Pan-segmental intraprostatic lesions involving mid-gland and apex of prostate (mid-apical lesions): assessing the true value of extreme apical biopsy cores.

When considering increased morbidity of apical biopsies, the added diagnostic value of separate targeting of mid-gland and apical segment of the pan-segmental mid-apical mpMRI prostate cancer (PCa) suspicious lesions was assessed.

A total of 420 patients with a single mpMRI PCa-suspicious PI-RADS ≥ 3 intraprostatic lesion extending from the mid-gland to the apical segment of the gland underwent transrectal MRI-targeted (TBx) and systematic prostate biopsy. Clinically significant PCa (CsPCa) was defined as Gleason Score (GS) ≥ 3 + 4. PCa detection rates of TBx cores were assessed according to targeted anatomical segments. Finally, the diagnostic values of two theoretical TBx protocols utilizing 1-core (A) vs. 2-cores (B) per anatomical segment were compared.

TBx within the pan-segmental mid-apical lesions yielded 44% of csPCa. After stratification into mid- vs. apical segment of the lesion, csPCa was detected in 36% (mid-gland) and 32% (apex), respectively. Within the patients who had no csPCa detection by mid-gland sampling (64%, n = 270), extreme apical TBx yielded additional 8.1% of csPCa. Comparison of extreme apical TBx strategy B vs. overall PCa detection in our cohort revealed corresponding similar rates of 49 vs.50% and 31 vs.32%, respectively.

Separate analyses of both segments, mid-gland and apex, clearly revealed the diagnostic contribution of apical TBx. Our findings strongly suggest to perform extreme apical TBx even within pan-segmental lesions. Moreover, our results indicate that a higher number of cores sampled from the mid-gland segment might be avoided if complemented with a two-core extreme apical TBx.

World journal of urology. 2022 May 02 [Epub ahead of print]

Sami-Ramzi Leyh-Bannurah, Svitlana Boiko, Dirk Beyersdorff, Fabian Falkenbach, Jonas Ekrutt, Tobias Maurer, Markus Graefen, Mykyta Kachanov, Lars Budäus

Prostate Center Northwest, Department of Urology, Pediatric Urology and Urooncology, St. Antonius Hospital, Gronau, Germany., Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany., Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. .

Go Beyond the Abstract and Read a Commentary by the Authors

email news signup