AUA 2022: Comparison Between Targeted versus Targeted Plus Standard Biopsy for Prostate Cancer Diagnosis in Biopsy Naïve Patients: A Randomized Controlled Trial

(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on detection and screening of prostate cancer and a presentation by Dr. Francesco Porpiglia discussing a randomized trial comparing targeted versus targeted plus standard biopsy for prostate cancer diagnosis in biopsy naïve patients. In biopsy naïve patients with suspected prostate cancer, the indication to perform multiparametric magnetic resonance imaging (mpMRI) guided target biopsy associated to or in place of standard biopsy is still discussed. The aim of this randomized trial was to evaluate the detection rate of overall prostate cancer and clinically significant prostate cancer in patients with positive mpMRI who were randomized to undergo target biopsy (Group A) vs target biopsy + standard biopsy (Group B). 

 This study enrolled patients from April 2019 to October 2021 at a single center. The inclusions criteria were: (i) age <75, (ii) no previous prostate biopsy, (iii) PSA <15 ng/ml, and (iv) positive (PIRADs >3) mpMRI. All target biopsies were performed with the BioJet fusion system, either by a transrectal or transperineal approach. Overall, 4 or 6 cores were taken in case of lesions <8 or >8 mm respectively, and transrectal standard biopsy was performed obtaining 12 cores via a transrectal approach. Clinically significant prostate cancer was defined as ISUP > 2 for target biopsy and the updated Epstein criteria for standard biopsy.

 There were 201 and 190 patients enrolled in Group A and B, respectively, with patient demographics comparable between arms. Overall prostate cancer detection rate was 64.7% and 71.1% in Group A and B (p=0.17), respectively, while clinically significant prostate cancer detection rate was 60.7% and 63.2% (p=0.61), respectively. 

Focusing on Group B, prostate cancer and clinically significant prostate cancer were found at standard biopsy alone in 11.1% and 7.9% of cases, respectively. Furthermore, a clinically significant prostate cancer was found contralateral to the index lesion in 2.6% of cases. Upgrading from a non-clinically significant prostate cancer to clinically significant prostate cancer with standard biopsy was registered in 4.2% of the cases. No significant differences in terms of periprocedural complications were recorded between the two groups.

 

Dr. Porpiglia concluded his presentation by discussing a randomized trial comparing targeted versus targeted plus standard biopsy for prostate cancer diagnosis in biopsy naïve patients with the following take-home messages:

  • In biopsy-naive patients with suspected prostate cancer and positive mpMRI, the addition of standard biopsy to target biopsy did not significantly increase the detection rate of prostate cancer or clinically significant prostate cancer, even if a non-negligible rate of clinically significant prostate cancer were diagnosed by standard biopsy alone
  • Especially in cases of index lesions <10 mm, the addition of further sampling in the “grey area” improves the detection rate of targeted biopsy-only approach

Presented by: Francesco Porpiglia, MD, Division of Urology, San Luigi Hospital, University of Turin, Turin, Italy

Co-Authors: Enrico Checcucci, Matteo Manfredi, Sabrina De Cillis, Daniele Amparore, Federico Piramide, Alberto Piana, Gabriele Volpi, Michele Sica, Paolo Verri, Stefano Granato, Stefano Piscitello, Mariano Burgio, Ola Luciano, Beatrice Carbonaro, Davide Zamengo, Alberto Quara, Marcello Della Corte, Edoardo Dibilio, Paolo Alessio, Angela Pecoraro, Ilaria Sturia, Orbassano (Turin), Italy; Giuseppe Migliaretti, Turin, Italy; Cristian Fiori, Stefano De Luca, Orbassano (Turin), Italy

 

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.