Login / register
ABSTRACT
Introduction – Active surveillance is an ideal option for low risk prostate cancer patients. Transperineal template biopsy of prostate and multi-parametric MRI are increasingly becoming inevitable tools in the management of prostate cancer especially low risk disease.
Methods - We retrospectively reviewed patients who underwent transperineal template biopsies from January 2016 till December 2018. 142 patients were on active surveillance and underwent mapping transperineal template biopsies and cognitive target biopsies. 130 of them had multi-parametric MRI prior to the template biopsies.
Results – In 52% cases the histology was upgraded, 34 patients (24%) the cancer was upgraded to Gleason 3+4 and 39 (28%) it was upgraded to scores higher than Gleason 3+4. Higher PIRAD scores on MRI were associated with higher Gleason grades on histology post-template biopsies. Only 64 (45%) patients continued on Active Surveillance post-template biopsies due to significant upgrading of histology. Abnormal prostate on digital rectal examination was associated with clinically significant prodstatae cancer in more than 2/3 of the cases and hence a bad prognostic factor for active surveillance.
Conclusions - We advocate an early transperineal template guided prostatic biopsies for intermediate risk prostate cancer, multiple core involvement, higher PIRAD grades and suspicious prostate on digital rectal examination.
