It is important to explore strategies reducing the number of SB cores taken to minimize biopsy-related morbidity and patient's discomfort during biopsy. This study aims to optimize prostate biopsy procedures by reducing the number of systematic biopsy (SB) cores while preserving cancer detection rates in the era of combined biopsy.
We prospectively recruited patients with ≥1 magnetic resonance imaging (MRI) lesions and they underwent transperineal combined 12-core SB+3-core targeted prostate biopsy (TB, reference standard). New strategy was defined as a laterally 6-core SB+3-core TB. Patients were served as their own control. Detection rates for overall prostate cancer (PCa) and clinically significant PCa (csPCa) were compared among the standard SB, MRI-TB, 6-core SB +3-core TB, and reference standard. Pathology consistency was assessed using the Kappa test.
A total of 204 men were included, of which 111 (54.41%) and 92 (45.10%) harbored overall PCa and csPCa. Referenced combined biopsy detected significantly 6.86% (P = .0005) or 4.90% (P = .0044) more csPCa than performing only SB or 3-core TB, but was comparable to the new biopsy strategy. (45.10% vs. 43.14%, P = .1336) Similar results persisted when limiting patients in biopsy-naïve men or stratified by Prostate Imaging Reporting and Data System scores, PSAD, and index lesion parameters. Additionally, performing 6-core SB+3-core TB demonstrated high consistency with reference standard in grade group distribution (Kappa coefficient: 0.952 for all, 0.961 for biopsy-naïve men) and achieved superior sensitivity of 95.7% (All: 95% CI: 89.2%-99.8%) and 96.9% (Biopsy-naïve: 95% CI: 91.1%-99.7%), respectively.
The 6-core SB+3-core TB approach maintains expected detection rates while reducing the total core count, offering a promising alternative to the reference standard, which may help to tailor transperineal combined biopsy procedures.
Clinical genitourinary cancer. 2024 May 14 [Epub ahead of print]
Chichen Zhang, Qiyou Wu, Qiong Zhang, Mengni Zhang, Diming Cai, Ling Nie, Xueqin Chen, Zhenhua Liu, Tianhai Lin, Shulei Xiao, Lu Yang, Shi Qiu, Yige Bao, Qiang Wei, Xiang Tu
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Department of Pathology and Laboratory of Pathology, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China., School of Science and Engineering, University of Dundee, Scotland, UK., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Molecular Oncology, Institute of Oncology Research (IOR), Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: ., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: ., Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: .