Transperineal versus transrectal prostate biopsy for predicting the final laterality of prostate cancer: are they reliable enough to select patients for focal therapy? Results from a multicenter international study

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Objectives: To compare the concordance of prostate cancer (PCa) laterality between the extended transperineal (TP) or transrectal (TR) prostate biopsy (BP) and radical prostatectomy (RP) specimens. To identify predictors of laterality agreement between BP and RP. Materials and Methods: Data from 533 consecutive patients with PCa (278 TP and 255 TR-diagnosed) treated with RP were analyzed. A 12-core technique was used for both TP and TR biopsies. Additional cores were obtained when necessary.Results: Overall, the percentage of agreement of PCa laterality between BP and RP was 60% (K = 0.27, p < 0.001). However, the RP confirmation of unilaterality at BP was obtained in just 33% of the cases. Considering the concordance on bilaterality as the "target" of our analysis, the sensitivity and specificity were 54.3% and 98.2%, respectively, with TP and 47.5% and 92.5%, respectively with TR. Focusing on patients with unilaterality at biopsy, none of the evaluated preoperative variables (biopsy technique, age, total positive biopsy cores, PSA, prostate volume, Gleason score on biopsy) were able to predict RP bilaterality in the multivariate analyses. Conclusions: Most of the patients with unilateral involvement at BP harbored bilateral PCa after RP. TR and TP biopsy showed no difference in their capacity to predict the concordance of tumor laterality at RP. None of the preoperative evaluated variables can predict the tumor laterality at RP. Using BP unilaterality to include patients in focal therapy (FT) protocols may hinder the oncologic efficacy of FT.

Significance of MRI/Transrectal Ultrasound Fusion Three-Dimensional Model-Guided, Targeted Biopsy Based on Transrectal Ultrasound-Guided Systematic Biopsy in Prostate Cancer Detection: A Systematic Review and Meta-Analysis

“…contributed equally to the study. a study showed that the sensitivity and specificity of TRUS-Sb were 47.3 and 92.5% respectively [5]. The efficacy did not improve even by increasing the number of cores [6,7].…”

Prostate Cancer – Local Treatment after Radiorecurrence: Salvage Cryoablation

“…In order to accurately identify the area within the prostate containing the tumor recurrence, multiple image modalities have been used such as transrectal ultrasonography with target lesion biopsy and magnetic resonance imaging (MRI) with multiparametric approach (T2-weighted, diffusion-weighted, dynamic contrast-enhanced). The combination of image studies with transrectal or transperineal mapping biopsies ( 16 - 18 ).…”

Diagnosis and Monitoring of Prostatic Lesions: A Comparison of Three Modalities: Multiparametric MRI, Fusion MRI/Transrectal Ultrasound (TRUS), and Traditional TRUS

“…Schulte, et al determined that in men classified with unilateral disease on extended 12-core biopsy, only 40.4% had true unilateral disease when reevaluated on radical prostatectomy [14]. In addition, the transperineal approach has no advantage over the transrectal approach with respect to the determination of tumor laterality [15]. …”