Detection of clinically significant prostate cancer by transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in smaller prostates

Douglas M Dahl; Michelle M Kim; Shulin Wu; Sharron X Lin; Rory K Crotty; Kristine M Cornejo; Mukesh G Harisinghani; Adam S Feldman; Chin-Lee Wu

doi:10.1016/j.urolonc.2022.07.011

Detection of clinically significant prostate cancer by transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy in smaller prostates

Urol Oncol. 2022 Oct;40(10):451.e9-451.e14. doi: 10.1016/j.urolonc.2022.07.011. Epub 2022 Aug 23.

Authors

Douglas M Dahl¹, Michelle M Kim¹, Shulin Wu², Sharron X Lin¹, Rory K Crotty³, Kristine M Cornejo³, Mukesh G Harisinghani⁴, Adam S Feldman¹, Chin-Lee Wu⁵

Affiliations

¹ Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
² Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
³ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁴ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁵ Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: cwu2@mgh.harvard.edu.

PMID: 36008257
DOI: 10.1016/j.urolonc.2022.07.011

Abstract

Purpose: Transperineal (TP) multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) has been shown to detect more clinically significant (cs) prostate cancer (PCa) than standard template biopsies (SBx). Current data supports the inclusion of both TBx and SBx in obtaining an optimal csPCa detection rate. We compared csPCa detection rates in patients with different prostate volumes to examine the benefit of performing TBx in smaller prostates through the TP approach.

Methods: We identified all men who with suspicious lesions on mpMRI and underwent TP TBx (3-core) and concomitant SBx (20-core) in our single hospital from September 2019 to February 2021. Clinical, MRI and biopsy pathological characteristics were evaluated and compared between TBx and SBx. Grade group 2 or greater prostate adenocarcinoma was defined as csPCa.

Results: Three hundred and one (n = 301) men were included. The median prostate volume by MRI was 45 ml. The patients were divided by prostate volume into three groups: ≤30ml group (19.9%), >30 to ≤45 ml group (31.3%) and >45ml group (48.8%). Patients in the ≤30ml group showed significantly higher frequency of combined (both TBx and/or SBx) csPCa detection rate (65.0%) than patients in the >45ml group (39.5%) but similar frequency to the >30 to ≤45 ml group (54.2%,). By TBx only (55.0% vs 27.9%) or by SBx only (56.7% vs. 34.0%), patients in the ≤30ml group consistently showed significantly higher rates of csPCa detection than patients in the >45 ml group. In the ≤30ml group, the detection rate of csPCa was comparable by TBx, SBx or when combined. Four of 6 csPCa cases missed by TBx but detected by SBx were present at the base location.

Conclusion: Our data suggest that performing TBx with limited additional cores may potentially achieve the same csPCa detection rate as the combined SBx and TBx in smaller prostates.

Keywords: Clinically significant; Multiparametric MRI; Prostate cancer; Prostate volume; Targeted biopsy; Transperineal.

MeSH terms

Biopsy
Humans
Image-Guided Biopsy / methods
Magnetic Resonance Imaging
Male
Multiparametric Magnetic Resonance Imaging*
Neoplasm Grading
Prostate / diagnostic imaging
Prostate / pathology
Prostatic Neoplasms* / pathology