Clinically significant prostate cancer (csPCa) detection with various prostate sampling schemes based on different...

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Prostate cancer (PCa) diagnosis often combines systematic biopsy (SB) and targeted biopsy (TB) per European Association of Urology (EAU) guidelines.
• While effective, this combined approach increases the number of biopsy cores.
• Alternative strategies are needed to maintain detection rates while reducing invasiveness.

Purpose of the Study:

• To evaluate if ipsilateral SB (ipsi-SB) + TB or contralateral SB (contra-SB) + TB can achieve similar clinically significant prostate cancer (csPCa) detection rates as standard SB + TB.
• To compare these methods using fewer biopsy cores.
• To assess detection rates based on different csPCa definitions.

Main Methods:

• Prospective study of 279 men with MRI-positive prostate lesions.
• All patients underwent combined SB and TB.
• Comparison of csPCa detection rates for SB, TB, ipsi-SB + TB, and contra-SB + TB against SB + TB.

Main Results:

• Ipsi-SB + TB and contra-SB + TB used significantly fewer cores (median 7) than SB + TB (median 10).
• Ipsi-SB + TB showed a significantly higher csPCa detection rate than contra-SB + TB under EAU guidelines (P=0.042).
• Detection rates were comparable between ipsi-SB + TB and contra-SB + TB using Epstein criteria (P=1.000).

Conclusions:

• Ipsi-SB + TB achieves comparable csPCa detection to SB + TB with fewer cores, particularly under EAU guidelines.
• The low rate of significant Gleason score upgrading with contralateral biopsy suggests contra-SB may be avoidable.
• This approach could optimize biopsy strategies for prostate cancer diagnosis.