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Role of targeted biopsy, perilesional biopsy, and random biopsy in prostate cancer diagnosis by mpMRI/transrectal ultrasonography fusion biopsy

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Abstract

Purpose

It is still not clear the role of perilesional biopsy (PL) and the extension of the random biopsy (RB) scheme to be adopted during mpMRI-guided ultrasound fusion biopsy (FB). To evaluate the increase in diagnostic accuracy achieved by PL and different RB schemes over target biopsy (TB).

Methods

We collected prospectively 168 biopsy-naïve patients with positive mpMRI receiving FB and concurrent 24-core RB. The diagnostic yields of the different possible biopsy schemes (TB only; TB + 4 PL cores; TB + 12-core RB; TB + 24-core RB) were compared by the McNemar test. Clinically significant (CS) prostate cancer (PCA) was defined according to the definition of the PROMIS trial. Regression analyses were used to identify independent predictors of the presence of any cancer, csPCA.

Results

The detection rate of CS cancers increased to 35%, 45%, and 49% by adding 4 PL cores, 12, and 24 RB cores, respectively (all p < 0.02). Notably, the largest scheme including 3 TB and 24 RB cores identified a small but statistically significant 4% increase in detection rate of CS cancer, as compared with the second largest scheme. TB alone identified only 62% of the CS cancers. Such figure increased to 72% by adding 4 PL cores, and to 91% by adding 14 RB cores.

Conclusions

We found that PL biopsy increased the detection rate of CS cancers as compared with TB alone. However, the combination of those cores missed about 30% of the CS cancers identified with larger RB cores, notably including a considerable 15% of cases located contralaterally to the index tumor.

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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, Maria Carlesso, Giulia La Bombarda, Alessandro Morlacco, Giovanni Betto, Nicola Zanovello & 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

Authors
  1. Giacomo Novara
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  2. Fabio Zattoni
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  3. Giovanni Zecchini
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  4. Alberto Aceti
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Contributions

GN, GB, NZ, FDM: Protocol/project development. FZ, GZ, AA, AP, GF, MC: Manuscript writing, data analysis. GLB: Data collection, data collection. AM: Manuscript editing. CSL: Data collection. AL: Data management. MG: Data management.

Corresponding author

Correspondence to Giacomo Novara.

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Conflict of interest

The authors declared that they have no conflict of interests.

Research involving human participants and/or animals

Yes.

Informed consent

All included patients undergoing prostate biopsy provided written informed consent for surgery. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board was obtained due to observational and retrospective nature of the study.

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Novara, G., Zattoni, F., Zecchini, G. et al. Role of targeted biopsy, perilesional biopsy, and random biopsy in prostate cancer diagnosis by mpMRI/transrectal ultrasonography fusion biopsy. World J Urol 41, 3239–3247 (2023). https://doi.org/10.1007/s00345-023-04382-3

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