The Role of Prostate Combination Biopsy Consisting of Targeted and Additional Systematic Biopsy.

Chung Un Lee,Hyun Moo Lee,Joongwon Choi,Jae Hoon Chung,Seong Il Seo,Minyong Kang,Hwang Gyun Jeon,Byong Chang Jeong,Seong Soo Jeon,Si Hyun Sung,Wan Song,Hyun Hwan Sung

doi:10.3390/jcm10214804

Abstract

Background: To identify the role of combination biopsy, which consists of both targeted and additional systematic cores, in the diagnosis of clinically significant prostate cancer (csPCa). Methods: We retrospectively reviewed patients with PSA levels 2.5–15 ng/mL who have a suspicious prostate lesion (with the Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3) on multiparametric MRI (mpMRI) between January 2016 and December 2018. We analyzed biopsy results by PI-RADS score and biopsy methods (systematic, targeted, and combination biopsy). Results: Of the 711 total patients, an average of 4.0 ± 1.8 targeted and 8.6 ± 3.1 additional systematic biopsies were performed. The additional systematic biopsies were sampled outside the targeted biopsy area. The combination biopsies detected more csPCa (201 patients, 28.3%) than did the targeted (175 patients, 24.6%) or systematic (124 patients, 17.4%) biopsies alone (p < 0.001). In the initial biopsy samples, there was a 7% increase in the detection of csPCa than in targeted biopsy (62% to 69%). It increased by 11% in repeat biopsy (46% to 57%). There was no statistical significance in both groups (p = 0.3174). Conclusions: Combination biopsy has the benefit of detecting csPCa in both initial and repeat biopsy when there is a suspicious lesion on mpMRI.

Highlights

Though we could not find an association between Gleason score (G/S) upgrade and biopsy methods, we found that regardless of the Prostate Imaging Reporting and Data System (PI-RADS) score and biopsy setting, the detection rate of clinically significant prostate cancer (csPCa) is higher in the targeted biopsy group compared with the systematic biopsy group
Our findings showed a similar rate of csPCa detection with this paper, but further study is needed on racial differences in the cancer detection rate of the PI-RADS score
Regardless, we found that combination biopsies are advantageous when there is a suspicious lesion (PI-RADS ≥ 3) on multiparametric MRI (mpMRI)

Summary

Introduction

Prostate cancer is the most common cancer among American men and has accounted for 20% of newly developed male cancers in 2019 [1]. To identify the role of combination biopsy, which consists of both targeted and additional systematic cores, in the diagnosis of clinically significant prostate cancer (csPCa). The combination biopsies detected more csPCa (201 patients, 28.3%) than did the targeted (175 patients, 24.6%) or systematic (124 patients, 17.4%) biopsies alone (p < 0.001). In the initial biopsy samples, there was a 7% increase in the detection of csPCa than in targeted biopsy (62% to 69%).

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