Optimizing Spatial Biopsy Sampling for the Detection of Prostate Cancer

Abstract

Purpose: The appropriate number of systematic biopsy cores to retrieve during magnetic resonance imaging (MRI)-targeted prostate biopsy is not well defined. We aimed to demonstrate a biopsy sampling approach that reduces required core count while maintaining diagnostic performance. Materials and Methods: We collected data from a cohort of 971 men who underwent MRI-ultrasound fusion targeted biopsy for suspected prostate cancer. A regional targeted biopsy (RTB) was evaluated retrospectively; only cores within 2 cm of the margin of a radiologist-defined region of interest were considered part of the RTB. We compared detection rates for clinically significant prostate cancer (csPCa) and cancer upgrading rate on final whole mount pathology after prostatectomy between RTB, combined, MRI-targeted, and systematic biopsy. Results: A total of 16,459 total cores from 971 men were included in the study data sets, of which 1,535 (9%) contained csPCa. The csPCa detection rates for systematic, MRI-targeted, combined, and RTB were 27.0% (262/971), 38.3% (372/971), 44.8% (435/971), and 44.0% (427/971), respectively. Combined biopsy detected significantly more csPCa than systematic and MRI-targeted biopsy (p <0.001 and p[0.004, respectively) but was similar to RTB (p[0.71), which used on average 3.8 (22%) fewer cores per patient. In 102 patients who underwent prostatectomy, there was no significant difference in upgrading rates between RTB and combined biopsy (p[0.84). Conclusions: A RTB approach can maintain state-of-the-art detection rates while requiring fewer retrieved cores. This result informs decision making about biopsy site selection and total retrieved core count.

Clinically significant prostate cancer (csPCa) detection with various prostate sampling schemes based on different csPCa definitions

“…Recently, many different modified sampling schemes have emerged to increase the detection of aggressive tumors and decrease biopsy cores and concomitant complications [ 24 ]. A regional TB strategy (10.58 cores) proposed by Raman et al [ 25 ] detected a similar number of patients with csPCa to SB + TB. And many other studies [ 26 , 27 ] also focused on optimizing the number of cores sampled from the targeted area and reached the conclusion that saturation TB (10–20 cores) detected as many patients with csPCa as 20- to 26-core SB + TB.…”

Diagnostic Performance of a Magnetic Resonance Imaging-directed Targeted plus Regional Biopsy Approach in Prostate Cancer Diagnosis: A Systematic Review and Meta-analysis

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Fig. 2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram showing the search outcome and selection of full studies included in the review [3] , [9] , [10] , [11] , [12] , [13] , [18] , [19] and the studies excluded [38] , [39] , [40] .

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“…); an agreement rate of 78% was observed between the reviewers. Ultimately, eight studies were eligible for inclusion: three prospective cohort studies [9] , [11] , [18] and five retrospective cohort studies [3] , [10] , [12] , [13] , [19] . All the studies included investigated the performance of their proposed TBx + RBx approach relative to both TBx + SBx and TBx alone.…”

“…MRI-directed biopsy approaches using TBx and only regional systematic biopsies (RBx) rather than standard SBx have been explored as an alternative approach to minimize biopsy cores, targeting errors, and grade migration. Use of such an MRI-directed TBx + RBx approach yields equivalent detection rates for significant PCa in comparison to the recommended MRI-directed TBx + SBx approach and reduces the number of biopsy cores and overdiagnosis rates [9] , [10] , [11] , [12] . Currently, there is no consensus on such an MRI-directed TBx + RBx approach and several definitions can be found in the literature, including focal saturation biopsy , perilesional biopsy , regional targeted biopsy , and targeted sector biopsy [3] , [11] , [12] , [13] .…”

“…Use of such an MRI-directed TBx + RBx approach yields equivalent detection rates for significant PCa in comparison to the recommended MRI-directed TBx + SBx approach and reduces the number of biopsy cores and overdiagnosis rates [9] , [10] , [11] , [12] . Currently, there is no consensus on such an MRI-directed TBx + RBx approach and several definitions can be found in the literature, including focal saturation biopsy , perilesional biopsy , regional targeted biopsy , and targeted sector biopsy [3] , [11] , [12] , [13] . Although different interpretations exist, the scope of these interpretations is broadly in line: limit SBx to the proximity of the MRI-positive lesion.…”