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Re: Can fewer transperineal systematic biopsy cores have the same prostate cancer detection rate as of magnetic resonance imaging/ultrasound fusion biopsy?

Prostate Cancer and Prostatic Diseases volume 26, page 432 (2023)Cite this article

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Recently, we read the paper by Liu et al. [1]. As demonstrated by Liu et al., performing systematic biopsy of untargeted areas (nSB) combined with targeted biopsy (TB) can provide similar efficiency to the standard TB+SB [1]. This is a very amazing research, may end the controversy about biopsy methods and numbers. As we all know, performing biopsies on patients without high-grade cancer is unpleasant, inconvenient, and costly, and can sometimes increase the risk of infection and of finding indolent cancers; in addition, even though some diagnoses may be missed when the application of core biopsies is reduced, the mortality rate of these patients is very low.

However, we recommend authors do some further works to make this research better. First of all, according to the design, authors failed to provide the information about how long had the patients wait to participate in this trial after the last time TB+SB that considered as reference? Because the prostate anatomy could be changed by this invasive operation, and it will impact the accuracy of the results. Secondly, the authors reported the rate of false negatives detected by MRI, but they did not mention whether these false negative tissues were advanced cancer or indolent cancer, since if the false negatives were indolent cancer, it does not matter that they were not detected by MRI. Third, according to the demonstration of Checcucci et al., for lesions smaller than 8 mm, at least 100 FB of experience is needed to correctly sample the area [2]. So, authors should provide the experience about the surgeon who performed the operation. Lastly, a recently research reported that more than or equal to eight positive prostate biopsy cores cutoff yielded optimal results [3]. So we recommend authors provide the data about positive cores number, to compare with the above report.

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References

  1. Liu H, Ruan M, Wang H, Wang H, Li X, Song G. Can fewer transperineal systematic biopsy cores have the same prostate cancer detection rate as of magnetic resonance imaging/ultrasound fusion biopsy? Prostate Cancer Prostatic Dis. 2020;23:589–95. https://doi.org/10.1038/s41391-020-0260-0. PMID: 32719353

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  2. Checcucci E, Piramide F, Amparore D, De Cillis S, Granato S, Sica M, et al. Beyond the learning curve of prostate MRI/TRUS target fusion biopsy after more than 1000 procedures. Urology. 2021;155:39–45.

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  3. Wenzel M, Würnschimmel C, Chierigo F, Tian Z, Shariat SF, Terrone C, et al. Assessment of the optimal number of positive biopsy cores to discriminate between cancer-specific mortality in high-risk versus very high-risk prostate cancer patients. Prostate 2021;81:1055–63.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, 610072, China

    Shangqing Ren & Dong Wang

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  1. Shangqing Ren
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  2. Dong Wang
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Design this study: DW, SR. Written manuscript: SR. Correct the grammar and words: DW.

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Correspondence to Dong Wang.

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Ren, S., Wang, D. Re: Can fewer transperineal systematic biopsy cores have the same prostate cancer detection rate as of magnetic resonance imaging/ultrasound fusion biopsy?. Prostate Cancer Prostatic Dis 26, 432 (2023). https://doi.org/10.1038/s41391-021-00471-9

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