Optimizing Spatial Biopsy Sampling for the Detection of Prostate Cancer

Area of Science:

• Urology
• Radiology
• Pathology

Background:

• The optimal number of biopsy cores for MRI-targeted prostate biopsy remains undefined.
• Accurate cancer detection and staging are crucial for prostate cancer management.

Purpose of the Study:

• To evaluate a regional targeted biopsy (RTB) approach for prostate cancer detection.
• To determine if RTB can reduce core count while maintaining diagnostic performance compared to standard methods.

Main Methods:

• Retrospective analysis of 971 men undergoing MRI-ultrasound fusion biopsy for suspected prostate cancer.
• RTB defined as cores within 2 cm of radiologist-identified regions of interest.
• Comparison of detection rates and cancer upgrading between RTB, systematic, MRI-targeted, and combined biopsy strategies.

Main Results:

• RTB detected clinically significant prostate cancer (csPCa) at a rate of 44.0%, comparable to combined biopsy (44.8%) but higher than systematic (27.0%) or MRI-targeted (38.3%) biopsy alone.
• RTB required an average of 3.8 fewer cores per patient (22% reduction) compared to standard methods.
• No significant difference in cancer upgrading rates was observed between RTB and combined biopsy in patients who underwent prostatectomy.

Conclusions:

• Regional targeted biopsy (RTB) offers a viable strategy to maintain high diagnostic accuracy for prostate cancer.
• This approach allows for a reduction in the total number of biopsy cores, potentially improving efficiency and patient experience.
• RTB findings can guide biopsy site selection and inform decisions on the total number of cores to retrieve.