title: TOP: Prospective Evaluation of a Volume Based, Computer Assisted Method for Transperineal Optimized Prostate Biopsy.
abstract: OBJECTIVE
  This study is a prospective evaluation of a volume-based, computer-assisted method for transperineal optimized prostate (TOP) biopsy. The TOP algorithm automates core planning for systematic prostate biopsies using the 3-dimensional organ contour and an alterable volume for tumors to be excluded.
  
  
  METHODS
  MRI-transrectal ultrasound fusion biopsy with MRI-targeted biopsies (TBs) and systematic-TOP biopsies were performed on 172 men between October 2013 and March 2014. Systematic biopsies were placed according to TOP for detection of tumor volumes >0.5 mL with a minimum of 80% organ coverage in prostates up to 50 mL (70% in larger organs).
  
  
  RESULTS
  Median 24 TOP cores and 3 MRI-TBs have been placed. Prostate cancer (PCa) was detected in 112 of 172 (65%) of men; TOP detected 109 (97%) and TB 62 (55%). Significant cancer (Gleason score ≥7) was detected in 75 (44%) of men and of these TOP detected 73 of 75 (97%) and TB 51 of 75 (68%). Overall, systematic-TOP sampling significantly outperformed TB for the detection of both, all PCa as well as significant PCa (p < 0.0001, p = 0.0005).
  
  
  CONCLUSIONS
  The TOP method is innovative by integrating the individual prostate volume and PCa volume detection thresholds. In the present cohort, it diagnosed more significant tumors than TB alone. However, at the same time, more low-risk tumors are detected.
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Kesch
authors.forename: Jan Philipp
authors.initials: JP
authors.lastname: Radtke
authors.forename: Ionel Valentin
authors.initials: IV
authors.lastname: Popeneciu
authors.forename: Claudia
authors.initials: C
authors.lastname: Gasch
authors.forename: Svenja C
authors.initials: SC
authors.lastname: Dieffenbacher
authors.forename: Tilman
authors.initials: T
authors.lastname: Klein
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Wieczorek
authors.forename: Pawel
authors.initials: P
authors.lastname: Zogal
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: Georgios
authors.initials: G
authors.lastname: Sakas
authors.forename: Boris Alexander
authors.initials: BA
authors.lastname: Hadaschik
mesh_terms: D000368:Aged; D000465:Algorithms; D001331:Automation; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D061705:Image-Guided Biopsy / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D012307:Risk Factors; D047368:Tumor Burden; D018084:Ultrasonography, Interventional
keywords: Prostate biopsy; Prostate cancer; Transperineal biopsy; Transperineal template-guided mapping biopsy; Transperineal template-guided saturation biopsy