Clinical‐Pathologic Correlation Between Transperineal Mapping Biopsies of the Prostate and Three‐Dimensional Reconstruction of Prostatectomy Specimens

Abstract

Background Extended transrectal ultrasound guided biopsies (TRUSB) of the prostate may not accurately convey true morphometric information and Gleason score (GS) of prostate cancer (PCa) and the clinical use of template-guided (5-mm grid) transperineal mapping biopsies (TPMBs) remains controversial. Methods We correlated the clinical-pathologic results of 1,403 TPMB cores obtained from 25 men diagnosed with PCa with 64 cancer lesions found in their corresponding radical prostatectomy (RP) specimens. Special computer models of three-dimensional, whole-mounted radical prostatectomy (3D-WMRP) specimens were generated and used as gold standard to determine tumor morphometric data. Between-sample rates of upgrade and downgrade (highest GS and a novel cumulative GS) and upstage and downstage (laterality) were determined. Lesions ≥ 0.5 cm3 or GS ≥ 7 were considered clinically significant. Results From 64 separate 3D-WMRP lesions, 25 had significant volume (mean 1.13 cm3) and 39 were insignificant (mean 0.09 cm3) (P < 0.0001); 18/64 lesions were missed by TPMB, but only one was clinically significant with GS-8 (0.02 cm3). When comparing the cumulative GS of TPMB versus RP, 72% (n = 18) had identical scores, 12% (n = 3) were upgraded, and only 16% (n = 4) were downgraded. Laterality of TPMB and RP was strongly correlated, 80% same laterality, 4% were up-staged, and 16% down-staged. Conclusions Our clinical-pathology correlation showed very high accuracy of TPMB with a 5-mm grid template to detect clinically significant PCa lesions as compared with 3D-WMRP, providing physicians and patients with a reliable assessment of grade and stage of disease and the opportunity to choose the most appropriate therapeutic options.

Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach

“…Transperineal biopsies are often applied in a mapping technique, sampling the whole-gland with a fixed sampling frame of 5-10mm. This method has demonstrable diagnostic accuracy when compared to the reference standard of radical prostatectomy 8 . However, barriers to widespread adoption include the necessity of general or spinal anaesthetic; operating room time; pathology resources/costs and increased risks of urinary retention, haematuria, haematospermia and temporary erectile dysfunction.…”

Deflection Analysis of Different Needle Designs for Prostate Biopsy and Focal Therapy

“…7 Crawford et al investigated the clinicopathological correlation of TTMB with 3D reconstruction of RP specimens and demonstrated 72% of the TTMB cores were similar in grade to RP specimens and 80% accuracy in predicting laterality. 8 These data proved the superiority of TTMB over standard TRUS-guided biopsy in accuracy of cancer detection. This is critical to selecting appropriate candidates for active surveillance versus focal or whole-gland therapies.…”

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

“…Template transperineal prostate mapping biopsies might provide more exact information about the spatial tumor distribution of PCa and might accurately identify unilateral cancer for the purpose of FT (13,19,20). When used with a 5mm sampling frame, this approach can rule in and rule out PCa foci of 0.5cc and 0.2cc volumes, with 90% certainty (19).…”

“…Several studies have investigated the degree of concordance in tumor laterality between prostate biopsy (BP) and RP (3)(4)(5)(6)(7)(8)(9)(10)(11) and its implication for focal therapy (3,4,6,(8)(9)(10)(11). However, in the majority of these studies the BP was performed through the transrectal approach; no data have been published on the transperineal approach, while the use of the perineal template has been recently described, although the procedure is more invasive and has health-care resource implications (2,12,13). Multiparametric MRI is receiving a great interest in the last years having the performance characteristics required to localize significant areas of prostate cancer, but the routine use of this technique can not be proposed for clinical (expertise of the radiologist) and health-care (cost and diffusion of MRI) implications (12).…”