Mykyta Kachanov1, Sami-Ramzi Leyh-Bannurah2, Matthew J Roberts3,4, Markus Sauer5, Dirk Beyersdorff5, Svitlana Boiko1, Tobias Maurer1,6, Thomas Steuber1,6, Markus Graefen1, Lars Budäus1. 1. Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. 2. Prostate Center Northwest, Department of Urology, Pediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany. 3. Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia. 4. University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia. 5. Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg- Eppendorf, Hamburg, Germany. 6. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
PURPOSE: We assessed whether sampling of the transitional zone can be spared in patients with exclusively peripheral prostate cancer (PCa)-suspicious multiparametric magnetic resonance imaging (mpMRI) lesions who undergo combined mpMRI targeted (TBx) and systematic prostate biopsies (SBx). MATERIALS AND METHODS: Of 1,685 patients who underwent extended SBx including transitional zone sampling and had TBx of ≥1 lesion in the peripheral and/or transitional zone, we selected 863 patients with exclusively peripheral PCa-suspicious lesions and negative transitional zone mpMRI. Clinically significant PCa (csPCa) was defined as Gleason score (GS) ≥3+4. Within the selected cohort we performed a retrospective head-to-head comparison of csPCa detection rates between biopsy protocols: A) combination of peripheral TBx plus extended SBx including transitional zone sampling vs B) peripheral TBx plus SBx without any transitional zone sampling. Analyses were complemented with multivariable logistic regression models (LRMs) in the total cohort for predicting csPCa in SBx transitional zone sampling. RESULTS: Compared to the extended protocol (A), omission of systematic transitional zone sampling (B) yielded similar PCa detection for csPCa (48% vs 47%) and GS 3+3 (21% vs 20%). Only 2.0% csPCa was additionally detected with transitional zone SBx sampling (A). LRM confirmed that intraprostatic zonal distribution of mpMRI lesions independently influences csPCa detection rates of transitional zone SBx sampling. CONCLUSIONS: A peripheral TBx plus SBx without any transitional zone sampling protocol (B) yields similar csPCa detection rates as the standard extended protocol (A) but may reduce biopsy-related morbidity. This zone-dependent biopsy strategy warrants prospective evaluation to optimize the extent of systematic biopsies in presence of suspicious mpMRI lesions.
PURPOSE: We assessed whether sampling of the transitional zone can be spared in patients with exclusively peripheral prostate cancer (PCa)-suspicious multiparametric magnetic resonance imaging (mpMRI) lesions who undergo combined mpMRI targeted (TBx) and systematic prostate biopsies (SBx). MATERIALS AND METHODS: Of 1,685 patients who underwent extended SBx including transitional zone sampling and had TBx of ≥1 lesion in the peripheral and/or transitional zone, we selected 863 patients with exclusively peripheral PCa-suspicious lesions and negative transitional zone mpMRI. Clinically significant PCa (csPCa) was defined as Gleason score (GS) ≥3+4. Within the selected cohort we performed a retrospective head-to-head comparison of csPCa detection rates between biopsy protocols: A) combination of peripheral TBx plus extended SBx including transitional zone sampling vs B) peripheral TBx plus SBx without any transitional zone sampling. Analyses were complemented with multivariable logistic regression models (LRMs) in the total cohort for predicting csPCa in SBx transitional zone sampling. RESULTS: Compared to the extended protocol (A), omission of systematic transitional zone sampling (B) yielded similar PCa detection for csPCa (48% vs 47%) and GS 3+3 (21% vs 20%). Only 2.0% csPCa was additionally detected with transitional zone SBx sampling (A). LRM confirmed that intraprostatic zonal distribution of mpMRI lesions independently influences csPCa detection rates of transitional zone SBx sampling. CONCLUSIONS: A peripheral TBx plus SBx without any transitional zone sampling protocol (B) yields similar csPCa detection rates as the standard extended protocol (A) but may reduce biopsy-related morbidity. This zone-dependent biopsy strategy warrants prospective evaluation to optimize the extent of systematic biopsies in presence of suspicious mpMRI lesions.
Entities:
Keywords:
biopsy; image-guided biopsy; multiparametric magnetic resonance imaging
Authors: Sergey Sarychev; Jorn H Witt; Christian Wagner; Matthias Oelke; Andreas Schuette; Nikolaos Liakos; Theodoros Karagiotis; Mikolaj Mendrek; Mykyta Kachanov; Markus Graefen; Malte W Vetterlein; Christian P Meyer; Zhe Tian; Sami-Ramzi Leyh-Bannurah Journal: World J Urol Date: 2022-03-27 Impact factor: 4.226