title: Characterizing clinically significant prostate cancer using template prostate mapping biopsy.
abstract: OBJECTIVE
  Definitions of prostate cancer risk are limited since accurate attribution of the cancer grade and burden is not possible due to the random and systematic errors associated with transrectal ultrasound guided biopsy. Transperineal prostate mapping biopsy may have a role in accurate risk stratification. We defined the transperineal prostate mapping biopsy characteristics of clinically significant disease.
  
  
  METHODS
  A 3-dimensional model of each gland and individual cancer was reconstructed using 107 radical whole mount specimens. We performed 500 transperineal prostate mapping simulations per case by varying needle targeting errors to calculate sensitivity, specificity, and negative and positive predictive value to detect lesions 0.2 ml or greater, or 0.5 ml or greater. Definitions of clinically significant cancer based on a combination of Gleason grade and cancer burden (cancer core length) were derived.
  
  
  RESULTS
  Mean±SD patient age was 61±6.4 years (range 44 to 74) and mean prostate specific antigen was 9.7±5.9 ng/ml (range 0.8 to 36.2). We reconstructed 665 foci. The total cancer core length from all positive biopsies for a particular lesion that detected more than 95% of lesions 0.5 ml or greater and 0.2 ml or greater was 10 mm or greater and 6 mm or greater, respectively. The maximum cancer core length that detected more than 95% of lesions 0.5 ml or greater and 0.2 ml or greater was 6 mm or greater and 4 mm or greater, respectively. We combined these cancer burden thresholds with dominant and nondominant Gleason pattern 4 to derive 2 definitions of clinically significant disease.
  
  
  CONCLUSIONS
  Transperineal prostate mapping may provide an effective method to risk stratify men with localized prostate cancer. The definitions that we present require prospective validation.
authors.affiliation: Division of Surgery and Interventional Science, Centre for Medical Imaging Computing, University College London, Department of Histopathology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom. hashim.ahmed@ucl.ac.uk
authors.forename: Hashim Uddin
authors.initials: HU
authors.lastname: Ahmed
authors.forename: Yipeng
authors.initials: Y
authors.lastname: Hu
authors.forename: Tim
authors.initials: T
authors.lastname: Carter
authors.forename: Nimalan
authors.initials: N
authors.lastname: Arumainayagam
authors.forename: Emilie
authors.initials: E
authors.lastname: Lecornet
authors.forename: Alex
authors.initials: A
authors.lastname: Freeman
authors.forename: David
authors.initials: D
authors.lastname: Hawkes
authors.forename: Dean C
authors.initials: DC
authors.lastname: Barratt
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D003198:Computer Simulation; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies