Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer
Objectives To assess the value of risk‐stratification based on magnetic resonance imaging (MRI) and prostate‐specific antigen density (PSA‐D) in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer in men on active surveillance (AS). Patients and Methods In all, 210 men on...
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| Veröffentlicht in: | BJU international 2017-10, Vol.120 (4), p.511-519 |
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| creator | Alberts, Arnout R. Roobol, Monique J. Drost, Frank‐Jan H. Leenders, Geert J. Bokhorst, Leonard P. Bangma, Chris H. Schoots, Ivo G. |
| description | Objectives
To assess the value of risk‐stratification based on magnetic resonance imaging (MRI) and prostate‐specific antigen density (PSA‐D) in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer in men on active surveillance (AS).
Patients and Methods
In all, 210 men on AS with Gleason score 3 + 3 prostate cancer received a first MRI and if indicated [Prostate Imaging Reporting and Data System (PI‐RADS) score ≥3] targeted biopsy (TBx) using MRI‐transrectal ultrasonography (TRUS) fusion. The MRI was performed 3 months after diagnosis (group A: n = 97), at confirmatory biopsy (group B: n = 39) or at surveillance biopsy after one or more repeat TRUS‐guided systematic biopsies (TRUS‐Bx) (group C: n = 74). The primary outcome was upgrading to Gleason score ≥3 + 4 prostate cancer based on MRI ± TBx in groups A, B and C. Biopsy outcomes were stratified for the overall PI‐RADS score and PSA‐D to identify a subgroup of men in whom a biopsy could have been avoided as no Gleason score upgrading was detected.
Results
In all, 134/210 (64%) men had a positive MRI and 51/210 (24%) men had Gleason score upgrading based on MRI‐TBx. The percentage of Gleason score upgrading based on MRI‐TBx was 23% (22/97), 23% (9/39) and 27% (20/74) in respectively groups A, B and C. Additional Gleason score upgrading detected by TRUS‐Bx occurred in 8% (3/39) of men in group B and 6% (1/17) of men who received TRUS‐Bx in group C. No Gleason score upgrading was detected by MRI‐TBx in men with a PI‐RADS score of 3 and a PSA‐D of |
| doi_str_mv | 10.1111/bju.13836 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1875400374</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1875400374</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3886-77af6e18c8cd8ce4a47e43f530eecf20a1fb053df2278d638b74be6fc9d64afe3</originalsourceid><addsrcrecordid>eNp1kc1u1TAQhS0Eoj-w4AWQJTZ0cVs79nWcJa1oAVVCQlRiFznO-MqXXDvYSavseATerW_QJ2HStF0g4YVtTb45c5xDyBvOjjmuk2Y7HnOhhXpG9rlUciU5-_H88c4qtUcOct4yhgW1fkn2Cl2oUlfVPrn95vPPu99_8pDM4J23uMdAG5OhpXjZmU2AwVuaIMdgggXqsebDhprQ0j7FPJgBZoUe7CyA9cFvINAWQvbDhBITdrcjto4hgIWcTZqoi10Xb7Bx7GnjY5-nWc0iiKOox9GogQ6MHfw10Dyma_Bdd2_BxUSX5oT2n1xQO39Nr8gLZ7oMrx_OQ3J1_vH72afV5deLz2cfLldWaK1WZWmcAq6ttq22II0sQQq3FgzAuoIZ7hq2Fq0rilK3SuimlA0oZ6tWSeNAHJL3iy7O_zVCHuqdzxZmjxDHXHNdriVjopSIvvsH3cYxBXRX8woZDEpUSB0tlMUH5QSu7hP-7TTVnNVz0jUmXd8njezbB8Wx2UH7RD5Gi8DJAtz4Dqb_K9WnX64Wyb_zXb3Z</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1940046439</pqid></control><display><type>article</type><title>Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Alberts, Arnout R. ; Roobol, Monique J. ; Drost, Frank‐Jan H. ; Leenders, Geert J. ; Bokhorst, Leonard P. ; Bangma, Chris H. ; Schoots, Ivo G.</creator><creatorcontrib>Alberts, Arnout R. ; Roobol, Monique J. ; Drost, Frank‐Jan H. ; Leenders, Geert J. ; Bokhorst, Leonard P. ; Bangma, Chris H. ; Schoots, Ivo G.</creatorcontrib><description>Objectives
To assess the value of risk‐stratification based on magnetic resonance imaging (MRI) and prostate‐specific antigen density (PSA‐D) in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer in men on active surveillance (AS).
