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Novel sampling scheme with reduced cores in men with multiparametric MRI-visible lesions undergoing prostate biopsy

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Abstract

Purpose

To investigate the effects of various prostate biopsy protocols with reduced cores on the detection of clinically significant prostate cancer (csPCa) in individuals with MRI-visible lesions (Prostate Imaging Reporting and Data System ≥ 3).

Methods

A total of 464 patients with MRI-visible lesions were recruited. All patients underwent two or more targeted biopsies (TB) and systematic biopsies (SB). Several hypothetical biopsy schemes were set-up: TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+SB of the targeted sector (TB+t-SB), and TB+SB of the non-targeted sector (TB+n-SB). A subgroup analysis of patients with multiple MRI-visible lesions was performed. The standard of reference was defined as TB+SB. McNemar test was used to compare csPCa detection rates between various sampling schemes.

Results

The detection rates for prostate cancer and csPCa were 72.8% (338 of 464) and 62.1% (288 of 464), respectively. There were 8.0%, 0.3%, 6.3%, 1.0%, and 4.5% cases in which TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+t-SB, and TB+n-SB would have missed csPCa, respectively. All hypothetical schemes, with the exception of TB+contralateral SB (p = 0.063), significantly outperformed TB alone in terms of csPCa detection (p < 0.05). As for the multi-focus cohort, which included 48 cases, none of the non-index lesions had a higher Gleason grade than the index lesions within the same patients.

Conclusion

TB+ipsilateral SB might be the optimal biopsy scheme for detecting csPCa. As for the multi-focus cohort, the biopsy of the non-index lesions provided limited pathological information.

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Abbreviations

PCa:

Prostate cancer

csPCa:

Clinically significant prostate cancer

mpMRI:

Multiparametric magnetic resonance imaging

US:

Ultrasound

TB:

Targeted biopsy

PI-RADS v2.1:

Prostate Imaging Reporting and Data System version 2.1

SB:

Systematic biopsy

ciPCa:

Clinically insignificant prostate cancer

TS:

Target saturation

ipsi-SB:

Ipsilateral systematic biopsy

n-SB:

Systematic biopsy of the non-targeted sector

contra-SB:

Contralateral systematic biopsy

t-SB:

Systematic biopsy of the targeted sector

IL:

Index lesion

PSA:

Prostate-specific antigen

PSAD:

Prostate-specific antigen density

PV:

Prostate volume

DRE:

Digital rectal examination

GS:

Gleason score

PZ:

Peripheral zone

TZ:

Transitional zone

nIL:

Non-index lesion

GG:

Grade group

IQR:

Interquartile range

NPV:

Negative predictive value

ROC:

Receiver operating characteristic curve

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence interval

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Funding

This study was supported by funding from Capital’s Funds for Health Improvement and Research (Grant No. 2022-3-40714).

Author information

Authors and Affiliations

  1. Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, China

    Mingjian Ruan & Gang Song

  2. Institute of Urology, Peking University, Beijing, China

    Mingjian Ruan & Gang Song

  3. National Urological Cancer Center of China, Beijing, China

    Mingjian Ruan & Gang Song

  4. Department of Radiology, Peking University First Hospital, Beijing, China

    He Wang

  5. Department of Statistics, Peking University First Hospital, Beijing, China

    Xueying Li

  6. Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Gang Song

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  1. Mingjian Ruan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MR, HW, XL, and GS. The first draft of the manuscript was written by MR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Conceptualization: GS and MR; Methodology: GS and MR; Formal analysis and investigation: MR and HW, XL; Writing—original draft preparation: MR; Writing—review and editing: GS; Funding acquisition: GS; Resources: GS and HW; Supervision: GS.

Corresponding author

Correspondence to Gang Song.

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Competing interests

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards and approved by the Ethics Committee of Peking University First Hospital.

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Informed consent was obtained from all subjects involved in the study.

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Ruan, M., Wang, H., Li, X. et al. Novel sampling scheme with reduced cores in men with multiparametric MRI-visible lesions undergoing prostate biopsy. Abdom Radiol 48, 2139–2147 (2023). https://doi.org/10.1007/s00261-023-03894-1

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  • DOI: https://doi.org/10.1007/s00261-023-03894-1

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