Systematic biopsy should not be omitted in the era of combined magnetic resonance imaging/ultrasound fusion-guided biopsies of the prostate

Lodeta, Branimir; Trkulja, Vladimir; Kolroser-Sarmiento, Georg; Jozipovic, Danijel; Salmhofer, Aigul; Augustin, Herbert

doi:10.1007/s11255-021-02989-2

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…In our overall patient cohort, we observed that 30% of PCa patients received a RP, which seems to represent a realistic threshold for surgical treatment decisions, assumed that the FB study cohort is larger (31%–39%) ( 2 , 10 , 12 , 42 ). Interestingly, TB/SB predicts the WMPR-ISUP grade in our total- and BN-cohort significantly better than the TB or SB approach alone.…”

Section: Discussionmentioning

confidence: 86%

“…Nevertheless, our study is not devoid of limitations: Performing SB always after TB seems to be common practice also in other analysis ( 4 , 5 , 7 , 42 ) and may be criticized as it could lead to a bias arising from the knowledge of just previously performed TB. On the contrary performing SB first could impair the diagnostic performance of the TB by SB induced bleeding artifacts ( 3 ).…”

Section: Discussionmentioning

confidence: 95%

“…Some authors conclude that the additional value of performing SB after TB is limited in patients with PI-RADS 5 lesions with or without a PSA density (PSAD) ≥0.15 or anterior lesions and thus could be omitted ( 41 ). In contrast, others proclaim that they failed to identify those patients who might safely benefit from TB alone and recommend SB since TB/SB have a higher detection rate of csPC ( 8 , 42 ) and false negative TB missing relevant PCa in 9%–27% of heterogenous cohorts ( 7 , 10 , 11 , 42 ). Nevertheless, it was not within the focus of this work to assess the influence of a certain additional PSAD cut-off or specific tumor location on the csPCa detection rate of patients.…”

Section: Discussionmentioning

confidence: 99%

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Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

et al. 2022

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ObjectiveGuidelines for previous negative biopsy (PNB) cohorts with a suspicion of prostate cancer (PCa) after positive multiparametric (mp) magnetic-resonance-imaging (MRI) often favour the fusion-guided targeted prostate-biopsy (TB) only approach for Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions. However, recommendations lack direct biopsy performance comparison within biopsy naïve (BN) vs. PNB patients and its prognostication of the whole mount pathology report (WMPR), respectively. We suppose, that the combination of TB and concomitant TRUS-systematic biopsy (SB) improves the PCa detection rate of PI-RADS 2, 3, 4 or 5 lesions and the International Society of Urological Pathology (ISUP)-grade predictability of the WMPR in BN- and PNB patients.MethodsPatients with suspicious mpMRI, elevated prostate-specific-antigen and/or abnormal digital rectal examination were included. All PI-RADS reports were intramurally reviewed for biopsy planning. We compared the PI-RADS score substratified TB, SB or combined approach (TB/SB) associated BN- and PNB-PCa detection rate. Furthermore, we assessed the ISUP-grade variability between biopsy cores and the WMPR.ResultsAccording to BN (n = 499) vs. PNB (n = 314) patients, clinically significant (cs) PCa was detected more frequently by the TB/SB approach (62 vs. 43%) than with the TB (54 vs. 34%) or SB (57 vs. 34%) (all p < 0.0001) alone. Furthermore, we observed that the TB/SB strategy detects a significantly higher number of csPCa within PI-RADS 3, 4 or 5 reports, both in BN and PNB men. In contrast, applied biopsy techniques were equally effective to detect csPCa within PI-RADS 2 lesions. In case of csPCa diagnosis the TB approach was more often false-negative in PNB patients (BN 11% vs. PNB 19%; p = 0.02). The TB/SB technique showed in general significantly less upgrading, whereas a higher agreement was only observed for the total and BN patient cohort.ConclusionDespite csPCa is more frequently found in BN patients, the TB/SB method always detected a significantly higher number of csPCa within PI-RADS 3, 4 or 5 reports of our BN and PNB group. The TB/SB strategy predicts the ISUP-grade best in the total and BN cohort and in general shows the lowest upgrading rates, emphasizing its value not only in BN but also PNB patients.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

et al. 2022

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“…The necessity for systematic biopsy during combined biopsy has been studied. 19 20 Almost all previous studies conducted 12-core systematic biopsy in combined biopsy. However, the methodological aspects of this procedure have not been studied.…”

Section: Introductionmentioning

confidence: 99%

Sextant Systematic Biopsy Versus Extended 12-Core Systematic Biopsy in Combined Biopsy for Prostate Cancer

Chung,

Song,

Kang

et al. 2024

J Korean Med Sci

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Background This study assessed the comparative effectiveness of sextant and extended 12-core systematic biopsy within combined biopsy for the detection of prostate cancer. Methods Patients who underwent combined biopsy targeting lesions with a Prostate Imaging Reporting and Data System (PI-RADS) score of 3–5 were assessed. Two specialists performed all combined cognitive biopsies. Both specialists performed target biopsies with five or more cores. One performed sextant systematic biopsies, and the other performed extended 12-core systematic biopsies. A total of 550 patients were analyzed. Results Cases requiring systematic biopsy in combined biopsy exhibited a significant association with age ≥ 65 years (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.25–4.32; P = 0.008), PI-RADS score (OR, 2.32; 95% CI, 1.25–4.32; P = 0.008), and the number of systematic biopsy cores (OR, 3.69; 95% CI, 2.11–6.44; P < 0.001). In patients with an index lesion of PI-RADS 4, an extended 12-core systematic biopsy was required (target-negative/systematic-positive or a greater Gleason score in the systematic biopsy than in the targeted biopsy) ( P < 0.001). Conclusion During combined biopsy for prostate cancer in patients with PI-RADS 3 or 5, sextant systematic biopsy should be recommended over extended 12-core systematic biopsy when an effective targeted biopsy is performed.

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Evaluation of systematic prostate biopsies when performing transperineal MRI/TRUS fusion biopsy with needle tracking—what is the additional value?

et al. 2022

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Systematic biopsy should not be omitted in the era of combined magnetic resonance imaging/ultrasound fusion-guided biopsies of the prostate

Cited by 3 publications

References 27 publications

Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

Sextant Systematic Biopsy Versus Extended 12-Core Systematic Biopsy in Combined Biopsy for Prostate Cancer

Evaluation of systematic prostate biopsies when performing transperineal MRI/TRUS fusion biopsy with needle tracking—what is the additional value?

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