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Optimized Biopsy Strategy for Transition Zone Prostate Cancer With Enhanced Perilesional Sampling: A Retrospective
Xin Chen1,2, Chen Huang1, Chenchao Zhou1
1Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
JCO Precision Oncology
|September 17, 2025
Summary
Increasing transition zone (TZ) biopsies improves prostate cancer detection. Peripheral zone (PZ) biopsies do not benefit TZ lesions, suggesting optimized strategies for TZ tumor diagnosis.
Area of Science:
- Urology
- Oncology
- Medical Imaging
Background:
- Prostate biopsy (PBx) is essential for diagnosing prostate cancer (PCa).
- Underdiagnosis of transition zone (TZ) prostate cancer (PCa) is a concern compared to peripheral zone (PZ) tumors.
- Current PBx strategies may not adequately detect TZ PCa.
Purpose of the Study:
- To identify underdiagnosis of TZ PCa compared to PZ tumors.
- To validate a novel PBx strategy for improved TZ tumor detection.
- To optimize PBx strategies for TZ lesions.
Main Methods:
- Retrospective analysis of 217 patients undergoing radical prostatectomy after 8 PZ + 4 TZ + X PBx.
- Randomized clinical trial involving 400 patients comparing modified 8 PZ + 10 TZ + X PBx with 8 PZ + 4 TZ + X PBx.
- Utilized transperineal transrectal ultrasound-magnetic resonance imaging-fusion PBx.
Main Results:
- Retrospective analysis showed insufficient TZ clinically significant PCa (csPCa) detection with 8 PZ + 4 TZ + X and 4 TZ + X PBx.
- The 8 PZ + 10 TZ + X PBx demonstrated superior TZ csPCa detection rates compared to 8 PZ + 4 TZ + X PBx in the trial.
- No increase in complications was observed with the modified biopsy strategy.
Conclusions:
- Peripheral zone biopsies do not offer additional benefit for TZ lesions.
- Increasing the number of transition zone cores can improve detection of TZ prostate cancer.
- Findings suggest optimized biopsy strategies for TZ lesions are feasible.
