Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy

Abstract

Introduction: To determine whether unilateral prostate cancer diagnosed at 12-core prostate biopsy harbours relevant prostate cancer foci in contralateral lobe in cases eligible for hemiablative focal therapy. Material and Methods: We analysed 112 radical prostatectomies of unilateral Gleason 6/7 prostate cancer based on prostate biopsy information. The presence of significant prostate cancer foci and/or the index lesion in the contralateral lobe is described. A subanalysis is performed in cases of Gleason score 6 and in cases of very-low-risk prostate cancer. Results: Contralateral prostate cancer was present in 69.6% of cases, fulfilling significant prostate cancer criteria in 33% and being the index lesion in 32%. No significant differences were found when analysing the Gleason 6 group (73% contralateral prostate cancer, 34% significant prostate cancer and 35% index lesion) or the very-low-risk prostate cancer group (80% contralateral prostate cancer, 29% significant prostate cancer and 45% index lesion). Conclusions: The assumption of unilateral prostate cancer based on 12-core template prostate biopsy information is unreliable. In about one third of the cases, there will be focus of significant prostate cancer or the index lesion in the contralateral lobe. This information should be taken into account when hemiablative focal therapies are considered.

Do contemporary imaging and biopsy techniques reliably identify unilateral prostate cancer? Implications for hemiablation patient selection

“…[11][12][13][14][15][16][17][18] Two of these studies reported on the rate of bilateral csCaP on WMP (33% and 50%, respectively) in patients with only unilateral disease on TRUS biopsy alone. [11][12][13][14][15][16][17][18] Two of these studies reported on the rate of bilateral csCaP on WMP (33% and 50%, respectively) in patients with only unilateral disease on TRUS biopsy alone.…”

“…[11][12][13][14][15][16][17] Although there is strong clinical evidence that prostate imaging with mpMRI and targeted biopsy improves csCaP detection on the patient level, [18][19][20][21][22][23] to our knowledge the detection sensitivity for mpMRI for individual CaP foci remains moderate, particularly in smaller, nonindex, multifocal lesions. Appropriate candidates for hemiablation have csCaP limited to 1 prostate lobe.…”

Relationship between Gleason score and apparent diffusion coefficients of diffusion-weighted magnetic resonance imaging in prostate cancer patients

“…6,7 However, determination of GS is based on transrectal ultrasoundguided prostate biopsy, which is associated with sampling error and severe adverse events; [8][9][10] in particular, upgrading a patient with a higher GS from biopsy to prostatectomy specimen occurs in up to one-third of patients. 11,12 Recently, multiparametric magnetic resonance imaging (mpMRI), including diffusion-weighted imaging (DWI), has emerged as an important modality in prostate cancer diagnosis.…”

Patient-Reported Experience of Modified Transperineal Template Guided Saturation Biopsy Under General Anaesthesia and without Prophylactic Catheterisation

“…Furthermore, it lacks the ability to precisely characterise the site, extent and grade of tumours identified [2], although availability of accurate information is obviously preferable when planning patient management. Transperineal template guided saturation biopsy (TPSB) has been introduced in an attempt to overcome the failings of conventional biopsy [3,4], but with a wide variation in reported incidence of retention, added cost concerns and uncertainty regarding optimum anaesthetic requirements [5,6]. Furthermore, patients and clinical governance bodies are increasingly expecting greater information to be supplied routinely regarding what individuals are likely to experience when undergoing any interventional procedure, but although prospective in-depth data are often lacking.…”