Presented by: Vladislav Petov MD
Institute for Urology and Reproductive Health, Sechenov University

Introduction

Currently, prostate biopsy remains the only reliable method for PCa diagnosis. Taking into consideration the variety of prostate biopsy methods, the issue of indications for each of them remains unresolved. Current EAU guidelines recommend combining MR-targeted biopsy with systematic biopsy for high yield of PCa diagnosis. Nevertheless, it remains unclear which biopsy is more accurate for PCa detection. The aim of the study: to compare PCa detection rate among the transrectal cognitive biopsy (COG-TB), transperineal mpMR/US-fusion biopsy (FUS-TB) and transperineal template mapping biopsy (TPMB).

Materials

Inclusion criteria were as follows: PSA>2 ng/mL, and/or positive digital rectal examination, and/or suspicious lesion on TRUS or MRI (according to Pi-RADSv2.1≥3 score). All patients underwent mpMRI (Siemens Magneton Skyra 3T, protocol – T2WI, DWI, ADC map, T1WI, DCE). Then one of 3 experienced urologists performed TPMB (>20 cores) or one of the targeted biopsy methods: COG-TB or FUS-TB (MIM Software, MIM Symphony).

Results

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Totally 475 patients were enrolled into the study: 102 of them underwent COG-TB, 176 – FUS-TB and 197 – TPMB. Median PSA level (6.7 ng/ml – in COG-TB group, 6.4 ng/ml – in FUS-TB group, 6.9 ng/ml – in TPMB group (p=0.36)), prostate volume (46; 46 and 48 cm³; p=0.76) and PSA density (0.13; 0.13 и 0.13 ng/ml/cm³; p = 0.89) did not differ significantly among biopsy groups. Suspicious lesions classification by Pi-RADS v2.1 score did not show statistically significant difference among groups: Pi-RADS 3 (p=0.73), Pi-RADS 4 (p=0.99), Pi-RADS 5 (p=0.56). 

Overall PCa detection rate was higher for TPMB, but the result was not statistically significant (COG-TB – 42.1% vs FUS-TB – 50.5% vs TPMB – 56.3%; p=0.06). CsPCa (ISUP≥2) detection rate was higher for COG-TB among biopsy methods, also not statistically significant (30.3%, 25.0%, 27.4%; p=0.61). Less was detected cisPCa [А О1] by COG-TB compared with other biopsy methods (11.8%, 25.5%, 28.9%; p=0.004). Median maximum cancer core length did not differ significantly among biopsy methods (7.6; 6.6 and 4.8 mm; p=0.42). Percentage of positive cores significantly increased for targeted biopsy methods (29.5%, 30.5%, 9.67%; p<0.001).

Conclusion

Targeted methods did not show an increase in detection of csPCa as well as overall PCa detection over TPMB. Wherein less CisPCa was detected by targeted biopsy methods in comparison with TPMB. Another advantage of targeted methods is increased sampling efficiency.

Funding

None.

Lead Authors

German Krupinov, MD, PHD, professor
Institute for Urology and Reproductive Health, Sechenov University

Co-Authors

Andrey Bazarkin,
Institute for Urology and Reproductive Health, Sechenov University

Timur Ganzha, MD, PHD
Institute for Urology and Reproductive Health, Sechenov University

Sergey Danilov, MD, PHD
Institute for Urology and Reproductive Health, Sechenov University

Yaroslav Chernov, MD, PHD
Institute for Urology and Reproductive Health, Sechenov University

Denis Chinenov, MD, PHD
Institute for Urology and Reproductive Health, Sechenov University

Ramin Rzayev, MD, PHD
University Clinical Hospital №2, Department of Radiology, Sechenov University

Alexander Suvorov, MD, PHD
"Digital Biodesign and Personalized Healthcare" World-Class Research Center, Sechenov University

Alexander Amosov, MD, PHD, professor
Institute for Urology and Reproductive Health, Sechenov University

Dmitry Enikeev, MD, PHD, professor
Department of Urology and Comprehensive Cancer Center, Medical University of Vienna