Difference in high-risk prostate cancer detection between transrectal and transperineal fusion approaches.

Abstract

273 Background: Present study aimed to gain insight into whether patients with high-risk prostate cancer (defined as Gleason 8-10) are being more precisely diagnosed by MRI fusion technique compared to TRUS-guided biopsy. Methods: A special retrospective cohort study database analysis was planned and conducted by urological department of University clinic of Cologne. After the database cut off the group of 779 patients with prostate cancer that underwent biopsy and further surgical treatment (radical prostatectomy) was selected. it was split into 2 cohorts according to biopsy type: TRUS guided biopsy and transperineal Fusion Biopsy. Standard systemic approach included 12 cores in TRUS and 18 in MRI-guided cohorts. Additional 5-6 cores were taken from the region of interest in the Fusion group. All the patients during analysis were divided into risk groups: Gleason 6 (3+3) - low risk group, Gleason 7a (3+4) - intermediate risk group, favourable prognosis, Gleason 7b (4+3) - intermediate risk group, unfavourable prognosis, Gleason 8-10 – high group. Concordance of primary and postoperative pathology was estimated by using re-grading levels and migration from low\intermediate to high-risk group. Additionally, the presence of one or more risk factors (perineural and lymphovascular invasion, presence of cribriform pattern, etc.) in primary specimens was evaluated. Results: The groups were statistically equal by age (p = 0,16), PSA risk-groups (χ2= 1,36; p = 0,53), density division ( χ2= 0,58; p = 0,74), prostate volume (p = 0,23) and ECOG status (Me [25 %; 75 %] p = 0,17). There were no significant differences between groups in terms of final pathology – number of cases in low, intermediate and high risk groups (χ2= 1,37; p= 0,5). Difference was observed in lower rate of upgrading to high-risk group and higher detection of risk factors in favour of transperineal-targeted biopsy (Table). Exposure of targeted biopsy increased the probability of detecting high risk PCa by 39% compared to systemic cores (OR 1.39, 95% CI: 0.9 - 1.9; p = 0,06). Conclusions: Transperineal fusion biopsy can be characterised by a higher possibility of detecting high-risk prostate cancer compared to conventional transrectal methods. A higher probability of discovering risk factors after transperineal fusion biopsy might be an important tool for proper staging and risk-adapted treatment strategy.[Table: see text]