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Role of targeted biopsy, perilesional biopsy, random biopsy, and their combination in the detection of clinically significant prostate cancer by mpMRI/transrectal ultrasonography fusion biopsy in confirmatory biopsy during active surveillance program

Prostate Cancer and Prostatic Diseases volume 27, pages 129–135 (2024)Cite this article

Subjects

Abstract

Background

Based on the findings of different trials in biopsy naïve patients, target biopsy (TB) plus random biopsy (RB) during mpMRI-guided transrectal ultrasound fusion biopsy (FB) are often also adopted for the biopsy performed during active surveillance (AS) programs. At the moment, a clear consensus on the extent and modalities of the procedure is lacking.

Objective

To evaluate the increase in diagnostic accuracy achieved by perilesional biopsy (PL) and different RB schemes during FB performed in AS protocol.

Design, setting, and participants

We collected prospectively the data of 112 consecutive patients with low- or very-low-risk prostate cancer; positive mpMRI underwent biopsy at a single academic institution in the context of an AS protocol.

Intervention(s)

mpMRI/transrectal US FB with Hitachi RVS system with 3 TB and concurrent transrectal 24-core RB.

Outcome measurements and statistical analysis

The diagnostic yield of the different possible biopsy schemes (TB only; TB + 4 perilesional (PL) cores; TB + 12-core RB; TB + 24-core RB) was compared by the McNemar test. Univariable and multivariable regression analyses were adopted to identify predictors of any cancer, Gleason grade group (GGG) ≥2 cancers, and the presence of GGG≥2 cancers in the larger schemes only.

Results and limitations

The detection rate of GGG ≥2 cancers increased to 30%, 39%, and 49% by adding 4 PL cores, 14, and 24 RB cores, respectively, to TB cores (all p values <0.01). On the whole, TB alone, 14-core RB, and 24-core-RB identified 38%, 47%, and 56% of all the GGG ≥2 cancers. Such figures increased to 62% by adding to TB 4 PL cores, and to 80% by adding 14 RB cores. Most of the differences were observed in PI-RADS 4 lesions.

Conclusions

We found that PL biopsy increased the detection rate of GGG ≥2 cancers as compared with TB alone. However, the combination of those cores missed a large percentage of the CS cancers identified with larger RB cores, including a 20% of CS cancers diagnosed only by the combination of TB plus 24-core RB.

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Fig. 1: Detection of any grade and Gleason grade group ≥2 prostate cancers in the different biopsy schemes for the whole cohort and stratified by PI-RADS score.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Authors and Affiliations

  1. Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy

    Giacomo Novara, Fabio Zattoni, Giovanni Zecchini, Alberto Aceti, Anna Pellizzari, Giordana Ferraioli, Claudia Cobacchini, Alessandra Taverna, Francesca Sattin, Filippo Carletti, Giulia La Bombarda, Alessandro Morlacco, Giovanni Betto & Fabrizio Dal Moro

  2. Radiology Unit, University Hospital of Padua, Padua, Italy

    Carmelo Salvino Lacognata & Alberto Lauro

  3. Surgical Pathology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy

    Marina Gardiman

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Contributions

The authors confirm contribution to the paper as follows: GN, FZ and FDM; conceptualization, critical review, and revisions for this manuscript. GZ, AA, AP, GF, CC, AT, FS, FC, GLB collected the data. GSL, AL, MG, AM and GB; analysis and interpretation of results.

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Correspondence to Giacomo Novara.

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Novara, G., Zattoni, F., Zecchini, G. et al. Role of targeted biopsy, perilesional biopsy, random biopsy, and their combination in the detection of clinically significant prostate cancer by mpMRI/transrectal ultrasonography fusion biopsy in confirmatory biopsy during active surveillance program. Prostate Cancer Prostatic Dis 27, 129–135 (2024). https://doi.org/10.1038/s41391-023-00733-8

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