Which Prostate Biopsy in Men Enrolled in Active Surveillance? Experience in 110 Men Submitted to Scheduled Three-Years Transperineal Saturation Biopsy Combined With Fusion Targeted Cores

Abstract

The reclassification rate for clinically significant prostate cancer (csPCa) has been evaluated in men enrolled in active surveillance (AS) protocol who previously underwent confirmatory biopsy. From May 2013 to September 2017, 110 patients (median age 63 years) with very low risk PCa underwent 3-years scheduled prostate biopsy performing repeated transperineal saturation biopsy (SPBx); in addition, the mpMRI lesions characterized by Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores ≥ 3 were submitted to additional mpMRI/TRUS fusion biopsies (4 cores). The reclassification rate for csPCa (over 3 or more than 10% of positive cores, ISUP Grade Group/GG ≥ 2, greatest percentage of cancer > 50%) has been evaluated. Six (5.4%) patients with PI-RADS score 3 (4 men) vs. 4 (2 men) were reclassified based on upgraded (GG2); SPBx and MRI/TRUS fusion biopsy diagnosed 100% and 0% of csPCa, respectively. Of the remaining 104 (94.5%) patients, 75 (72.2%) were found to have very low-risk PCa and in 29 (27.8%) cancer was absent (normal parenchyma). SPBx combined with mpMRI at confirmatory and repeated evaluation allow to reduce the reclassification rate during AS follow up (5.4% of the cases at 3 years from diagnosis).