Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical
  • Published:

Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

Background

Current prostate biopsy (PBx) protocol for prostate cancer (PCa) diagnosis is to perform systematic biopsies (SBx) combined with targeted biopsies (TBx) in case of positive MRI (i.e. PI-RADS ≥ 3). To assess the utility of performing SBx in combination with TBx, we determined the added value of SBx brought to the diagnosis of PCa according to their sextant location and MRI target characteristics.

Methods

In our local prospectively collected database, we conducted a single-center retrospective study including all patients with a suspicion of PCa, who underwent transrectal ultrasound-guided (TRUS) prostate biopsies (PBx) with a prior MRI and a single lesion classified as PI-RADS ≥ 3. We have characterized the SBx according to their location on MRI: same sextant (S-SBx), adjacent sextant (A-SBx), ipsilateral side (I-SBx) and contralateral side (C-SBx). The added value of SBx and TBx was defined as any upgrading to significant PCa (csPCa) (ISUP ≥2).

Results

371 patients were included in the study. The added value of SBx was 10% overall. Regarding the lesion location and the SBx sextant, the added value of SBx was: 5.1% for S-SBx, 5.4% for A-SBx, 4.9% for I-SBx and 1.9% for C-SBx. The overall added value of SBx was 6.8% for PI-RADS 3 lesions, 14% for PI-RADS 4 lesions and 6.7% for PI-RADS 5 lesions (p = 0.063). The added value of SBx for contralateral side was 1.9% (2/103), 3.1% (5/163) and 0% (0/105) for PI-RADS 3, PI-RADS 4 and PI-RADS 5 lesions, respectively (p = 0,4). The added value of SBx was lower when the number of TBx was higher (OR 0.57; CI 95% 0.37–0.85; p = 0.007).

Conclusions

Our results suggest that the utility of performing SBx in the contralateral lobe toward the MRI lesion was very low, supporting that they might be avoided.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Area of the systematic biopsies (SBx) according to their location relative to the MRI target.
Fig. 2

Similar content being viewed by others

Data availability

The datasets used and/or analysed for the study are available from the corresponding author on request.

References

  1. Uroweb - European Association of Urology [Internet]. [cited 2022 Jun 6]. EAU Guidelines on Prostate Cancer - Uroweb. Available from: https://uroweb.org/guidelines/prostate-cancer.

  2. Rouvière O, Puech P, Renard-Penna R, Claudon M, Roy C, Mège-Lechevallier F, et al. 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;20:100–9.

    Article  PubMed  Google Scholar 

  3. Van der Leest M, Cornel E, Israël B, Hendriks R, Padhani AR, Hoogenboom M, et al. Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol. 2019;75:570–8.

    Article  PubMed  Google Scholar 

  4. Drost FJH, Osses D, Nieboer D, Bangma CH, Steyerberg EW, Roobol MJ, et al. Prostate magnetic resonance imaging, with or without magnetic resonance imaging-targeted biopsy, and systematic biopsy for detecting prostate cancer: a cochrane systematic review and meta-analysis. Eur Urol. 2020;77:78–94.

    Article  PubMed  Google Scholar 

  5. Loeb S, Bjurlin MA, Nicholson J, Tammela TL, Penson DF, Carter HB, et al. Overdiagnosis and overtreatment of prostate cancer. Eur Urol. 2014;65:1046–55.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chowdhury R, Abbas A, Idriz S, Hoy A, Rutherford EE, Smart JM. Should warfarin or aspirin be stopped prior to prostate biopsy? An analysis of bleeding complications related to increasing sample number regimes. Clin Radiol. 2012;67:e64–70.

    Article  PubMed  CAS  Google Scholar 

  7. Eineluoto JT, Järvinen P, Kilpeläinen T, Lahdensuo K, Kalalahti I, Sandeman K, et al. Patient experience of systematic versus fusion prostate biopsies. Eur Urol Oncol. 2018;1:202–7.

    Article  PubMed  Google Scholar 

  8. Kalalahti I, Huotari K, Erickson AM, Petas A, Vasarainen H, Rannikko A. Infectious complications after transrectal MRI-targeted and systematic prostate biopsy. World J Urol. 2022;40:2261–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Bryk DJ, Llukani E, Taneja SS, Rosenkrantz AB, Huang WC, Lepor H. The Role of Ipsilateral and contralateral transrectal ultrasound-guided systematic prostate biopsy in men with unilateral magnetic resonance imaging lesion undergoing magnetic resonance imaging-ultrasound fusion-targeted prostate biopsy. Urology. 2017;102:178–82.

    Article  PubMed  Google Scholar 

  10. Freifeld Y, Xi Y, Passoni N, Woldu S, Hornberger B, Goldberg K, et al. Optimal sampling scheme in men with abnormal multiparametric MRI undergoing MRI-TRUS fusion prostate biopsy. Urol Oncol: Semin Orig Investig. 2019;37:57–62.

    Article  Google Scholar 

  11. Cata E, Andras I, Ferro M, Kadula P, Leucuta D, Musi G, et al. Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting. Transl Androl Urol. 2020;9:2510–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate imaging reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019;76:340–51.

    Article  PubMed  Google Scholar 

  13. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016;40:244–52.

    Article  PubMed  Google Scholar 

  14. Dell’Oglio P, Stabile A, Soligo M, Brembilla G, Esposito A, Gandaglia G, et al. There is no way to avoid systematic prostate biopsies in addition to multiparametric magnetic resonance imaging targeted biopsies. Eur Urol Oncol. 2020;3:112–8.

    Article  PubMed  Google Scholar 

  15. Ploussard G, Borgmann H, Briganti A, de Visschere P, Fütterer JJ, Gandaglia G, et al. Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies? World J Urol. 2019;37:243–51.

