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- Title
Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study.
- Authors
Krausewitz, Philipp; Fostitsch, Dorothea; Weiten, Richard; Kluemper, Niklas; Stein, Johannes; Luetkens, Julian; Kristiansen, Glen; Ellinger, Jörg; Ritter, Manuel
- Abstract
Purpose: Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution. Methods: Two hundred and fifty-nine men with PI-RADS 3–5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2. Results: CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p < 0.001). However, TB showed higher efficiency, defined as CDR per biopsy core, for PCA and csPCA in PI-RADS 4–5 rated patients (p < 0.001). Concordance between biopsy and prostatectomy grading was highest in CB with misdiagnosis of csPCA in 25% of men. TB missed cancer attributed to the index lesion in 10.2% and underestimated csPCA in 7%. In these cases, 76% of csPCA were detected and 85% were upgraded to csPCA by SB in adjacent sectors. Conclusion: SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.
- Subjects
PROSTATE cancer; BIOPSY; TUMOR grading; EARLY detection of cancer; RISK-taking behavior; DIAGNOSIS
- Publication
World Journal of Urology, 2023, Vol 41, Issue 1, p19
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-022-04230-w