A Multicentre Analysis of the Detection of Clinically Significant Prostate Cancer Following Transperineal Image-fusion Targeted and Nontargeted Systematic Prostate Biopsy in Men at Risk.

Prostate biopsy guided by magnetic resonance imaging (MRI) is increasingly used to obtain tissue from men with suspected prostate cancer (PC).

To report a multicentre series of image-fusion transperineal prostate biopsies and compare the diagnostic yield of clinically significant PC (csPC) between targeted and nontargeted biopsies.

The study included 640 consecutive patients with elevated prostate specific antigen (PSA) presenting for first biopsy or following a previous negative transrectal biopsy under the care of 13 urologists in 11 centres in the UK (April 2014-June 2017).

Multiparametric MRI was carried out in 61 approved prostate MRI centres with transperineal targeted alone (n=283) or targeted plus nontargeted (n=357) transperineal rigid image-fusion targeted biopsy (MIM-Symphony-DX).

Rates of csPC and insignificant cancer detection in targeted and nontargeted biopsies were measured using a number of thresholds to define clinical significance. The primary definition was Gleason≥4+3 or any grade ≥6mm.

The mean age, median PSA, and median prostate volume for the cohort were 63.8yr (standard deviation [SD] 8.4), 6.3 ng/ml (SD 5.8), and 42.0cm3 (SD 24.7), respectively. Overall, 276/640 men (43.1%) were diagnosed with csPC. csPC was detected from targeted biopsies alone in 263/640 cases (41.1%). Of the 357 men who underwent nontargeted biopsies, three (0.8%) had csPC exclusively in nontargeted cores, with no evidence of cancer in targeted cores. Overall, 32/357 (9.0%) had csPC in nontargeted biopsies regardless of the targeted biopsy findings. Clinically insignificant disease in nontargeted biopsies was detected in 93/357 men (26.1%). Our findings were consistent across all other thresholds of clinical significance. Limitations include the lack of nontargeted biopsies in all men.

In this large multicentre series, nontargeted prostate biopsy cores had a low yield of csPC and a high yield of clinically insignificant PC. An image-fusion targeted-biopsy-only approach maintains high detection for csPC and low detection of clinically insignificant cancers.

In this report, we found that following prostate multiparametric magnetic resonance imaging and targeted transperineal biopsies of suspicious areas, the clinical value of performing additional extensive unguided biopsies of nonsuspicious areas is limited and can often find insignificant cancers that do not need treatment.

European urology oncology. 2019 Mar 29 [Epub ahead of print]

Saiful Miah, Feargus Hosking-Jervis, Martin J Connor, David Eldred-Evans, Taimur T Shah, Manit Arya, Neil Barber, Jeetesh Bhardwa, Simon Bott, Daniel Burke, Alan Doherty, Christopher Foster, Alex Freeman, Richard Hindley, Charles Jameson, Omer Karim, Marc Laniado, Bruce Montgomery, Raj Nigam, Shonit Punwani, Andrew Sinclair, Mathias Winkler, Clare Allen, Hashim U Ahmed

Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK. Electronic address: ., Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK., Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK., Department of Urology, University College London Hospital, London, UK., The Prostate Unit, BUPA Cromwell Hospital, London, UK., HCA Laboratories, London, UK., Department of Pathology, University College London Hospital, London, UK., Department of Radiology, University College London Hospital, London, UK., Department of Urology, Charing Cross Imperial Healthcare NHS Trust, London, UK.

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