Pan-Segmental Intraprostatic Lesions Involving Mid-Gland and Apex of Prostate (Mid-Apical Lesions): Assessing the True Value of Extreme Apical Biopsy Cores

Apical prostate cancer lesions are rare, particularly compared to the rather frequently reported pan-segmental lesions extending from mid-gland to the prostate apex. However, biopsy sampling of apical segment of the gland is not only affected by the biopsy technique limitations e.g. transrectal approach but is also associated with higher morbidity of the procedure due to the proximity of the sphincter region. In pan-segmental mid-apical MRI prostate cancer-suspicious lesions, which are more prevalent than exclusively apex-located lesions, the assessment of the true diagnostic value of anatomic segments of the lesion may allow further tailoring and individualizing of the targeted biopsy strategy through adjustment of the number of biopsy cores taken.

To address this clinical scenario, we compared our institutional standard of bioptic saturation of the lesion with two theoretical targeted biopsy protocols utilizing 1-core vs.2-cores per anatomical segment of the lesion. Moreover, we aimed to assess an additional diagnostic yield of apical segment of the lesion.

As a result, we observed an up to 12% higher prostate cancer yield per segment or both, mid-gland and apex, combined if at least two cores were sampled per anatomical segment compared to only one core per segment. However, compared to the unstratified overall cohort with a respective median number of cores of 4 (IQR 3-6) and 3 (IQR 2-4) for mid-gland and apical segments, respectively, we observed that the apical sampling with two cores appears to be sufficient. This finding emphasizes that the initially higher number of targeted biopsy cores used for prostate cancer detection within the apical segment of mid-apical lesions could be optimized. Moreover, an additional yield of 8.1% prostate cancer Gleason score ≥3+4 of the apical TBx demonstrates that extreme apical targeting should not be spared from an oncological standpoint.

We demonstrate that sampling of both segments of mid-apical lesions avoids undersampling. Moreover, our findings suggest that a higher number of targeted biopsy cores sampled from the mid-gland segment might be avoided if the biopsy strategy is complemented with two extreme apical targeted biopsy cores. However, sparing extreme apical targeted biopsy sampling to avoid proximity to the sphincter resulted in decreased diagnostic accuracy.

Written by: Sami-Ramzi Leyh-Bannurah,¹Svitlana Boiko,² Dirk Beyersdorff,³ Fabian Falkenbach,²Jonas Ekrutt,²Tobias Maurer,²Markus Graefen,²Mykyta Kachanov,²^,4Lars Budäus²

Prostate Center Northwest, Department of Urology, Pediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Read the Abstract

Login