Reducing timelines in a time of increased demands

• To work collaboratively with all those involved in the pathway
• Try and trim off time at each step of the pathway without compromising patient care

mpMRI and biopsy

• Target the lesion, sample the other side
• Once you are happy with your MRI/targeted biopsy pathway, allow men with a negative MRI and low PSA density to choose not to have standard biopsy
• mpMRI is an effective, validated diagnostic tool in the detection of prostate cancer but, as a limited resource, should be used wisely and appropriately.
• Urologists should refrain from undertaking routine transrectal biopsy in patients with a marginally raised PSA without considering all factors in the decision making process e.g. FHX, DRE findings, BRCA status, MRI findings and PSA density.
• Transrectal biopsy is not without its morbidity and should not be used as a screening biopsy tool.

 Pathology in the pathway

• Clinicians do not need knowledge of histology but must be able to interpret pathology report data correctly
• Prostate biopsy report interpretation has several unique features. “Headline” figures may be misleading
• Grade and stage are biological continuums with subjective cut-offs. In borderline cases, effective communication is more important than the accuracy of assigned grade/stage.

Patient’s perspective from the CNS

• Consider what patients expect and require from the referral process and what constitutes a good patient experience
• Understand the MRI, understand the patient, plan a strategy

 

Editorial: Gleason score assignment is the sole responsibility of the pathologist Murali Varma, Dan Berney, Jon Oxley, Kiril Trpkov
Histopathology 2018;73:5-7.  https://onlinelibrary.wiley.com/doi/abs/10.1111/his.13472
J Clin Pathol 2018;71:874-878  https://jcp.bmj.com/content/71/10/874.abstract

Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study Hashim UAhmedFRCS^ab* AhmedEl-Shater BosailyMBBCh^ab* Louise CBrownPhD^d* RhianGabePhD^e ProfRichardKaplanFRCP^d ProfMahesh KParmarDPhil^d  YolandaCollaco-MoraesPhD^d KatieWardBSc^d Richard GHindleyFRCS^f AlexFreemanFRCPath^g Alex PKirkhamFRCR^h RobertOldroydMAⁱ  ChrisParkerFRCR^c  ProfMarkEmbertonFRCS^abPROMIS study group^†

MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis Veeru Kasivisvanathan, M.R.C.S., Antti S. Rannikko, Ph.D., Marcelo Borghi, M.D., Valeria Panebianco, M.D., Lance A. Mynderse, M.D., Markku H. Vaarala, Ph.D., Alberto Briganti, Ph.D., Lars Budäus, M.D., Giles Hellawell, F.R.C.S.(Urol.), Richard G. Hindley, et al., for the PRECISION Study Group Collaborators^*

A Prospective, Blinded Comparison of Magnetic Resonance (MR) Imaging–Ultrasound Fusion and Visual Estimation in the Performance of MR-targeted Prostate Biopsy: The PROFUS Trial James S.Wysock^a Andrew B.Rosenkrantz^b William C.Huang^a Michael D.Stifelman^a HerbertLepor^a Fang-MingDeng^c  JonathanMelamed^c  Samir S.Taneja^a
Eur Urol. 2018 Jul;74(1):48-54. doi: 10.1016/j.eururo.2018.03.007. Epub 2018 Mar 19.

Negative Multiparametric Magnetic Resonance Imaging for Prostate Cancer: What’s Next? Panebianco V¹, Barchetti G², Simone G³, Del Monte M⁴, Ciardi A⁴, Grompone MD⁴, Campa R⁴, Indino EL⁴, Barchetti F⁴, Sciarra A⁵, Leonardo C⁵, Gallucci M³, Catalano C⁶.

Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI‐transrectal ultrasonography (TRUS) fusion‐guided transperineal prostate biopsies as a validation tool Gabriele Gaziev, Karan Wadhwa, Tristan Barrett, Brendan C. Koo, Ferdia A. Gallagher, Eva Serrao, Julia Frey, Jonas Seidenader, Lina Carmona, Anne Warren.

