Optimizing the number of cores for MRI guided targeted and systematic transperineal prostate biopsy.

To assess cancer detection rates of different target-dependent transperineal magnetic resonance (MR) / ultrasound (US) fusion-guided biopsy templates with reduced number of systematic cores.

Single-centre outcome of transperineal MR/US fusion guided biopsies of 487 men with a single target MRI lesion, prospectively collected between 2012 and 2016. All men underwent transperineal targeted biopsy (TB) with 2 cores followed by 18-24 systematic sector biopsies (SB) using the Ginsburg protocol. Gleason score (GS) ≥ 7 prostate cancer detection rates for 2-core TB, 4-core extended target biopsy (eTB), 10- to 20-core saturation target biopsy (sTB) including cores from sectors adjacent to the target, and 14 core ipsilateral biopsy (iTB) were compared to combined TB+SB.

Cancer was detected in 345 and GS 7-10 cancer in 211 men. TB alone detected 67%, eTB 76%, sTB 91% and iTB 91% of these GS 7-10. In the sub-group of 33 men (7% of cohort) with an anterior >0.5 cc highly suspicious MRI lesion and a prostate volume ≤45 cc, 4-core eTB detected 31 (97%) of 32 cancers and all 26 GS 7-10 cancers.

Saturation TB detected GS 7-10 cancer in 25% more of the men than a 2-core TB approach, and in almost as many men (91%) as the 20- to 26- core combined targeted and systematic transperineal biopsy, while needing only 10-20 cores. A 4-core extended TB may suffice for large, highly suspicious anterior in small or slightly enlarged prostates. This article is protected by copyright. All rights reserved.

BJU international. 2019 Jul 15 [Epub ahead of print]

N L Hansen, T Barrett, T Lloyd, A Warren, C Samel, O Bratt, C Kastner

CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Germany.