Utility of early transperineal template-guided prostate biopsy for risk stratification in men undergoing active surveillance for prostate cancer

To assess the accuracy and utility of routine multiparametric MRI (mp-MRI) and transperineal template-guided prostate biopsy (TPB) following enrolment on to active surveillance.

From April 2012 to December 2016 consecutive men from our single institution diagnosed with low or intermediate risk prostate cancer on TRUS biopsy were offered further staging with early mp-MRI and TPB within 12 months of diagnosis. Data was collected prospectively. Eligibility criteria comprised: age ≤77 years; Gleason score ≤3+4; clinical stage T1-T2; PSA ≤15 ng/ml; <50% positive biopsy cores.

208 men were enrolled, including 196 with Gleason 3+3 and 12 with Gleason 3+4 disease. Median TPB core number was 50 (range 17-161) with a mean TPB core density of 1.2 cores/cm3 prostate volume. 83 men (39.9%) underwent histopathological upgrading after TPB, including 76 (38.8%) men with Gleason 3+3 disease and 7 (58.3%) men with Gleason 3+4 disease. Of these, 26 (31.3%) were found to harbour primary pattern Gleason grade ≥4. 24 (28.9%) upgraded cases had PIRADS 1 or 2 lesions on mp-MRI, including 5 patients with Gleason ≥4+3 disease. Of these, 14 (58.3%) had a PSA density of ≥0.15, including 4/5 with Gleason ≥4+3 disease. Overall there was a change in prostate cancer management in 77 (37.0%) men following TPB.

Early TPB during active surveillance is associated with significant upgrading and a change in treatment plan in over a third of men. If TPB was omitted in men with a PIRADS score <3 and PSA density <0.15, 12% of those harbouring more significant disease would have been misclassified. This article is protected by copyright. All rights reserved.

BJU international. 2017 Dec 14 [Epub ahead of print]

James Voss, Raj Pal, Shaista Ahmed, Magnus Hannah, Adil Jaulim, Thomas Walton

Department of Urology, Nottingham University Hospitals NHS Trust, United Kingdom.

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