Combination of prostate imaging reporting and data system (PI‐RADS) score and prostate‐specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naïve patients Satoshi Washino, Tomohisa Okochi, Kimitoshi Saito, Tsuzumi Konishi, Masaru Hirai, Yutaka Kobayashi, Tomoaki Miyagawa

Nuclear Magnetic Resonance Imaging of the Prostate H. Steyn, W. Smith  First published: December 1982  British Journal of Urology – Volume 54, Issue 6

NMR scanning of the pelvis: initial experience with a 0.3 T system PJ Bryan, HE Butler, JP LiPuma, Haaga, JR … Show all

MR imaging of the prostate gland: normal anatomy H Hricak, GC Dooms, JE McNeal, AS Mark.

Magnetic Resonance Imaging for the Detection, Localisation, and Characterisation of Prostate Cancer: Recommendations from a European Consensus Meeting LouiseDickinson^abc Hashim U.Ahmed^ab ClareAllen^d  Jelle O.Barentsz^e BrendanCarey^f Jurgen J.Futterer^e  Stijn W.Heijmink^e Peter J.Hoskin^g AlexKirkham^d Anwar R.Padhani^h RajPersadⁱ  PhilippePuech^j  ShonitPunwani^d Aslam S.Sohaib^k BertrandTombal^l ArnauldVillers^m Janvan der Meulen^cn  MarkEmberton^abc

DWI of Prostate Cancer: Optimal -Value in Clinical Practice Guglielmo Manenti,¹ Marco Nezzo,¹ Fabrizio Chegai,¹ Erald Vasili,¹Elena Bonanno,² and Giovanni Simonetti¹

The impact of computed high b-value images on the diagnostic accuracy of DWI for prostate cancer: A receiver operating characteristics analysis Peigang Ning, Dapeng Shi, Geoffrey A. Sonn, Shreyas S. Vasanawala, Andreas M. Loening, Pejman Ghanouni, Piotr Obara, Lewis K. Shin, Richard E. Fan, Brian A. Hargreaves & Bruce L. Daniel  Journal of Magnetic Resonance Imaging Volume 36, Issue 1

Clinical utility of apparent diffusion coefficient values obtained using high b‐value when diagnosing prostate cancer using 3 tesla MRI: Comparison between ultra‐high b‐value (2000 s/mm²) and standard high b‐value (1000 s/mm²) Kazuhiro Kitajima MD, PhD, Satoru Takahashi MD, PhD, Yoshiko Ueno MD, Takeshi Yoshikawa MD, PhD, Yoshiharu Ohno MD, PhD, Makoto Obara PhD… See all authors 

National implementation of multi‐parametric magnetic resonance imaging for prostate cancer detection – recommendations from a UK consensus meeting Mrishta Brizmohun Appayya, ¹ Jim Adshead, ² Hashim U. Ahmed, ^{3 , 4}Clare Allen, ⁵ Alan Bainbridge, ⁶ Tristan Barrett, ⁷ Francesco Giganti, ^{3 , 5}John Graham, ⁸ Phil Haslam, ⁹ Edward W. Johnston, ^{1 , 5}Christof Kastner, ¹⁰ Alexander P.S. Kirkham, ⁵ Alexandra Lipton, ¹¹Alan McNeill, ¹² Larissa Moniz, ¹³ Caroline M. Moore, ^{4 , 14} Ghulam Nabi, ¹⁵ Anwar R. Padhani, ¹⁶ Chris Parker, ¹⁷ Amit Patel, ¹⁸Jacqueline Pursey, ¹⁹ Jonathan Richenberg, ²⁰  John Staffurth,  ²¹Jan van der Meulen, ²² Darren Walls, ²³ and Shonit Punwani ^{1 , 5}

Eur Radiol. 2012 Apr;22(4):746-57. doi: 10.1007/s00330-011-2377-y. Epub 2012 Feb 10.

ESUR prostate MR guidelines 2012 Barentsz JO¹, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, Rouviere O, Logager V, Fütterer JJ; European Society of Urogenital Radiology.

