Accuracy of elastic fusion biopsy in daily practice: results of a multicenter study of 2115 patients

OBJECTIVES: To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice. METHODS: We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2-4) and random cores (usually 10-14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables. RESULTS: The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate-specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer. CONCLUSIONS: Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate-specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate

Effect of shared decision making on racial and ethnic disparity in prostate cancer screening: Results from a national behavioral survey

Introduction & Objectives: The 2018 United States Preventive Services Task Force recommendations endorsed shared decision making (SDM) for men aged 55-69 and encouraged consideration of patient race and ethnicity for prostate specific antigen (PSA) screening. We sought to assess whether SDM modified the effect of race and ethnicity on the likelihood of PSA screening. Materials & Methods: A cross-sectional analysis of men aged between 55 and 69 who responded to the PSA screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System (BRFSS) survey was performed. Men without a diagnosis of prostate cancer who self-reported a PSA test in the previous 12 months as part of a routine examination were considered screened. SDM was defined based upon whether the respondents had been informed by a physician about the benefits and harms of PSA screening. The main predictors were patient race and the interaction between race/ethnicity and SDM. Complex weighted sample multivariable logistic regression models were fitted to test the associations. Results: Out of a weighted sample of 26.8 million men eligible for PSA screening, 25.7% (6.9 million men) reported PSA screening. In adjusted analysis, SDM was a significant predictor of PSA screening (aOR:2.65, 95%CIs:2.36-2.98, p\u3c0.001). The interaction between race/ethnicity and SDM on the receipt of PSA screening was significant (pint=0.001), meaning that the effect of race on the odds of PSA screening varied based on SDM. Among those who did not report SDM, both non-Hispanic Black (OR:0.77, 95%CIs: 0.61–0.97, p=0.026) and Hispanic (OR:0.51, 95%CIs: 0.39–0.68, p\u3c0.001) men were significantly less likely to undergo PSA screening than non-Hispanic white men. On the contrary, among respondents who reported SDM, we found no race-based differences in the odds of PSA screening (Figure 1). Conclusions: SDM was a significant predictor of PSA screening use and has a direct impact on reducing disparities in PSA screening among racial and ethnic groups