The Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS<3

Hai Zhu; Xue-Fei Ding; Sheng-Ming Lu; Ning Ding; Shi-Yi Pi; Zhen Liu; Qin Xiao; Liang-Yong Zhu; Yang Luan; Yue-Xing Han; Hao-Peng Chen; Zhong Liu

doi:10.3389/fonc.2022.918300

The Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS<3

Front Oncol. 2022 Jun 8:12:918300. doi: 10.3389/fonc.2022.918300. eCollection 2022.

Authors

Hai Zhu^{1

2}, Xue-Fei Ding^{1

3}, Sheng-Ming Lu¹, Ning Ding⁴, Shi-Yi Pi², Zhen Liu¹, Qin Xiao⁵, Liang-Yong Zhu¹, Yang Luan¹, Yue-Xing Han², Hao-Peng Chen², Zhong Liu⁶

Affiliations

¹ Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, China.
² Graduate School, Dalian Medical University, Dalian, China.
³ Biobank, Northern Jiangsu People's Hospital, Yangzhou, China.
⁴ Operating Department, Northern Jiangsu People's Hospital, Yangzhou, China.
⁵ Pathology Department, Northern Jiangsu People's Hospital, Yangzhou, China.
⁶ Clinical Medical College, Yangzhou University, Yangzhou, China.

Abstract

Background: In patients with multiparameter magnetic resonance imaging (mpMRI) low-possibility but highly clinical suspicion of prostate cancer, the biopsy core is unclear. Our study aims to introduce the biopsy density (BD; the ratio of biopsy cores to prostate volume) and investigates the BD-predictive value of prostate cancer and clinically significant prostate cancer (csPCa) in PI-RADS<3 patients.

Methods: Patients underwent transperineal template-guided prostate biopsy from 2012 to 2022. The inclusion criteria were PI-RADS<3 with a positive digital rectal examination or persistent PSA abnormalities. BD was defined as the ratio of the biopsy core to the prostate volume. Clinical data were collected, and we grouped the patients according to pathology results. Kruskal-Wallis test and chi-square test were used in measurement and enumeration data, respectively. Logistics regression was used to choose the factor associated with positive biospy and csPCa. The receiver operating characteristic (ROC) curve was used to evaluate the ability to predict csPCa.

Results: A total of 115 patients were included in our study. Biopsy was positive in 14 of 115 and the International Society of Urological Pathology grade groups 2-5 were in 7 of all the PCa patients. The BD was 0.38 (0.24-0.63) needles per milliliter. Binary logistics analysis suggested that PSAD and BD were correlated with positive biopsy. Meanwhile, BD and PSAD were associated with csPCa. The ROC curve illustrated that BD was a good parameter to predict csPCa (AUC=0.80, 95% CI: 0.69-0.91, p<0.05). The biopsy density combined with PSAD increased the prediction of csPCa (AUC=0.90, 95% CI: 0.85-0.97, p<0.05). The cut-off value of the BD was 0.42 according to the Youden index.

Conclusion: In PI-RADS<3 patients, BD and PSAD are related to csPCa. A biopsy density of more than 0.42 needles per millimeter can increase the csPCa detection rate, which should be considered as an alternative biopsy method when we perform prostate biopsy in patients with PI-RADS<3.

Keywords: PI-RADS; clinically significant prostate cancer; mpMRI; prostate cancer; transperineal template-guided prostate biopsy.