Presented by: David Dothan MD
Shaare Zedek Medical Center , Urology department.

Introduction

There is no consensus for the number of targeted biopsies taken from a single lesion on prostate MRI. There are studies which addressed this topic, but all are retrospective. Each single biopsy increases the risk for complication mainly infections and urinary retention. We examined the incremental detection rate of prostate cancer in each subsequent biopsy from a single lesion, to find what is the ideal number of biopsies from a single lesion.  

Materials

The demographic, clinical and pathologic data from men who underwent transperineal fusion biopsy of the prostate was collected prospectively. Navigo fusion system was utilized. PI-RADS version 2.1 was utilized, a lesion PI-RADS 3 and more was targeted. From one Index lesion 5 sequential targeted biopsies were taken. Systematic biopsies were performed. Clinically significant prostate cancer was defined as Gleason grade ≥3+4. Patients with PSA above 20 ng/ml, status post local/systemic/hormonal therapy were excluded.

Results

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From March 2022 until March 2023, 96 men met the inclusion criteria. Mean age was 67.3± 6.2, mean PSA 7±3.7. Fifty-seven (59.4%) patients were diagnosed with prostate cancer. In 44(45.8%) patients cancer was detected in the targeted biopsies form the Index lesion: 32(33.3%) in the first biopsy, 39(40.62%) in the first two biopsies,43(44.8%) in the first three biopsies and 44(45.8%) in all five biopsies.  Clinically significant cancer was detected in 16(36.4%) of the first two biopsies, the 3rd, 4th and 5th biopsies together added only 1(2.3%) cases of clinically significant cancer.

Conclusion

The majority of clinically significant prostate cancer will be detected during the initial two transperineal fusion biopsies targeting the index lesion. Subsequent biopsies (3rd, 4th, and 5th) yield minimal additional cancer findings, primarily consisting of non-clinically significant cases.

Funding

None

Co-Authors

Ariel Mamber, MD
Shaare Zedek Medical Center, Urology department.

Abd Shabaneh,
Shaare Zedek Medical Center, Urology department.

Ofer Beniaminov, MD
Shaare Zedem Medical Center, Radiology department.

Sofia Zilber, MD
Shaare Zedek Medical Center, Pathology department.

Boris Chertin, MD
Shaare Zedek Medical Center, Urology department.

Dmitry Koulikov, MD
Shaare Zedek Medical Center, Urology department.