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No AccessJournal of UrologyAdult Urology1 Sep 2021

Optimizing Spatial Biopsy Sampling for the Detection of Prostate Cancer

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    Purpose:

    The appropriate number of systematic biopsy cores to retrieve during magnetic resonance imaging (MRI)-targeted prostate biopsy is not well defined. We aimed to demonstrate a biopsy sampling approach that reduces required core count while maintaining diagnostic performance.

    Materials and Methods:

    We collected data from a cohort of 971 men who underwent MRI-ultrasound fusion targeted biopsy for suspected prostate cancer. A regional targeted biopsy (RTB) was evaluated retrospectively; only cores within 2 cm of the margin of a radiologist-defined region of interest were considered part of the RTB. We compared detection rates for clinically significant prostate cancer (csPCa) and cancer upgrading rate on final whole mount pathology after prostatectomy between RTB, combined, MRI-targeted, and systematic biopsy.

    Results:

    A total of 16,459 total cores from 971 men were included in the study data sets, of which 1,535 (9%) contained csPCa. The csPCa detection rates for systematic, MRI-targeted, combined, and RTB were 27.0% (262/971), 38.3% (372/971), 44.8% (435/971), and 44.0% (427/971), respectively. Combined biopsy detected significantly more csPCa than systematic and MRI-targeted biopsy (p <0.001 and p=0.004, respectively) but was similar to RTB (p=0.71), which used on average 3.8 (22%) fewer cores per patient. In 102 patients who underwent prostatectomy, there was no significant difference in upgrading rates between RTB and combined biopsy (p=0.84).

    Conclusions:

    A RTB approach can maintain state-of-the-art detection rates while requiring fewer retrieved cores. This result informs decision making about biopsy site selection and total retrieved core count.

    References

    • 1. : MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018; 378: 1767. Google Scholar
    • 2. : Comparison of targeted vs systematic prostate biopsy in men who are biopsy naive. JAMA Surg 2019; 154: 811. Google Scholar
    • 3. : Multiparametric magnetic resonance imaging-ultrasound fusion biopsy improves but does not replace standard template biopsy for the detection of prostate cancer. J Urol 2019; 202: 944. LinkGoogle Scholar
    • 4. : Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2019; 20: 100. Google Scholar
    • 5. : Is it possible to predict sepsis, the most serious complication in prostate biopsy?Urol Int 2010; 84: 395. Google Scholar
    • 6. : Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol 2004; 171: 1478. LinkGoogle Scholar
    • 7. : Systematic review of complications of prostate biopsy. Eur Urol 2013; 64: 876. Google Scholar
    • 8. : MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med 2020; 382: 917. Google Scholar
    • 9. : Optimizing MRI-targeted prostate biopsy: the diagnostic benefit of additional targeted biopsy cores. Urol Oncol2021; 39: 193.e1. Google Scholar
    • 10. : Optimizing the number of cores targeted during prostate magnetic resonance imaging fusion target biopsy. Eur Urol Oncol 2018; 1: 418. Crossref, MedlineGoogle Scholar
    • 11. : What is the ideal number of biopsy cores per lesion in targeted prostate biopsy?Prostate Int 2020; 8: 112. Google Scholar
    • 12. : Role of core number and location in targeted magnetic resonance imaging-ultrasound fusion prostate biopsy. Eur Urol 2019; 76: 14. Google Scholar
    • 13. : Detection of significant prostate cancer using target saturation in transperineal magnetic resonance imaging/transrectal ultrasonography–fusion biopsy. Eur Urol Focus 2020; doi: 10.1016/j.euf.2020.06.020. CrossrefGoogle Scholar
    • 14. : Prostate Imaging-Reporting and Data System Steering Committee: PI-RADS v2 status update and future directions. Eur Urol 2019; 75: 385. Google Scholar
    • 15. : Magnetic resonance imaging underestimation of prostate cancer geometry: use of patient specific molds to correlate images with whole mount pathology. J Urol 2017; 197: 320. LinkGoogle Scholar
    • 16. : EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71: 618. Google Scholar
    • 17. : Prostate biopsy: how many cores are enough?Urol Oncol2003; 21: 135. Google Scholar
    • 18. : How many cores does systematic prostate biopsy need? A large‐sample retrospective analysis. J Ultrasound Med 2019; 38: 1491. Google Scholar
    • 19. : Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device. J Urol 2013; 189: 86. LinkGoogle Scholar
    • 20. : Comparison of performance of PI-RADSv2 and a quantitiative PI-RADSv1 based protocol in 3T multiparametric MRI for detection, grading and staging of prostate cancer using whole mount histopathology as reference standard in 569 patients. J Urol, suppl. 2019; 201: e1183. Google Scholar
    • 21. : The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2015; 40: 1. Google Scholar
    • 22. : Ray casting for modeling solids. Comput Graph Image Process 1982; 18: 109. Google Scholar
    • 23. : Proposed adjustments to PI-RADS version 2 decision rules: impact on prostate cancer detection. Radiology 2017; 283: 119. Google Scholar
    • 24. : Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies. Cancer 2016; 122: 884. Google Scholar
    • 25. : Prospective evaluation of PI-RADS version 2 using the International Society of Urological Pathology prostate cancer grade group system. J Urol 2017; 198: 583. LinkGoogle Scholar
    • 26. : Targeted prostate biopsy: cancer extends beyond the ROI!J Urol, suppl. 2018; 199: e519. LinkGoogle Scholar
    • 27. : Comparison of the upgrading rates of International Society of Urological Pathology grades and tumor laterality in patients undergoing standard 12-core prostate biopsy versus fusion prostate biopsy for prostate cancer. Urol Int 2019; 103: 256. Google Scholar
    • 28. : MRI–ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol 2013; 23: 43. Google Scholar

    Funded by NIH NCI R21 CA220352, NIH NCI P50 CA092131, and a NVIDIA Corporation Academic Hardware Grant (CWA); NCI F30CA210329, NIH NIGMS GM08042, and the UCLA-Caltech Medical Scientist Training Program (KVS); and NIH NCI R01 CA195505 and R01 CA158627 (LSM).

    All data were used for this work under the approval of the UCLA Institutional Review Board (IRB Nos. 11-001580 and 16-001087) and in compliance with HIPAA regulations.

    None of the sponsors of this study were involved in study design or performance, or in the writing or submission of this manuscript.

    Financial interest and/or other relationship with Avenda Health (LSM, AMP) and the American Medical Association (KVS). No other authors have competing interests to disclose.

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