Gleason grade accuracy of transperineal and transrectal prostate biopsies in MRI-naïve patients

Abstract

Purpose Accurate assessment of Gleason grade is essential to guiding prostate cancer management. Not all healthcare systems have universal access to prostate MRI. We investigated whether transperineal (TP) prostate biopsies provide more accurate Gleason grading than transrectal (TR) biopsies in MRI-naïve patients. Methods Consecutive patients undergoing TP and TR systematic prostate needle biopsies from 2011 to 2018 were analysed. Patients who underwent radical prostatectomy (RP) within 180 days of biopsies were included. Patients undergoing MRI prior to biopsies were excluded. Pathological concordance, incidence of Gleason upgrading, and correlation coefficients among biopsies and RP Gleason grade were compared. A sub-analysis for concordance in anterior prostate tumours was conducted. Results 262 patients were included (112 TP; 150 TR), the median age was 63 years, and median time from biopsy to RP was 68 days. Concordance with RP histology for TP was 65% compared to 49% for TR (p = 0.011). Biopsy technique predicted RP concordance independent of the number of cores. Gleason upgrading occurred following 24% of TP versus 33% of TR biopsies. In anterior and apical tumours, upgrading occurred in 19% of TP biopsies and 38% of TR biopsies (p = 0.027). Conclusion This study suggests TP approach to prostate biopsies result in improved histological grade accuracy in men whom MRI is not available, even after controlling for number of cores. TP approach also resulted in less upgrading for lesions in the anterior and apical prostate compared to TR.

Decade‐long trends in prostate cancer biopsy grade groups and treatment within a population‐based registry

“…From 2016, TPB has overtaken TRUS biopsy as the preferred biopsy approach in Victoria. Consistent with previous studies, in our cohort, we observed greater grade concordance between TPB and prostatectomy specimens compared to TRUS biopsy, consistent with published results [10]. Although increased accuracy due to TPB may have partly contributed to the reduction in GG 1 disease, the proportion of GG 1 disease has also decreased over time in patients who underwent TRUS biopsy, therefore, it is unlikely that biopsy approach is a major factor in grade migration over the last decade.…”

“…The landscape of prostate cancer diagnosis has changed in 10 years, with increased attention focused on careful selection of patients for PSA testing aiming to reduce overdiagnosis and overtreatment of low‐grade prostate cancer. Furthermore, the increased uptake of mpMRI and TPB have improved diagnostic accuracy of biopsy [10–12]. Our study has identified that there has been a substantial reduction in the proportion of low‐grade prostate cancer being diagnosed over the last decade at the population level.…”

“…Although this may be partly driven by changes in PSA testing recommendations, several other developments in the diagnostic pathway may also have influenced these trends. Transperineal prostate biopsy (TPB) has become increasingly prevalent, with expanding evidence suggesting improved diagnostic accuracy compared to TRUSguided biopsy [10]. In addition, the use of multiparametric MRI (mpMRI) has enabled improved detection and targeting of suspicious lesions, further increasing the accuracy of biopsy [11,12].…”

Improving the understanding of PI-RADS in practice: characters of PI-RADS 4 and 5 lesions with negative biopsy

“…Studies have shown that transperineal puncture can detect more clinically meaningful cancers than transrectal puncture. 20 , 21 Our research showed that the imperfect diagnosis of radiologists also played a role as a supplement in the transperineal era.…”

Editorial: Challenges in the prevention of prostate cancer

“…Discrimination between aggressive and indolent PCa as well as the prediction of the future progression of the disease is the real challenge in clinical practice of PCa management. Currently, pre-treatment risk assessment is based on limited clinical parameters, such as histological grading of needle biopsies ( 4 ). The benefit of population-based screening with prostate-specific antigen (PSA), the most used approach to identify at-risk patients, is controversial, mainly because of the high frequency of indolent tumors that dopes the result and may result in an anxious condition for the patient and/or to the initiation of treatments that often do not provide a clear survival benefit ( 5 ).…”