Introduction and objectives:
Purpose of our study was to investigate the potential benefit in terms of Detection Rate and pathological stratification of a contextual standard systematic biopsy (SB) during an MRI-TRUS targeted biopsy (TB) in different biopsy settings.
Material and methods:
Between January 2015 and December2018 we submitted 305 patients to TB: 122 cases were biopsy naïve, 128 had a previous negative biopsy and 55 were enrolled under an active surveillance. Within these groups, we enrolled 183 men underwent both to TB and SB in the same session: 94 biopsy naïve patients (51,4 %), 63 patients with a raised PSA serum level with a previous negative biopsy performed within 4 months (34,4 %), and 26 patients enrolled in an active surveillance (AS) program (14,2 %). All cases had a suspicious area at the mpMRI (1.5T magnet with endorectal coil). Patients enrolled under AS were submitted to a confirmatory biopsy after positive mpMRI within 4 months or submitted to the one-year re-biopsy. 6 targeted cores per patient were taken. Overall detection rate of PCa and clinically significant PCa (csPCa) for the two biopsy methods were compared separately between the three groups of patients (first biopsy, previous negative biopsy and active surveillance re-biopsy). We also analyzed differences in Gleason Score of diagnosed PCa between the two methods. CsPCA was defined by the presence of ISUP grade ≥2 PCa.
Results:
Table 1 depicts overall patients’ characteristics. Non-statistical differences were observed between the three groups concerning age, PSA level, PSA density, suspected lesion’s size, location and PIRADs v2 score. Overall, 195 (64 %) and 110 (36 %) mpMRI suspect areas were posterior and anterior, respectively. Within 305 patients. Table 2a displays TB and SB performance in biopsy naïve patients (94 cases): we found no statistically significant differences between the two groups in terms of overall PCa detection (66 % vs. 63,8 %, p=0,617) and csPCa detection (56,4 % vs. 51,1 %; p=0,225). Table 2b shows TB and SB performance in patients with a previous negative SB (63 cases): TB showed higher detection rate of csPCa compared to SB alone (41,3 % vs 27 % respectively, p=0.038). Table 2c depicts TB and SB performance in patients under AS protocol (26 cases): no statistically significant differences between the two groups were observed in terms of overall PCa detection (50 % vs. 73,1 %) and csPCa detection (30,8 % vs. 26,9 %, respectively; p=0,705). Table 3 represents a contingency table comparing histologic results of TB and SB. Overall, 17 (22.6%) negative SB and 13 (34.2%) ISUP grade 1 at SB, resulted positive for csPCa at the TB. However, 11 (14.5%) negative TB and 3 (14.3%) ISUP grade 1 at TB resulted positive for csPCa at SB.
Conclusion
Our study demonstrated that TB cannot disregard SB both in biopsy naïve patients and in a re-biopsy setting for patients in AS protocol. However, in very selected cases, TB alone could be performed in patients with a recent negative SB.
