Abstract
Introduction: This study aimed to investigate the number of cores needed in a systematic biopsy (SB) in men with clinical suspicion of prostate cancer (PCa) but negative prebiopsy multiparametric magnetic resonance imaging and to test prostate-specific antigen (PSA) density as an indicator for reduced SB. Methods: Two hundred and seventy-four patients were analyzed, extracted from an institutional database. Detection rates of any PCa and clinically significant (CS) PCa for different reduced biopsy protocols were compared by using Fisher’s exact test. Results: In total, 12-core SB revealed PCa in 103 (37.6%) men. Detection rates of reduced biopsy protocols were 74 (27%, 6-core) and 82 (29.9%, 8-core). Regarding CSPCa, 12-core SB revealed a detection rate of 26 (9.5%). Reduced biopsy protocols detected less CSPCa: 15 (5.5%) and 18 (6.6%), respectively. All differences were statistically significant, p < 0.05. PSA density ≥0.15 did not help to filter out men in whom a reduced biopsy may be sufficient. Conclusions: Twelve-core SB still has the highest detection rate of any PCa and CSPCa compared to reduced biopsy protocols. If the investigator and patient agree – based on individual risk calculation – to perform a biopsy, this SB should contain at least 12 cores regardless of PSA density.
References
1.
Rouviere
O
, Puech
P
, Renard-Penna
R
, Claudon
M
, Roy
C
, Mege-Lechevallier
F
, Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study
. Lancet Oncol
. 2019
;20
(1
):100
–9
.2.
Ahmed
HU
, El-Shater Bosaily
A
, Brown
LC
, Gabe
R
, Kaplan
R
, Parmar
MK
, Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study
. Lancet
. 2017
;389
(10071
):815
–22
.3.
Ahdoot
M
, Wilbur
AR
, Reese
SE
, Lebastchi
AH
, Mehralivand
S
, Gomella
PT
, MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis
. N Engl J Med
. 2020
;382
(10
):917
–28
.4.
Kohestani
K
, Wallstrom
J
, Dehlfors
N
, Sponga
OM
, Mansson
M
, Josefsson
A
, Performance and inter-observer variability of prostate MRI (PI-RADS version 2) outside high-volume centres
. Scand J Urol
. 2019
;53
(5
):304
–11
.5.
Haffner
J
, Lemaitre
L
, Puech
P
, Haber
GP
, Leroy
X
, Jones
JS
, Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection
. BJU Int
. 2011
;108
(8 Pt 2
):E171
–8
.6.
Kasivisvanathan
V
, Rannikko
AS
, Borghi
M
, Panebianco
V
, Mynderse
LA
, Vaarala
MH
, MRI-targeted or standard biopsy for prostate-cancer diagnosis
. N Engl J Med
. 2018
;378
(19
):1767
–77
.7.
Tully
KH
, Bahlburg
H
, Berg
S
, Hanske
J
, von Landenberg
N
, Noldus
J
, Changing the prostate cancer detection paradigm: clinical application of European Association of Urology Guideline-recommended magnetic resonance imaging-based risk stratification in men with suspected prostate cancer
. Eur Urol Focus
. 2020
;7
(5
):1101
–8
.8.
Pereira-Azevedo
N
, Osório
L
, Fraga
A
, Roobol
MJ
. Rotterdam prostate cancer risk calculator: development and usability testing of the mobile phone app
. JMIR Cancer
. 2017
;3
(1
):e1
. .9.
Mottet
N
, Cornford
P
, van den Bergh
RCN
, Briers
E
, De Santis
M
, Fanti
S
, Willemse EUA Guidelines. Edn. presented at the EUA Annual Congress Amsterdam 2020
. 2020
.10.
Lughezzani
G
, Sun
M
, Budaus
L
, Thuret
R
, Shariat
SF
, Perrotte
P
, Effect of the number of biopsy cores on prostate cancer detection and staging
. Future Oncol
. 2010
;6
(3
):381
–90
.11.
Chrouser
KL
, Lieber
MM
. Extended and saturation needle biopsy for the diagnosis of prostate cancer
. Curr Urol Rep
. 2004
;5
(3
):226
–30
. .12.
Eichler
K
, Hempel
S
, Wilby
J
, Myers
L
, Bachmann
LM
, Kleijnen
J
. Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review
. J Urol
. 2006
;175
(5
):1605
–12
. .13.
Presti
JC
Jr, Chang
JJ
, Bhargava
V
, Shinohara
K
. The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial
. J Urol
. 2000
;163
(1
):163
–7
; discussion 6–7. .14.
Ravery
V
, Goldblatt
L
, Royer
B
, Blanc
E
, Toublanc
M
, Boccon-Gibod
L
. Extensive biopsy protocol improves the detection rate of prostate cancer
. J Urol
. 2000
;164
(2
):393
–6
. .15.
Washino
S
, Okochi
T
, Saito
K
, Konishi
T
, Hirai
M
, Kobayashi
Y
, Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naive patients
. BJU Int
. 2017
;119
(2
):225
–33
.16.
Hansen
NL
, Barrett
T
, Koo
B
, Doble
A
, Gnanapragasam
V
, Warren
A
, The influence of prostate-specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7-10 prostate cancer in a repeat biopsy setting
. BJU Int
. 2017
;119
(5
):724
–30
.17.
Boesen
L
, Norgaard
N
, Logager
V
, Balslev
I
, Bisbjerg
R
, Thestrup
KC
, Prebiopsy biparametric magnetic resonance imaging combined with prostate-specific antigen density in detecting and ruling out gleason 7-10 prostate cancer in biopsy-naive men
. Eur Urol Oncol
. 2019
;2
(3
):311
–9
.18.
Oishi
M
, Shin
T
, Ohe
C
, Nassiri
N
, Palmer
SL
, Aron
M
, Which patients with negative magnetic resonance imaging can safely avoid biopsy for prostate cancer?
J Urol
. 2019
;201
(2
):268
–76
.19.
Epstein
JI
, Walsh
PC
, Carmichael
M
, Brendler
CB
. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer
. JAMA
. 1994
;271
(5
):368
–74
. .20.
Mottet
N
, van den Bergh
RCN
, Briers
E
, Van den Broeck
T
, Cumberbatch
MG
, De Santis
M
, EAU-EANM-ESTRO-ESUR-SIOG Guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent
. Eur Urol
. 2021
;79
(2
):243
–64
.21.
Hu
Z
, Wang
J
, Sun
D
, Cui
L
, Ran
W
. How many cores does systematic prostate biopsy need?: a large-sample retrospective analysis
. J Ultrasound Med
. 2019
;38
(6
):1491
–9
. .22.
Wegelin
O
, Exterkate
L
, van der Leest
M
, Kelder
JC
, Bosch
J
, Barentsz
JO
, Complications and adverse events of three magnetic resonance imaging-based target biopsy techniques in the diagnosis of prostate cancer among men with prior negative biopsies: results from the FUTURE trial, a multicentre randomised controlled trial
. Eur Urol Oncol
. 2019
;2
(6
):617
–24
.23.
Ghani
KR
, Dundas
D
, Patel
U
. Bleeding after transrectal ultrasonography-guided prostate biopsy: a study of 7-day morbidity after a six-, eight- and 12-core biopsy protocol
. BJU Int
. 2004
;94
(7
):1014
–20
. .24.
Meng
Y
, Vetter
JM
, Parker
AA
, Arett
CT
, Andriole
GL
, Shetty
AS
, Improved detection of clinically significant prostate cancer with software-assisted systematic biopsy using MR/US fusion in patients with negative prostate MRI
. Urology
. 2018
;120
:162
–6
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