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Gleason grade accuracy of transperineal and transrectal prostate biopsies in MRI-naïve patients

  • Urology - Original Paper
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Abstract

Purpose

Accurate assessment of Gleason grade is essential to guiding prostate cancer management. Not all healthcare systems have universal access to prostate MRI. We investigated whether transperineal (TP) prostate biopsies provide more accurate Gleason grading than transrectal (TR) biopsies in MRI-naïve patients.

Methods

Consecutive patients undergoing TP and TR systematic prostate needle biopsies from 2011 to 2018 were analysed. Patients who underwent radical prostatectomy (RP) within 180 days of biopsies were included. Patients undergoing MRI prior to biopsies were excluded. Pathological concordance, incidence of Gleason upgrading, and correlation coefficients among biopsies and RP Gleason grade were compared. A sub-analysis for concordance in anterior prostate tumours was conducted.

Results

262 patients were included (112 TP; 150 TR), the median age was 63 years, and median time from biopsy to RP was 68 days. Concordance with RP histology for TP was 65% compared to 49% for TR (p = 0.011). Biopsy technique predicted RP concordance independent of the number of cores. Gleason upgrading occurred following 24% of TP versus 33% of TR biopsies. In anterior and apical tumours, upgrading occurred in 19% of TP biopsies and 38% of TR biopsies (p = 0.027).

Conclusion

This study suggests TP approach to prostate biopsies result in improved histological grade accuracy in men whom MRI is not available, even after controlling for number of cores. TP approach also resulted in less upgrading for lesions in the anterior and apical prostate compared to TR.

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Data will be provided upon request.

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Funding

The authors declare no funding was used to support this study.

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Authors and Affiliations

  1. Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia

    Liang G. Qu, Modher Al-Shawi, Tess Howard, Cedric Poyet, Brian Kelly, Nathan Lawrentschuk, Damien Bolton & Gregory S. Jack

  2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Nathan Papa

  3. Olivia Newton John Cancer Research Institute, Austin Health, Melbourne, Australia

    A. J. Matthew Egan, Nathan Lawrentschuk, Damien Bolton & Gregory S. Jack

  4. Department of Pathology, Austin Health, Melbourne, Australia

    A. J. Matthew Egan

  5. Department of Urology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Gregory S. Jack

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  1. Liang G. Qu
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  10. Gregory S. Jack
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Contributions

LGQ: data collection, data analysis, manuscript writing/editing; MA: data collection; TH: data collection; NP: data analysis, manuscript writing/editing; CP: manuscript writing/editing; BK: manuscript writing/editing; AJME: data analysis, manuscript writing; NL: manuscript writing/editing; DB: manuscript writing/editing; GSJ: Protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Gregory S. Jack.

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The authors declare that they have no conflicts of interest.

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Ethics approval was obtained from the Austin Health Human Research Ethics Committee. This study was performed in line with the principles of the Declaration of Helsinki.

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Qu, L.G., Al-Shawi, M., Howard, T. et al. Gleason grade accuracy of transperineal and transrectal prostate biopsies in MRI-naïve patients. Int Urol Nephrol 53, 2445–2452 (2021). https://doi.org/10.1007/s11255-021-03007-1

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  • DOI: https://doi.org/10.1007/s11255-021-03007-1

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