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Ipsilateral hemigland prostate biopsy may underestimate cancer burden in patients with unilateral mpMRI-visible lesions

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Abstract

Purpose

To evaluate the cancer detection rates of reduced-core biopsy schemes in patients with unilateral mpMRI-visible intraprostatic lesions and to analyze the contribution of systematic biopsy cores in clinically significant prostate cancer (csPCa) detection.

Methods

212 patients with mpMRI-visible unilateral intraprostatic lesions undergoing MRI/TRUS fusion-guided targeted biopsy (TBx) and systematic biopsy (SBx) were included. Cancer detection rates of TBx + SBx, as determined by highest Gleason Grade Group (GG), were compared to 3 reduced-core biopsy schemes: TBx alone, TBx + ipsilateral systematic biopsy (IBx; MRI-positive hemigland), and TBx + contralateral systematic biopsy (CBx; MRI-negative hemigland). Patient-level and biopsy core-level data were analyzed using descriptive statistics with confidence intervals. Univariable and multivariable logistic regression analysis was conducted to identify predictors of csPCa (≥ GG2) detected in MRI-negative hemiglands at p < 0.05.

Results

Overall, 43.4% (92/212) of patients had csPCa and 66.0% (140/212) of patients had any PCa detected by TBx + SBx. Of patients with csPCa, 81.5% had exclusively ipsilateral involvement (MRI-positive), 7.6% had only contralateral involvement (MRI-negative), and 10.9% had bilateral involvement. The csPCa detection rates of reduced-core biopsy schemes were 35.4% (75/212), 40.1% (85/212), and 39.6% (84/212) for TBx alone, TBx + IBx, and TBx + CBx, respectively, with detection sensitivities of 81.5%, 92.4%, and 91.3% compared to TBx + SBx.

Conclusion

Reduced-core prostate biopsy strategies confined to the ipsilateral hemigland underestimate csPCa burden by at least 8% in patients with unilateral mpMRI-visible intraprostatic lesions. The combined TBx + SBx strategy maximizes csPCa detection.

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Funding

This research is funded by intramural research program of NIH.

Author information

Author notes

  1. Tim E. Phelps and Enis C. Yilmaz have contributed equally to this work.

  2. Peter A. Pinto and Baris Turkbey shared senior authorship.

Authors and Affiliations

  1. Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    Tim E. Phelps, Enis C. Yilmaz, Stephanie A. Harmon, Mason J. Belue, Peter L. Choyke & Baris Turkbey

  2. Biometric Research Program, National Cancer Institute, NIH, Rockville, MD, USA

    Joanna H. Shih

  3. Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA

    Charisse Garcia, Lindsey A. Hazen & Bradford J. Wood

  4. Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA

    Charisse Garcia, Lindsey A. Hazen & Bradford J. Wood

  5. Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA

    Antoun Toubaji & Maria J. Merino

  6. Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    Sandeep Gurram & Peter A. Pinto

  7. Molecular Imaging Branch, National Cancer Institute, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892-1088, USA

    Baris Turkbey

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  1. Tim E. Phelps
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Correspondence to Baris Turkbey.

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Conflict of interest

Author BJW is supported by the Intramural Research Program of the NIH and the NIH Center for Interventional Oncology and NIH Grant # Z1A CL040015-08. NIH and Philips/InVivo Inc have a cooperative Research and Development Agreement. NIH and Philips/InVivo Inc have a patent license agreement and NIH and BJW, BT, PAP, PLC may receive royalties. The remaining authors have no disclosures.

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Phelps, T.E., Yilmaz, E.C., Harmon, S.A. et al. Ipsilateral hemigland prostate biopsy may underestimate cancer burden in patients with unilateral mpMRI-visible lesions. Abdom Radiol 48, 1079–1089 (2023). https://doi.org/10.1007/s00261-022-03775-z

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  • DOI: https://doi.org/10.1007/s00261-022-03775-z

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