Individualized Decision Making in Transperineal Prostate Biopsy: Should All Men Undergo an Additional Systematic Biopsy?

August Sigle; Rodrigo Suarez-Ibarrola; Matthias Benndorf; Moritz Weishaar; Jonathan Morlock; Arkadiusz Miernik; Christian Gratzke; Cordula A Jilg; Markus Grabbert

doi:10.3390/cancers14215230

Individualized Decision Making in Transperineal Prostate Biopsy: Should All Men Undergo an Additional Systematic Biopsy?

Cancers (Basel). 2022 Oct 25;14(21):5230. doi: 10.3390/cancers14215230.

Authors

August Sigle^{1

2}, Rodrigo Suarez-Ibarrola¹, Matthias Benndorf³, Moritz Weishaar¹, Jonathan Morlock¹, Arkadiusz Miernik¹, Christian Gratzke¹, Cordula A Jilg¹, Markus Grabbert¹

Affiliations

¹ Department of Urology, Faculty of Medicine, Medical Center-University of Freiburg, 79106 Freiburg, Germany.
² Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79110 Freiburg, Germany.
³ Department of Radiology, Faculty of Medicine, Medical Center-University of Freiburg, 79106 Freiburg, Germany.

Abstract

Background: In prostate cancer (PC) diagnosis, additional systematic biopsy (SB) is recommended to complement MRI-targeted biopsy (TB) to address the limited sensitivity of TB alone. The combination of TB+SB is beneficial for diagnosing additional significant PC (sPC) but harmful in terms of the additional diagnosis of indolent PC (iPC), morbidity, and resource expenditures. We aimed to investigate the benefit of additional SB and to identify predictors for this outcome. Methods: We analyzed the frequency of upgrading to sPC by additional SB in a retrospective single-center cohort of 1043 men. Regression analysis (RA) was performed to identify predictors for this outcome. Reclassification rates of ISUP grade groups between prostate biopsy and a subsequent radical prostatectomy were assessed. Results: Additional SB led to upgrading to sPC in 98/1043 men (9.4%) and to the additional diagnosis of iPC in 71/1043 (6.8%). In RA, men harboring a PI-RADS 2-4 lesion were more likely to have TB results upgraded by SB (p < 0.01) compared to PI-RADS 5 men. When analyzing reclassification rates, additional SB reduced the upgrading to sPC from 43/214 (20.1%) to 8/214 (3.7%). In the PI-RADS 5 subgroup, this difference decreased: 4/87 (4.7%) with TB only vs. 1/87 (1.2%) with TB+SB. Conclusion: Men with a PI-RADS 5 lesion may obviate additional SB.

Keywords: biopsy strategy; fusion biopsy; image-guided biopsy; prostatic neoplasms.

Grants and funding

The article processing charge was funded by the Baden-Wuerttemberg Ministry of Science, Research and Art and the University of Freiburg in the funding programme Open Access Publishing.