title: Transrectal ultrasound (TRUS) and TRUS-biopsy accuracy in potential candidates for PRIAS active surveillance protocol.
abstract: OBJECTIVE
  Evaluate the transrectal ultrasound (TRUS) and TRUS-guided Biopsy (TRUS-Bx) accuracy in patients with low risk prostate cancer (PCA) that were potential candidate for PRIAS active surveillance (AS) protocol but underwent to immediate radical prostatectomy (RP).
  
  
  METHODS
  616 men were extracted from our institutional RP database. We selected the patients who met PRIAS inclusion criteria. The primary outcome was to evaluate the positive predictive value (PPV) and the specificity of suspected lesions at TRUS. The secondary outcome was to evaluate the TRUS-Bx accuracy in term of pathological upstaging and pathological upgrading with respect of RP specimen pathology report.
  
  
  RESULTS
  147 men of 616 (23.8%) in our RP database met PRIAS criteria; in this group we found 66 suspected lesions at TRUS examination (66/147: PPV 44.8%). Prostate cancer was really present in the biopsy specimen in only 32/66 of suspected lesions; in 28/66 the suspect lesion at TRUS was in the same position of the index lesion at final pathology. TRUS/biopsy specificity was 48% and TRUS/surgical specimen specificity 39%. TRUS-Bx staging accuracy: upgrading between biopsy and RP was recorded in 57/147 (38%) whereas 30/147 (20%) were upstaged on final pathology up to N1.
  
  
  CONCLUSIONS
  TRUS and TRUS-Bx are insufficient tools to detect the grade, the location and the extent of PCA. New emerging techniques, such as US-MRI fusion biopsy and 3D template-guided transperineal saturation biopsy are promising to minimize the risk of misclassification and therefore to better select the best option of treatment (radical treatments or focal therapies or active surveillance) in each patient with low risk prostate cancer.
authors: Institute of Urology, Polytechnic University of Marche, Azienda O.U. Ospedali Riuniti, Ancona. vlacetera@gmail.com
authors: Vito
authors: V
authors: Lacetera
authors: Andrea Benedetto
authors: AB
authors: Galosi
authors: Ubaldo
authors: U
authors: Cantoro
authors: Francesco
authors: F
authors: Catanzariti
authors: Daniele
authors: D
authors: Mazzaferro
authors: Daniele
authors: D
authors: Cantoro
authors: Luigi
authors: L
authors: Quaresima
authors: Alessandro
authors: A
authors: Conti
authors: Rami
authors: R
authors: Raquban
authors: Rodolfo
authors: R
authors: Montironi
authors: Giovanni
authors: G
authors: Muzzonigro
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D002985:Clinical Protocols; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D014463:Ultrasonography; D057832:Watchful Waiting