Patients and Methods
In all, 210 men on AS with Gleason score 3 + 3 prostate cancer received a first MRI and if indicated [Prostate Imaging Reporting and Data System (PI‐RADS) score ≥3] targeted biopsy (TBx) using MRI‐transrectal ultrasonography (TRUS) fusion. The MRI was performed 3 months after diagnosis (group A: n = 97), at confirmatory biopsy (group B: n = 39) or at surveillance biopsy after one or more repeat TRUS‐guided systematic biopsies (TRUS‐Bx) (group C: n = 74). The primary outcome was upgrading to Gleason score ≥3 + 4 prostate cancer based on MRI ± TBx in groups A, B and C. Biopsy outcomes were stratified for the overall PI‐RADS score and PSA‐D to identify a subgroup of men in whom a biopsy could have been avoided as no Gleason score upgrading was detected.
Results
In all, 134/210 (64%) men had a positive MRI and 51/210 (24%) men had Gleason score upgrading based on MRI‐TBx. The percentage of Gleason score upgrading based on MRI‐TBx was 23% (22/97), 23% (9/39) and 27% (20/74) in respectively groups A, B and C. Additional Gleason score upgrading detected by TRUS‐Bx occurred in 8% (3/39) of men in group B and 6% (1/17) of men who received TRUS‐Bx in group C. No Gleason score upgrading was detected by MRI‐TBx in men with a PI‐RADS score of 3 and a PSA‐D of <0.15 ng/mL2(n = 15), nor by TRUS‐Bx in men with a PI‐RADS score of 1–3 and a PSA‐D of <0.15 ng/mL2 (n = 15).
Conclusion
At least one out of five men on AS with Gleason score 3 + 3 prostate cancer at diagnostic TRUS‐Bx show Gleason score upgrading based on first MRI ± TBx at baseline, confirmatory or surveillance biopsy. Men with a PI‐RADS score of 1–3 and PSA‐D of <0.15 ng/mL2 did not show Gleason score upgrading at MRI ± TBx or TRUS‐Bx at each time point of surveillance. Thus risk‐stratification based on PI‐RADS and PSA‐D may reduce unnecessary follow‐up biopsy procedures in men on AS.</description><identifier>ISSN: 1464-4096</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/bju.13836</identifier><identifier>PMID: 28267899</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>active surveillance ; Aged ; Antigens ; Biopsy ; Biopsy, Needle ; Cohort Studies ; Follow-Up Studies ; Humans ; Image-Guided Biopsy - methods ; Immunohistochemistry ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; Neoplasm Grading ; Netherlands ; NMR ; Nuclear magnetic resonance ; PCSM ; Prostate cancer ; Prostate-specific antigen ; Prostate-Specific Antigen - blood ; ProstateCancer ; Prostatic Neoplasms - diagnostic imaging ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - therapy ; PSA density ; Retrospective Studies ; Risk Assessment ; Surveillance ; target biopsy ; Time Factors ; Ultrasound ; Unnecessary Procedures ; Watchful Waiting</subject><ispartof>BJU international, 2017-10, Vol.120 (4), p.511-519</ispartof><rights>2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd</rights><rights>2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.</rights><rights>BJUI © 2017 BJU International</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3886-77af6e18c8cd8ce4a47e43f530eecf20a1fb053df2278d638b74be6fc9d64afe3</citedby><cites>FETCH-LOGICAL-c3886-77af6e18c8cd8ce4a47e43f530eecf20a1fb053df2278d638b74be6fc9d64afe3</cites><orcidid>0000-0003-4358-2840</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbju.13836$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbju.13836$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28267899$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alberts, Arnout R.</creatorcontrib><creatorcontrib>Roobol, Monique J.</creatorcontrib><creatorcontrib>Drost, Frank‐Jan H.</creatorcontrib><creatorcontrib>Leenders, Geert J.</creatorcontrib><creatorcontrib>Bokhorst, Leonard P.</creatorcontrib><creatorcontrib>Bangma, Chris H.</creatorcontrib><creatorcontrib>Schoots, Ivo G.</creatorcontrib><title>Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>Objectives
To assess the value of risk‐stratification based on magnetic resonance imaging (MRI) and prostate‐specific antigen density (PSA‐D) in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer in men on active surveillance (AS).
Patients and Methods
In all, 210 men on AS with Gleason score 3 + 3 prostate cancer received a first MRI and if indicated [Prostate Imaging Reporting and Data System (PI‐RADS) score ≥3] targeted biopsy (TBx) using MRI‐transrectal ultrasonography (TRUS) fusion. The MRI was performed 3 months after diagnosis (group A: n = 97), at confirmatory biopsy (group B: n = 39) or at surveillance biopsy after one or more repeat TRUS‐guided systematic biopsies (TRUS‐Bx) (group C: n = 74). The primary outcome was upgrading to Gleason score ≥3 + 4 prostate cancer based on MRI ± TBx in groups A, B and C. Biopsy outcomes were stratified for the overall PI‐RADS score and PSA‐D to identify a subgroup of men in whom a biopsy could have been avoided as no Gleason score upgrading was detected.
