Reduktion der Gesamtbiopsieanzahl und Verbesserung der Tumordetektionsrate in der MRT/TRUS-Fusionsbiopsie der Prostata unter Verwendung eines optimierten Computeralgorithmus

Reduction of total biopsy number and improvement of tumor detection rate in MRI/TRUS fusion biopsy of the prostate using an optimized computer algorithm

by Joost Wilhelm Voß
Doctoral thesis
Date of Examination:2023-07-06
Date of issue:2023-06-28
Advisor:Prof. Dr. Lutz Trojan
Referee:Prof. Dr. Lutz Trojan
Referee:Prof. Dr. Joachim Lotz
Referee:Prof. Dr. Thomas Meyer
Persistent Address: http://dx.doi.org/10.53846/goediss-9966

 

 

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Abstract

English

Prostate carcinoma is the most frequently diagnosed male carcinoma in Germany. For patients, it is crucial to detect clinically significant malignancies. Here, the prostate biopsy is the method of choice. The aim of this work is to significantly reduce the necessary number of prostate lancet biopsies in the context of MRI/TRUS fusion biopsy while still ensuring a good detection rate of clinically significant prostate carcinoma. 229 male patients with a conspicuous area of the prostate on mpMRI who underwent an MRI/TRUS fusion biopsy of the prostate between 01.01.2016 and 31.12.2017 will be evaluated. The computer algorithm was used to reduce the total number of biopsies. Potential demographic and clinical influencing factors are also tested for the presence of prostate cancer using univariate and multivariate analysis. Patients received a biopsy cylinder count of 17.5 (IQR 16.0 - 19.0) with a median gland volume of 60 ml (IQR 44.8 - 89.3) and a PSA value of 8.7 ng/ml (IQR 6.6 - 12.7). This gave an overall detection rate of 61%, with significant prostate carcinomas in 38% of cases. Glands with an organ volume of less than 80 ml showed a median volume of 49 ml (IQR 39 - 62). This gland volume showed an overall detection rate of 70 % and a detection rate of 47 % for significant prostate carcinomas. These results are comparable to those of the reference studies with regard to gland volume as well as detection rate. The present work successfully demonstrated the clinical effectiveness of the combined approach of targeted MRI/TRUS fusion biopsy in conspicuous areas with saturation biopsy of the remaining glandular portions using an optimised computer algorithm with a significant reduction in the required number of punch cylinders while maintaining a high detection rate of significant prostate carcinoma compared to the results from the present reference studies. In addition, unwanted non-significant tumours are demonstrably not detected more frequently. With this study, the superiority of the applied method compared to the classical systematic as well as solely targeted biopsy can be proven and demonstrated.
Keywords: MRI-targeted biopsy; Prostate cancer
 
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