Abstract
Purpose
Multiparametric MRI and the transperineal approach have become standard in the diagnostic pathway for suspected prostate cancer. Targeting of MRI lesions is performed at most centers, but the routine use of systematic cores is controversial. We aim to assess the value of obtaining systematic cores in patients undergoing cognitive fusion targeted double-freehand transperineal prostate biopsy.
Materials and methods
Patients who underwent a cognitive fusion, freehand TPB at a single tertiary urology service (Perth, Australia) between November 2020 and November 2021 were retrospectively reviewed. Patients were included if they were biopsy naive and had a clinical suspicion of prostate cancer, based on their mpMRI results. Both targeted and systematic cores were taken at the time of their biopsy.
Results
One hundred forty patients suited the selection criteria. Clinically significant cancer was identified in 63% of patients. Of those that had clinically significant cancer, the target lesion identified 91% of the disease, missing 9% of patients whom the target biopsy detected non-clinically significant cancer but was identified in the systematic cores. Higher PI-RADS category patients were also found to be associated with an increasing likelihood of identifying clinically significant cancer within the target.
Conclusions
In patients with PI-RADS 3 and higher, the target biopsy can miss up to 9% of clinically significant cancer. Systematic cores can add value as they can also change management by identifying a high-risk disease where only intermediate cancer was identified in the target. A combination of targeted and systematic cores is still required to detect cancer.
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Data Availability
Data is available on request.
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M. Barns: data collection, data analysis, and manuscript editing. O. Barratt: data collection. M. Chau: project development, data collection, data analysis, and manuscript writing/editing. M. Kuan: data collection and manuscript editing. K. McDermott: data collection and manuscript editing. P. Teloken: project development, data collection, and manuscript editing.
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Ethical approval for this study was obtained from Sir Charles Gairdner Hospital (GEKO ID: 42421). Informed consent was not sought for the present study because of its retrospective nature, requiring only the review of database. All information and data was de-identified. The IRB waived the requirements for informed consent due to the retrospective nature.
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Chau, M., Barns, M., Barratt, O. et al. Are systematic prostate biopsy still necessary in biopsy naive men?. Ir J Med Sci (2024). https://doi.org/10.1007/s11845-024-03637-1
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DOI: https://doi.org/10.1007/s11845-024-03637-1