PI-RADS Prostate Imaging – Reporting and Data System: 2015, Version 2Jeffrey C.Weinreb^a† Jelle O.Barentsz^b† Peter L.Choyke^c FrancoisCornud^d Masoom A.Haider^e Katarzyna J.Macura^f DanielMargolis^g Mitchell D.Schnall^h FainaShternⁱ Clare M.Tempany^j Harriet C.Thoeny^k SadnaVerma^l

Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use Jelle O. Barentsz. Correspondence information about the author Jelle O. Barentsz, Jeffrey C. Weinreb, Sadhna Verma, Harriet C. Thoeny, Clare M. Tempany, Faina Shtern, Anwar R. Padhani, Daniel Margolis, Katarzyna J. Macura, Masoom A. Haider, Francois Cornud, Peter L. Choyke  Journal of Magnetic Resonance Imaging Volume 48, Issue 2

All over the map: An interobserver agreement study of tumor location based on the PI-RADSv2 sector map Matthew D. Greer MD, Joanna H. Shih PhD, Tristan Barrett MD, Sandra Bednarova MD, Ismail Kabakus MD, Yan Mee Law MD, Haytham Shebel MD, Maria J. Merino MD… See all authors   First published: 17 January 2018

Prostate MRI: Who, when, and how? Report from a UK consensus meeting A.P.S.Kirkham^a P.Haslam^b J.Y.Keanie^c I.McCafferty^d A.R.Padhani^e S.Punwani^a J.Richenberg^f G.Rottenberg^g A.Sohaib^h P.Thompson^f L.W.Turnbullⁱ L.Kurban^j A.Sahdev^k   R.Clements^l B.M.Carey^m C.Allen^a

Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer: The PRECISE Recommendations—A Report of a European School of Oncology Task Force Caroline M.Moore^ab‡ FrancescoGiganti^cd‡ PeterAlbertsen^e ClareAllen^c ChrisBangma^f AlbertoBriganti^g PeterCarroll^h MasoomHaider ⁱVeeruKasivisvanathan^ab AlexKirkham^c LaurenceKlotz^j AdilOuzzane^k   Anwar R.Padhani^l ValeriaPanebianco^m PeterPintoⁿ PhilippePuech^o AnttiRannikko^p RaphaeleRenard-Penna^q IvoSchoots^x

Sequential prostate MRI reporting in men on active surveillance: initial experience of a dedicated PRECISE software program FrancescoGiganti^ab ClareAllen^a Jonathan W.Piper^c DavidMirando^c ArmandoStabile^{bd e}ShonitPunwani^af AlexKirkham^a MarkEmberton^be Caroline M.Moore^be

A Prospective, Blinded Comparison of Magnetic Resonance (MR) Imaging–Ultrasound Fusion and Visual Estimation in the Performance of MR-targeted Prostate Biopsy: The PROFUS Trial

European Urology Volume 66, Issue 2, August 2014, Pages 343-351 James S.Wysock^a Andrew B.Rosenkrantz^b William C.Huang^a Michael D.Stifelman^a HerbertLepor^a Fang-MingDeng^c JonathanMelamed^c Samir S.Taneja^a  BJU International    Volume 117, Issue 1

Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI‐transrectal ultrasonography (TRUS) fusion‐guided transperineal prostate biopsies as a validation tool Gabriele Gaziev, Karan Wadhwa, Tristan Barrett, Brendan C. Koo, Ferdia A. Gallagher, Eva Serrao, Julia Frey, Jonas Seidenader, Lina Carmona, Anne Warren… See all authors  First published: 07 August 2014 BJU International     Volume 119, Issue 2

Combination of prostate imaging reporting and data system (PI‐RADS) score and prostate‐specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naïve patientsSatoshi Washino, Tomohisa Okochi, Kimitoshi Saito, Tsuzumi Konishi, Masaru Hirai, Yutaka Kobayashi, Tomoaki Miyagawa   First published: 02 March 2016

VANGUARDS:  ‘Each vanguard will take a lead on the development of new care models which will act as the blueprints for the NHS moving forward and the inspiration to the rest of the health and care system’(www.england.nhs.uk/ourwork/futurenhs/new-care-models)

 

 

Coming soon…..

TIPTOP – Greater Manchester 12th February 2019 Final programme for TIPTOP 12.2.19