Results
In all, 134/210 (64%) men had a positive MRI and 51/210 (24%) men had Gleason score upgrading based on MRI‐TBx. The percentage of Gleason score upgrading based on MRI‐TBx was 23% (22/97), 23% (9/39) and 27% (20/74) in respectively groups A, B and C. Additional Gleason score upgrading detected by TRUS‐Bx occurred in 8% (3/39) of men in group B and 6% (1/17) of men who received TRUS‐Bx in group C. No Gleason score upgrading was detected by MRI‐TBx in men with a PI‐RADS score of 3 and a PSA‐D of <0.15 ng/mL2(n = 15), nor by TRUS‐Bx in men with a PI‐RADS score of 1–3 and a PSA‐D of <0.15 ng/mL2 (n = 15).
Conclusion
At least one out of five men on AS with Gleason score 3 + 3 prostate cancer at diagnostic TRUS‐Bx show Gleason score upgrading based on first MRI ± TBx at baseline, confirmatory or surveillance biopsy. Men with a PI‐RADS score of 1–3 and PSA‐D of <0.15 ng/mL2 did not show Gleason score upgrading at MRI ± TBx or TRUS‐Bx at each time point of surveillance. Thus risk‐stratification based on PI‐RADS and PSA‐D may reduce unnecessary follow‐up biopsy procedures in men on AS.</description><subject>active surveillance</subject><subject>Aged</subject><subject>Antigens</subject><subject>Biopsy</subject><subject>Biopsy, Needle</subject><subject>Cohort Studies</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Image-Guided Biopsy - methods</subject><subject>Immunohistochemistry</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Netherlands</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>PCSM</subject><subject>Prostate cancer</subject><subject>Prostate-specific antigen</subject><subject>Prostate-Specific Antigen - blood</subject><subject>ProstateCancer</subject><subject>Prostatic Neoplasms - diagnostic imaging</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - therapy</subject><subject>PSA density</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surveillance</subject><subject>target biopsy</subject><subject>Time Factors</subject><subject>Ultrasound</subject><subject>Unnecessary Procedures</subject><subject>Watchful Waiting</subject><issn>1464-4096</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1u1TAQhS0Eoj-w4AWQJTZ0cVs79nWcJa1oAVVCQlRiFznO-MqXXDvYSavseATerW_QJ2HStF0g4YVtTb45c5xDyBvOjjmuk2Y7HnOhhXpG9rlUciU5-_H88c4qtUcOct4yhgW1fkn2Cl2oUlfVPrn95vPPu99_8pDM4J23uMdAG5OhpXjZmU2AwVuaIMdgggXqsebDhprQ0j7FPJgBZoUe7CyA9cFvINAWQvbDhBITdrcjto4hgIWcTZqoi10Xb7Bx7GnjY5-nWc0iiKOox9GogQ6MHfw10Dyma_Bdd2_BxUSX5oT2n1xQO39Nr8gLZ7oMrx_OQ3J1_vH72afV5deLz2cfLldWaK1WZWmcAq6ttq22II0sQQq3FgzAuoIZ7hq2Fq0rilK3SuimlA0oZ6tWSeNAHJL3iy7O_zVCHuqdzxZmjxDHXHNdriVjopSIvvsH3cYxBXRX8woZDEpUSB0tlMUH5QSu7hP-7TTVnNVz0jUmXd8njezbB8Wx2UH7RD5Gi8DJAtz4Dqb_K9WnX64Wyb_zXb3Z</recordid><startdate>201710</startdate><enddate>201710</enddate><creator>Alberts, Arnout R.</creator><creator>Roobol, Monique J.</creator><creator>Drost, Frank‐Jan H.</creator><creator>Leenders, Geert J.</creator><creator>Bokhorst, Leonard P.</creator><creator>Bangma, Chris H.</creator><creator>Schoots, Ivo G.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4358-2840</orcidid></search><sort><creationdate>201710</creationdate><title>Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer</title><author>Alberts, Arnout R. ; Roobol, Monique J. ; Drost, Frank‐Jan H. ; Leenders, Geert J. ; Bokhorst, Leonard P. ; Bangma, Chris H. ; Schoots, Ivo G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3886-77af6e18c8cd8ce4a47e43f530eecf20a1fb053df2278d638b74be6fc9d64afe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>active surveillance</topic><topic>Aged</topic><topic>Antigens</topic><topic>Biopsy</topic><topic>Biopsy, Needle</topic><topic>Cohort Studies</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Image-Guided Biopsy - methods</topic><topic>Immunohistochemistry</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Netherlands</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>PCSM</topic><topic>Prostate cancer</topic><topic>Prostate-specific antigen</topic><topic>Prostate-Specific Antigen - blood</topic><topic>ProstateCancer</topic><topic>Prostatic Neoplasms - diagnostic imaging</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - therapy</topic><topic>PSA density</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Surveillance</topic><topic>target biopsy</topic><topic>Time Factors</topic><topic>Ultrasound</topic><topic>Unnecessary Procedures</topic><topic>Watchful Waiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alberts, Arnout R.