Evaluating limited biopsy templates for men with markedly elevated PSAs.

Area of Science:

• Urology
• Oncology
• Diagnostic Pathology

Background:

• Men with markedly elevated PSA (>100 ng/mL) require accurate prostate needle biopsy (PNB) for diagnosis.
• Current PNB protocols aim for comprehensive tissue sampling, potentially increasing procedural morbidity.

Purpose of the Study:

• To determine the minimum prostate needle biopsy template for accurate diagnosis in men with PSA > 100 ng/mL.
• To assess the feasibility of reducing biopsy cores while maintaining diagnostic accuracy and minimizing morbidity.

Main Methods:

• Retrospective chart review of 80 men with PSA > 100 ng/mL who underwent biopsy.
• Simulation of 2- to 10-core biopsy templates from full 12-core biopsies.
• Comparison of simulated templates to full-template findings for cancer detection and Grade Group (GG) accuracy.

Main Results:

• 93% of PNB patients had Grade Group 4 or 5 disease.
• Simulated 4-core, 6-core, and 8-core templates achieved 91%, 95%, and 97% accuracy in identifying maximal GG, respectively.
• A 4-core template targeting medial mid and base sites bilaterally accurately detected maximal GG in 95% of patients.

Conclusions:

• A 4-core prostate biopsy template can achieve universal cancer detection in men with PSA > 100 ng/mL.
• Reducing the biopsy template to 4 cores minimizes under-grading and theoretically reduces procedural morbidity and cost.