Author: Giannarini, Gianluca ; Lauwers, Carol Nancy Gianna ; Budäus, Lars ; Uleri, Alessandro ; Padhani, Anwar R. ; Padhani, Anwar R ; Basile, Giuseppe ; Budeaus, Lars ; Tedde, Alessandro ; Chernysheva, Daria ; Madonia, Massimo ; Lauwers, Carol Nelly Gianna ; Breda, Alberto ; Sanguedolce, Francesco ; Schoots, Ivo ; Baboudjian, Michael ; Roupret, Morgan ; Palou, Joan ; Panebianco, Valeria

BACKGROUND AND OBJECTIVEIntensification of targeted biopsy (TBx) around a magnetic resonance imaging (MRI)-visible lesion with regional biopsy (RBx) could obviate the need for systematic biopsy (SBx). We aimed to compare the detection yields of clinically significant prostate cancer (csPCa)-defined as International Society of Urological Pathology (ISUP) grade group ≥2-between TBx + RBx and the reference standard (TBx + SBx).METHODSRBx was defined as perilesional or ipsilateral biopsy. A literature search was conducted up to September 2023 using PubMed, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Included studies were eligible when presenting data from SBx, TBx, and TBx + RBx cores and their detection yields. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria were used to assess the risk of bias of the included studies.KEY FINDINGS AND LIMITATIONSTwenty-one studies were included for a meta-analysis. The overall detection yield of csPCa was not statistically different between TBx + SBX and TBx + RBx (46.1% vs 44.2%; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.99-1.16, p = 0.07); similar findings were found also for ISUP grade group ≥3 prostate cancer (PCa; OR 1.06, 95% CI 0.92-1.22, p = 0.43) and in different subgroup analyses. TBx + SBx was associated with higher cancer detection of ISUP grade group 1 PCa (OR 1.16, 95% CI 1.04-1.30, p = 0.008). The main limitations include the retrospective nature of most of the selected studies, heterogeneity of RBx definition, and template.CONCLUSIONS AND CLINICAL IMPLICATIONSOur study supports the use of the TBx + RBx template in the early detection pathway for the detection of csPCa. SBx can be omitted when targeting lesions visible on MRI.PATIENT SUMMARYA prostate biopsy strategy consisting of taking biopsy in and around an magnetic resonance imaging-visible lesion reduces the risk of detecting indolent prostate cancers without affecting the detection of aggressive tumours.

01 Apr 2025·European Urology

Novel Methods to Assess Tumor Burden and Minimal Residual Disease in Genitourinary Cancers

Review

Author: Hofman, Michael S ; Powles, Thomas ; Zarrabi, Kevin K ; Grivas, Petros ; Barata, Pedro C ; Lopez-Beltran, Antonio ; Bex, Axel ; Taplin, Mary-Ellen ; Padani, Anwar R ; Li, Roger ; Hermann, Ken ; Loriot, Yohann

BACKGROUND AND OBJECTIVEAdvances in molecular diagnostics have ushered in a new era for patients with prostate, renal, and urothelial cancers, with novel radiographic and molecular modalities for the assessment of disease burden and minimal residual disease (MRD). Conventional imaging has a limited threshold for disease detection and is often unable to discern clinically occult disease with varying risks of false-negative or false-positive findings depending on the disease state and type of imaging.METHODSWe provide an overview of emerging radiographic and molecular tools in development within the genitourinary (GU) disease space. A literature review of contemporary basic, translational, and clinical research studies was performed, covering the timeframe of 1980-2024 through the MEDLINE (via PubMed) and Scopus databases. We highlight select examples of emerging technologies and biomarker-informed clinical trials, which aim to quantify disease at lower thresholds and have the potential for integrating MRD in clinical practice for GU patients.KEY FINDINGS AND LIMITATIONSThe development of novel radiotracers, such as prostate-specific membrane antigen or carbonic anhydrase IX, is being evaluated in both clinical practice and trial setting, aiming to change the management of these tumors. Molecular tools including circulating tumor cells and byproducts such as plasma and urine cell-free circulating tumor DNA provide the opportunity for MRD detection. MRD capture on single-cell or cellular byproducts can serve as a conduit for genomic and transcriptomic analyses, providing insight into the molecular underpinnings and clonal evolution of disease.CONCLUSIONS AND CLINICAL IMPLICATIONSWhile the full potential for MRD applications has yet to be realized, we are witnessing the emergence of novel techniques aimed at MRD detection and the rapid development of elegantly designed studies implementing iterative detection of MRD as means to provide biological rationale and tailor therapeutic options in GU tumors.

01 Apr 2025·Radiology

Requirements for AI Development and Reporting for MRI Prostate Cancer Detection in Biopsy-Naive Men: PI-RADS Steering Committee, Version 1.0

Review

Author: Huisman, Henkjan ; Padhani, Anwar R ; Rouvière, Olivier ; Tempany, Clare M ; Haider, Masoom A ; Turkbey, Baris ; Bittencourt, Leonardo K ; Oto, Aytekin ; Macura, Katarzyna J ; Schoots, Ivo G ; Panebianco, Valeria ; Margolis, Daniel J ; Fedorov, Andriy ; Moore, Caroline M ; Siddiqui, M Minhaj

This document provides guidance based on subspecialty expertise from the Prostate Imaging Reporting and Data System Steering Committee for the development of an artificial intelligence interpretation model for prostate cancer in biopsy-naive men.

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