectal ultrasound-guided systemic biopsy is the recommended method in most cases with suspicion of prostate cancer. Transrectal periprostatic injection with a local anesthetic may be offered as effective analgesia; periprostatic nerve block with 1% or 2% lidocaine is the recommended form of pain control. On initial biopsy, a minimum of 10 systemic, laterally directed cores is recommended, with more cores in larger glands. Extended prostate biopsy schemes, which require cores weighted more laterally at the base (lateral horn) and medially to the apex, show better cancer detection rates without increasing adverse events. Transition zone biopsies are not recommended in the first set of biopsies, owing to low detection rates. One set of repeat biopsies is warranted in cases with persistent indication. Saturation biopsy (=20 cores) should be reserved for repeat biopsy in patients who have negative results on initial biopsy but who are still strongly suspected to have prostate cancer. [Rev Urol. 2008;10(4):262-280]Prostate cancerBiopsyProstate-specific antigenTransrectal ultrasoundNomogramsAnesthesia
Volume 19, Number 3Review ArticlesClinical Performance of the 4Kscore Test to Predict High-grade Prostate Cancer at Biopsy: A Meta-analysis of US and European Clinical Validation Study ResultsPredictive Performance EvaluationStephen M ZappalaPeter T ScardinoYan DongVincent LinderDavid OkronglyThe 4Kscore® Test (OPKO Diagnostics, Woburn, MA) is a blood test utilized prior to a prostate biopsy to determine a patient’s risk of high-grade prostate cancer (PCa) should the biopsy be performed, thus providing critical information in the clinical management of men with a suspicious prostate-specific antigen value or digital rectal examination result. Multiple US and European clinical studies confirmed that a prebiopsy 4Kscore Test has a high degree of discrimination for a subsequent discovery of high-grade (Gleason score ≥7) PCa. The aim of this study was to evaluate the predictive accuracy of the 4Kscore Test to discriminate between patients with and without high-grade PCa based on published clinical validation studies. A systematic review and meta-analysis of the eligible 4Kscore Test clinical validation studies was conducted. The pooled area under the curve (AUC) of the 4Kscore Test as reported from all the studies, and the heterogeneity among these studies were analyzed and repeated for subgroups of the studies. Twelve clinical validation studies were included in the meta-analysis, comprising a total of 11,134 patients. The pooled AUC to discriminate for high-grade PCa for all 12 studies was 0.81 (fixed effects 95% CI, 0.80-0.83). Restricting the analysis to the six publications that used the contemporary 4Kscore Test algorithm led to very similar results (AUC 0.81; 95% CI, 0.79-0.83). Heterogeneity was high among all of the 12 studies, as well as among the six publications that used the contemporary 4Kscore Test (Cochrane’s Q test, p = 0.001 for both); however, in both cases, after exclusion of a single outlying study with a much lower AUC, heterogeneity was no longer significant (p = 0.08 and p = 0.21). The pooled estimate of 4Kscore Test discrimination (AUC) for high-grade PCa is .0.80, and is consistent across multiple US and European clinical validation studies. [Rev Urol. 2017;19(3):149–155 doi: 10.3909/riu0776] © 2017 MedReviews®, LLCBiopsyBiomarkers4KscoreHigh-grade prostate cancerEarly detection
Volume 21, Number 2Original ResearchThe Effect of Local Antibiogram–based Augmented Antibiotic Prophylaxis on Infection-related Complications Following Prostate BiopsyOriginal ResearchNeal D ShoreDeepak A KapoorGary M KirshRaoul S ConcepcionEdward M SchaefferJeffrey A ScottGiven the number of prostate biopsies performed annually in the United States and associated infectious events as a result, we sought to determine if implementation of a standardized biopsy protocol utilizing antibiotic prophylaxis based on locally derived antibiograms would result in a decrease, relative to a contemporary control population, in the incidence of infection-related complications among community-based practices. A total of nine member groups of LUGPA participated in both a retrospective review and a prospective study of infection-related complications following prostate biopsy. Historic infectious complications, defined as chills/rigor, temperature higher than 101 °F, or documented positive blood or urine cultures, were self-reported by a retrospective review of patients undergoing prostate biopsy under the practice’s current protocol in the year prior to the study. The prospective phase of the study required each group to develop a locally derived augmented prophylaxis regimen (>2 antibiotics) based on local antibiograms. After implementation, the practices enrolled patients undergoing prostate biopsy over an 8-week period. Monitoring for infection-related complication took place over the ensuing 3 weeks post-biopsy. Seven hundred fifty-nine patients over nine practices were enrolled into the study utilizing the augmented locally determined prophylaxis protocol. There was a 53% reduction in the incidence of infection-related complication, relative to the historical rate. By developing a standardized biopsy protocol with specific emphasis on incorporating an augmented antibiotic prophylactic regimen based upon local antibiograms, we were able to demonstrate in a prospective trial across nine geographically distinct community practices a significant reduction in the incidence of infection-related complications. [Rev Urol. 2019;21(2/3):93–101] © 2019 MedReviews®, LLCAntibiotic prophylaxisProstateBiopsyDrug-resistant bacteria