Abstract
PurposeTo determine whether additional systematic biopsy is necessary in all biopsy naïve patients with MRI visible lesions by taking PI-RADS score and prostate volume into consideration.Materials and MethodsPatients who underwent combined systematic biopsy (SB) and cognitive MRI-targeted biopsy (TB) in our hospital between May 2018 and June 2020 were retrospectively reviewed. The detection rate of clinical significant prostate cancer (csPCa), biopsy grade group (GG) concordance, and disease upgrading rate on radical prostatectomy were compared between SB and TB and further stratified by PI-RADS v2.0 category and prostate volume.ResultsA total of 234 patients were analyzed in this study. TB alone detected more csPCa and less clinically insignificant prostate cancer (cisPCa) than SB alone in the whole cohort (57.3 vs 53%, P = 0.041; 3.8 vs 7.7%, P = 0.049 respectively). The additional SB indicated only a marginal increase of csPCa detection but a remarkable increase of cisPCa detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012). As stratified by PI-RADS category, the difference of csPCa detection rate between TB and SB was not significant either in PI-RADS 5 subgroup (83.8 vs 76.3%, P = 0.07) or in PI-RADS 3–4 subgroup (43.5 vs 40.9%, P = 1.0). Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than TB alone in PI-RADS 3–4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0). When stratified by prostate volume (PV), TB alone detected more csPCa than SB in small prostate (PV < 30 ml) group (81.0 vs 71.0%, P = 0.021) but not in large prostate (PV ≥ 30 ml) group (44.0 vs 42.7%, P = 0.754). The additional SB did not significantly decrease the rate of disease upgrading on RP than TB alone in either small or large prostate (6.4 vs 8.5%, P = 1.0; 13.8 vs 22.4%, P = 0.063).ConclusionThe combination biopsy method was no superior than targeted biopsy alone in PI-RADS 5 or in small volume prostate subgroup.
Highlights
The standard 10 or 12 cores systematic transrectal ultrasound biopsy (TRUS) was the most common diagnostic method for men suspected with prostate cancer (PCa) on the basis of elevated prostate-specific antigen (PSA) level or an abnormal digital rectal examination [1]
The additional systematic biopsy (SB) indicated only a marginal increase of clinically significant PCa (csPCa) detection but a remarkable increase of clinically insignificant prostate cancer (cisPCa) detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012)
Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than targeted biopsy (TB) alone in PI-RADS 3–4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0)
Summary
The standard 10 or 12 cores systematic transrectal ultrasound biopsy (TRUS) was the most common diagnostic method for men suspected with prostate cancer (PCa) on the basis of elevated prostate-specific antigen (PSA) level or an abnormal digital rectal examination [1]. This random sampling strategy is lacking reliability and associated with missed clinically significant PCa (csPCa) and substantial inaccurate risk stratification [2, 3]. It is of clinical importance to assess the clinical implications of targeted biopsy with additional systematic biopsy
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