Perineural invasion (PNI) on biopsy is associated with adverse features in prostate cancer (PCa). Transrectal multiparametric magnetic resonance imaging (MRI) targeted biopsy (TBx) has shown to detect higher presence of PNI than standard template biopsies (SBx). Transperineal biopsy provides effective cancer detection with lower complications than the transrectal approach. We compared PNI detection efficiency between SBx and TBx through transperineal approach.
We identified PCa patients who underwent transperineal TBx and concomitant standard 20-core template SBx from September 2019 to February 2021. Clinical, MRI imaging and biopsy characteristics were evaluated and compared between TBx and SBx.
Two hundred and thirty-eight PCa patients underwent concomitant transperineal SBx and TBx procedures. Combined PNI+ (SBxPNI+ and/or TBxPNI+) was identified in 77/238 (32.4%) patients. SBx detected 23.9% PNI-positive patients and TBx detected 19.3% PNI-positive patients of all PCa patients. Patients with PNI were with significantly different clinicopathological characteristics than patients without PNI. Although significantly more positive PCa cores and higher positive PCa core rate were found in SBx method, patients with SBxPNI+ only shared similar features as TBxPNI+ only patients. Of 176 cases who with both SBxPCa and TBxPCa, TBx could detect 19 (15.1%) more PNI cases than SBx while SBx could detect 24 (18.3%) more PNI cases than TBx.
mpMRI fusion targeted biopsy in combination with template biopsy through transperineal approach achieved PNI detection rate over 30% of PCa cases. The increased PNI detection may improve the model to select active surveillance candidates in clinical practice.
Human pathology. 2021 Aug 27 [Epub ahead of print]
Chin-Lee Wu, Michelle Kim, Shulin Wu, Sharron X Lin, Rory K Crotty, Mukesh Haringhani, Adam S Feldman, Douglas M Dahl
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: ., Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: .