    Article  PubMed  Google Scholar 

  16. Borghesi M, Ahmed H, Nam R, Schaeffer E, Schiavina R, Taneja S, et al. Complications after systematic, random, and image-guided prostate biopsy. Eur Urol. 2017;71:353–65.

    Article  PubMed  Google Scholar 

  17. Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, et al. MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N. Engl J Med. 2020;382:917–28.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nobin JL, Orczyk C, Deng FM, Melamed J, Rusinek H, Taneja SS, et al. Prostate tumour volumes: evaluation of the agreement between magnetic resonance imaging and histology using novel co-registration software. BJU Int. 2014;114:E105–12.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Padhani AR, Weinreb J, Rosenkrantz AB, Villeirs G, Turkbey B, Barentsz J. Prostate Imaging-Reporting and Data System Steering Committee: PI-RADS v2 Status Update and Future Directions. Eur Urol. 2019;75:385–96.

    Article  PubMed  Google Scholar 

  20. Brisbane WG, Priester AM, Ballon J, Kwan L, Delfin MK, Felker ER, et al. Targeted prostate biopsy: umbra, penumbra, and value of perilesional sampling. Eur Urol. 2022;82:303–10.

    Article  PubMed  Google Scholar 

  21. Lahoud J, Doan P, Kim L, Patel MI. Perilesional biopsies increase detection of significant prostate cancer in men with PI-RADS 4/5 Lesions: Validation of the PI-RADS Steering Committee Recommendation. Eur Urol. 2021;80:260–1.

    Article  PubMed  Google Scholar 

  22. Radtke JP. Multiparametric Magnetic Resonance Imaging (MRI) and MRI–Transrectal Ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen. Eur Urol. 2016;70;846–853.

  23. Porpiglia F, Checcucci E, De Cillis S, Piramide F, Amparore D, Piana A, et al. A prospective randomized controlled trial comparing target prostate biopsy alone approach vs. target plus standard in naïve patients with positive mpMRI. Minerva Urol Nephrol. 2023;75;31–41.

  24. Günzel K, Haas M, Maxeiner A, Stephan C, Buckendahl J, Asbach P, et al. Predictive parameters identifying men eligible for a sole MRI/Ultrasound fusion-guided targeted biopsy without an additional systematic biopsy. Urol Int. 2017;98:15–21.

    Article  PubMed  Google Scholar 

  25. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N. Engl J Med. 2018;378:1767–77.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ploussard G, Beauval JB, Renard-Penna R, Lesourd M, Manceau C, Almeras C, et al. Assessment of the minimal targeted biopsy core number per MRI Lesion for improving prostate cancer grading prediction. J Clin Med. 2020;9:225.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Calio BP, Sidana A, Sugano D, Gaur S, Maruf M, Jain AL, et al. Risk of upgrading from prostate biopsy to radical prostatectomy pathology—does saturation biopsy of index lesion during multiparametric magnetic resonance imaging-transrectal ultrasound fusion biopsy help? J Urol. 2018;199:976–82.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Diamand R, Hollans M, Lefebvre Y, Sirtaine N, Limani K, Hawaux E, et al. The role of perilesional and multiparametric resonance imaging-targeted biopsies to reduce the risk of upgrading at radical prostatectomy pathology: A retrospective monocentric study. Urol Oncol: Semin Orig Investig. 2022;40:192.e11–192.e17.

  29. Falagario U, Jambor I, Taimen P, Syvänen KT, Kähkönen E, Merisaari H, et al. Added value of systematic biopsy in men with a clinical suspicion of prostate cancer undergoing biparametric MRI-targeted biopsy: multi-institutional external validation study. World J Urol. 2021;39:1879–87.

    Article  PubMed  Google Scholar 

  30. Uleri A, Baboudjian M, Tedde A, Gallioli A, Long-Depaquit T, Palou J, et al. Is there an impact of transperineal versus transrectal magnetic resonance imaging–targeted biopsy in clinically significant prostate cancer detection rate? A systematic review and meta-analysis. Eur Urol Oncol. 2023;6:621–8.

Download references

Author information

Authors and Affiliations

  1. Urology Department, Brest University Hospital, Brest, France

    A. Zambon, T-A. Nguyen, A. Fourcade, T. Segalen, K. Saout, C. Deruelle, V. Joulin, G. Fournier & A. Valeri

  2. LaTIM-UMR 1101, INSERM, EFS, Université de Bretagne Occidentale, Brest, France

    T-A. Nguyen, G. Fournier & A. Valeri

  3. Radiology Department, Brest University Hospital, Brest, France

    V. Tissot

  4. Pathology Department, Brest University Hospital, Brest, France

    L. Doucet

  5. CeRePP, Paris, France

    G. Fournier & A. Valeri

Authors
  1. A. Zambon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T-A. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Fourcade
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Segalen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Saout
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Deruelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Joulin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. V. Tissot
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Doucet
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Fournier
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. Valeri
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design, drafting of the manuscript: AZ, AV, TAN. Acquisition of data: AZ, TAN, KS. Statistical analysis: TAN. Interpretation of data, critical revisions to manuscript: AZ, AV, TAN. Manuscript revision: all authors.

Corresponding author

Correspondence to A. Zambon.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval and consent

All procedures in the study were performed with local ethics committee approval. Informed consent was obtained from all individual participants included in the study as requested by the ethical committee (29BRC21.0148-B2021CE.28).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zambon, A., Nguyen, TA., Fourcade, A. et al. Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00770-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41391-023-00770-3

This article is cited by

Search

Advanced search

Quick links