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Histopathological concordance between prostate biopsies and radical prostatectomy specimens—implications of transrectal and transperineal biopsy approaches

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

This study aimed to evaluate the histopathological concordance rates between prostate biopsies and radical prostatectomy specimens according to the applied biopsy approach (transrectal or transperineal).

Methods

We studied patients who had been newly diagnosed with clinically significant prostate cancer and who underwent a radical prostatectomy between 2018 and 2022. Patients were included if they underwent a prebiopsy magnetic resonance imaging and if they had not been previously treated for prostate cancer. Histopathological grading on prostate biopsies was compared with that on radical prostatectomy specimens. Univariable and multivariable logistic regression analyses were performed to assess the effect of the applied biopsy approach on histopathological concordance. Additional analyses were performed to assess the effect of the applied biopsy approach on American Urological Association risk group migration, defined as any change in risk group after radical prostatectomy.

Results

In total, 1058 men were studied, of whom 49.3% (522/1058) and 50.7% (536/1058) underwent transrectal and transperineal prostate biopsies, respectively. Histopathological disconcordance was observed in 37.8% (400/1058) of men while American Urological Association risk group migration was observed in 30.2% (320/1058) of men. A transperineal biopsy approach was found to be independently associated with higher histopathological concordance rates (OR 1.33 [95% CI 1.01–1.75], p = 0.04) and less American Urological Association risk group migration (OR 0.70 [95% CI 0.52–0.93], p = 0.01).

Conclusions

The use of a transperineal biopsy approach improved histopathological concordance rates compared to the use of a transrectal biopsy approach. A transperineal biopsy approach may provide more accurate risk stratification for clinical decision-making. Despite recent improvements, histopathologic concordance remains suboptimal and should be considered before initiating management.

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Data availability

The research data for this study is available from the corresponding authors on reasonable requests.

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Author information

Author notes

  1. These authors contributed equally: M. J. Hagens, L. L. A. Ribbert.

Authors and Affiliations

  1. Department of Urology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    M. J. Hagens, L. L. A. Ribbert, H. Veerman, K. Barwari, A. N. Vis, P. J. van Leeuwen & H. G. van der Poel

  2. Department of Urology, Amsterdam University Medical Centers location Boelelaan, Amsterdam, the Netherlands

    M. J. Hagens, A. Jager, H. Veerman, A. N. Vis, P. J. van Leeuwen & H. G. van der Poel

  3. Prostate Cancer Network the Netherlands, Amsterdam, the Netherlands

    M. J. Hagens, A. Jager, H. Veerman, K. Barwari, B. Boodt, R. E. de Bruijn, A. Claessen, M. R. Leter, M. Smeenge, T. A. Roeleveld, S. P. Rynja, M. Schaaf, S. Weltings, A. N. Vis & H. G. van der Poel

  4. Department of Urology, Andros Clinics, Amsterdam, the Netherlands

    K. Barwari

  5. Department of Urology, Flevoziekenhuis, Almere, the Netherlands

    B. Boodt

  6. Department of Urology, Ziekenhuis Amstelland, Amstelveen, the Netherlands

    R. E. de Bruijn

  7. Department of Urology, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands

    A. Claessen

  8. Department of Urology, Dijklander Ziekenhuis, Hoorn, the Netherlands

    M. R. Leter

  9. Department of Statistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    V. van der Noort

  10. Department of Urology, St Jansdal Ziekenhuis, Harderwijk, the Netherlands

    M. Smeenge

  11. Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands

    T. A. Roeleveld

  12. Department of Urology, Spaarne Gasthuis, Hoofddorp, the Netherlands

    S. P. Rynja

  13. Department of Urology, BovenIJ Ziekenhuis, Amsterdam, the Netherlands

    M. Schaaf

  14. Department of Urology, Zaans Medisch Centrum, Zaandam, the Netherlands

    S. Weltings

  15. Department of Pathology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    E. Bekers

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Contributions

Study concept and design: MH, LR, PVL, HVP; Statistical Analysis: MH, LR, VVN; Interpretation: MH, LR, PVL, HVP; Initial drafting of manuscript: MH, LR; Critical review: AJ, HV, KB, BB, RDB, AC, ML, MS, TR, SR, MS, SW, AV, PVL, HVP.

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Correspondence to M. J. Hagens.

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Hagens, M.J., Ribbert, L.L.A., Jager, A. et al. Histopathological concordance between prostate biopsies and radical prostatectomy specimens—implications of transrectal and transperineal biopsy approaches. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00714-x

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