</creatorcontrib><creatorcontrib>Roobol, Monique J.</creatorcontrib><creatorcontrib>Drost, Frank‐Jan H.</creatorcontrib><creatorcontrib>Leenders, Geert J.</creatorcontrib><creatorcontrib>Bokhorst, Leonard P.</creatorcontrib><creatorcontrib>Bangma, Chris H.</creatorcontrib><creatorcontrib>Schoots, Ivo G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>BJU international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alberts, Arnout R.</au><au>Roobol, Monique J.</au><au>Drost, Frank‐Jan H.</au><au>Leenders, Geert J.</au><au>Bokhorst, Leonard P.</au><au>Bangma, Chris H.</au><au>Schoots, Ivo G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer</atitle><jtitle>BJU international</jtitle><addtitle>BJU Int</addtitle><date>2017-10</date><risdate>2017</risdate><volume>120</volume><issue>4</issue><spage>511</spage><epage>519</epage><pages>511-519</pages><issn>1464-4096</issn><eissn>1464-410X</eissn><abstract>Objectives
To assess the value of risk‐stratification based on magnetic resonance imaging (MRI) and prostate‐specific antigen density (PSA‐D) in reducing unnecessary biopsies without missing Gleason pattern 4 prostate cancer in men on active surveillance (AS).
Patients and Methods
In all, 210 men on AS with Gleason score 3 + 3 prostate cancer received a first MRI and if indicated [Prostate Imaging Reporting and Data System (PI‐RADS) score ≥3] targeted biopsy (TBx) using MRI‐transrectal ultrasonography (TRUS) fusion. The MRI was performed 3 months after diagnosis (group A: n = 97), at confirmatory biopsy (group B: n = 39) or at surveillance biopsy after one or more repeat TRUS‐guided systematic biopsies (TRUS‐Bx) (group C: n = 74). The primary outcome was upgrading to Gleason score ≥3 + 4 prostate cancer based on MRI ± TBx in groups A, B and C. Biopsy outcomes were stratified for the overall PI‐RADS score and PSA‐D to identify a subgroup of men in whom a biopsy could have been avoided as no Gleason score upgrading was detected.
Results
In all, 134/210 (64%) men had a positive MRI and 51/210 (24%) men had Gleason score upgrading based on MRI‐TBx. The percentage of Gleason score upgrading based on MRI‐TBx was 23% (22/97), 23% (9/39) and 27% (20/74) in respectively groups A, B and C. Additional Gleason score upgrading detected by TRUS‐Bx occurred in 8% (3/39) of men in group B and 6% (1/17) of men who received TRUS‐Bx in group C. No Gleason score upgrading was detected by MRI‐TBx in men with a PI‐RADS score of 3 and a PSA‐D of <0.15 ng/mL2(n = 15), nor by TRUS‐Bx in men with a PI‐RADS score of 1–3 and a PSA‐D of <0.15 ng/mL2 (n = 15).
Conclusion
At least one out of five men on AS with Gleason score 3 + 3 prostate cancer at diagnostic TRUS‐Bx show Gleason score upgrading based on first MRI ± TBx at baseline, confirmatory or surveillance biopsy. Men with a PI‐RADS score of 1–3 and PSA‐D of <0.15 ng/mL2 did not show Gleason score upgrading at MRI ± TBx or TRUS‐Bx at each time point of surveillance. Thus risk‐stratification based on PI‐RADS and PSA‐D may reduce unnecessary follow‐up biopsy procedures in men on AS.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28267899</pmid><doi>10.1111/bju.13836</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4358-2840</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | active surveillance Aged Antigens Biopsy Biopsy, Needle Cohort Studies Follow-Up Studies Humans Image-Guided Biopsy - methods Immunohistochemistry Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Middle Aged Neoplasm Grading Netherlands NMR Nuclear magnetic resonance PCSM Prostate cancer Prostate-specific antigen Prostate-Specific Antigen - blood ProstateCancer Prostatic Neoplasms - diagnostic imaging Prostatic Neoplasms - pathology Prostatic Neoplasms - therapy PSA density Retrospective Studies Risk Assessment Surveillance target biopsy Time Factors Ultrasound Unnecessary Procedures Watchful Waiting |
| title | Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer |
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