Transrectal ultrasound (TRUS) and TRUS-biopsy accuracy in potential candidates for PRIAS active surveillance protocol

Evaluate the transrectal ultrasound (TRUS) and TRUS-guided Biopsy (TRUS-Bx) accuracy in patients with low risk prostate cancer (PCA) that were potential candidate for PRIAS active surveillance (AS) protocol but underwent to immediate radical prostatectomy (RP).

616 men were extracted from our institutional RP database. We selected the patients who met PRIAS inclusion criteria. The primary outcome was to evaluate the positive predictive value (PPV) and the specificity of suspected lesions at TRUS. The secondary outcome was to evaluate the TRUS-Bx accuracy in term of pathological upstaging and pathological upgrading with respect of RP specimen pathology report.

147 men of 616 (23.8%) in our RP database met PRIAS criteria; in this group we found 66 suspected lesions at TRUS examination (66/147: PPV 44.8%). Prostate cancer was really present in the biopsy specimen in only 32/66 of suspected lesions; in 28/66 the suspect lesion at TRUS was in the same position of the index lesion at final pathology. TRUS/biopsy specificity was 48% and TRUS/surgical specimen specificity 39%. TRUS-Bx staging accuracy: upgrading between biopsy and RP was recorded in 57/147 (38%) whereas 30/147 (20%) were upstaged on final pathology up to N1.

TRUS and TRUS-Bx are insufficient tools to detect the grade, the location and the extent of PCA. New emerging techniques, such as US-MRI fusion biopsy and 3D template-guided transperineal saturation biopsy are promising to minimize the risk of misclassification and therefore to better select the best option of treatment (radical treatments or focal therapies or active surveillance) in each patient with low risk prostate cancer.