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Limitationen der Prostatakarzinomdetektion der multiparametrischen MRT/TRUS-Fusionsbiopsie im Vergleich zum Großflächenpräparat der radikalen Prostatektomie

dc.contributor.advisorTrojan, Lutz Prof. Dr.
dc.contributor.authorvon Knobloch, Hans Christoph
dc.format.extent85 Seitende
dc.titleLimitationen der Prostatakarzinomdetektion der multiparametrischen MRT/TRUS-Fusionsbiopsie im Vergleich zum Großflächenpräparat der radikalen Prostatektomiede
dc.title.translatedProstatecancer detection limitations of multiparametric MRI/TRUS fusion guided biopsy compared with wholemount slices from radical
dc.contributor.refereeTrojan, Lutz Prof. Dr.
dc.description.abstractengProstate Cancer is the most common cancer in men. This underlines the importance of accurate diagnostics. Multiparametric Magnet Resonance Imaging (mpMRI) fusion guided biopsy is also recommended in the german guidelines. In this dissertation we evaluate strength and weaknesses of mpMRI fusion biopsy by using a combined biopsy method. We compared the histological outcome between mpMRI fusion biopsy and the wholemount slice of prostate specimen after roboter assisted radical prostatectomy (RARP). Between 01.01.2016 and 31.12.2017 71 men underwent RARP after positive mpMRI fusion biopsy at our institution. We directly compared mpMRI- findings, histopathologic specimens of mpMRI fusion biopsy and the pathological reality in wholemount slice after RARP. Due to intraoperative artifacts 46 of 71 wholemount slices have been evaluated exactly. Demographics in this cohort show a median PSA value of 10,8 ng/ml (IQR 8,3ng/ml-15,5ng/ml) and a median prostate volume of 51 ml (IQR 37ml 75ml). 64 of 71 men (90,1%) had a PIRADS Score of III-V. 46 men (64,8%) had a previous conventional prostate biopsy. Comparing Gleason Scores resulting from mpMRI- fusion biopsy to those from RARP specimen showed 23,9% vs. 11,3% Gleason pattern 6 (3+3), 38% vs. 53,5% Gleason 7a (3+4), 25,4% vs. 21,1% Gleason 7b (4+3) and 12,7% vs. 12,7% Gleason ≥ 8. Further we compared the Gleason Score from fusionbiopsy to RARP between targeted vs. combined Biopsy. There was no up- or downgrading in 49% vs. 45%. That corresponds to an upgrading of 28% vs. 36% and a downgrading of 23% vs. 19%. Combined mpMRI- fusion biopsy shows high detection rates, non the less after RARP 9 off 46 (20%) new index lesions were identified in our cohort. 5 of 9 lesions (11%) were detected but not defined as index lesion. 4 index lesion were not detected at all. The individual evaluation of all biopsy cores enabled us to draw a heatmap of lesions before and after RARP. The interpretation leads to a relevant risk of missing lesions in apex of the prostate. Despite the small patient population of our study, in 9% of men the Index lesion was neither found by targeted nor by systematic samples. This is clinically relevant because the indication for Active Surveillance or curative Therapy is reliant on information from mpMRI- fusion
dc.contributor.coRefereeBremmer, Felix PD Dr.
dc.subject.engwholemount slicede
dc.affiliation.instituteMedizinische Fakultätde
dc.subject.gokfullMedizin (PPN619874732)de
dc.subject.gokfullUrologie / Andrologie - Allgemein- und Gesamtdarstellungen (PPN619876131)de
dc.notes.confirmationsentConfirmation sent 2023-02-14T06:15:01de

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