The accuracy of transperineal template-guided mapping biopsy in patients with negative magnetic resonance imaging

The aim of this study was to assess the diagnostic accuracy and spatial localization capability of transperineal template-guided mapping biopsy (TTMB) in the detection of prostate cancer in patients with negative magnetic resonance imaging (MRI).

A retrospective study was conducted to analyze the clinical data and follow-up outcomes of patients with negative MRI who underwent transperineal prostate biopsy at Northern Jiangsu People's Hospital, between January 2017 and August 2020. The patients were categorized into TTMB group and the systematic biopsy (SB) group according to the biopsy method. The biopsy positivity rate, detection rate of clinically significant prostate cancer (csPCa), pathological grade upgrading and downgrading following radical surgery, repeat biopsy rate, and positive rate of repeat biopsy were compared between the two patient groups. The diagnostic accuracy of TTMB in detecting and localizing prostate lesions was assessed using whole-mount radical prostatectomy specimens.

A total of 398 patients were enrolled in the study, of whom 185 were in the TTMB group and 213 in the SB group. The TTMB group had significantly higher biopsy cores (53.5 vs. 18.1), biopsy-positive rate [28.1% (52/185) vs. 15.5% (33/213)], and csPCa rate [15.7% (29/185) vs. 8.9% (19/213)] than the SB group. In radical prostatectomy, compared with SB, the pathological downgrade of TTMB was higher (36.4% vs. 19.2%), and the pathological upgrade was lower (6.8% vs. 30.8%). The incidence of hematuria (37.8%), perineal hematoma (34%), and urinary retention (11.9%) in TTMB is significantly higher than in SB (P < 0.05). The repeat biopsy rate (13.2%) and the csPCa detection rate (2.5%) in the TTMB group were both significantly lower than in the SB group (28.1% and 9.9). Whole-mount histopathological revealed 118 lesions, and 91.5% (108/118) lesions were detected by TTMB.

TTMB enhances biopsy accuracy and facilitates more precise detection and evaluation of tumor lesions patients with negative MRI.