The Detection of Prostate Cancer with Magnetic Resonance Imaging-Targeted Prostate Biopsies is Superior with the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-Ins

Our aim was to evaluate whether transperineal (TP) MRI-targeted prostate biopsy (TBx) may improve the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology ≥2, in comparison to transrectal (TR) TBx.

A multicenter retrospective cohort study comprising patients who underwent MRI-guided prostate biopsy was conducted. To address possible benefits of TP-TBx in the detection of prostate cancer (PCa) and csPCa, a cohort of patients undergoing TP-TBx were compared to patients undergoing TR-TBx. Multivariable logistic regression analyses were performed to assess predictors of PCa and csPCa detection.

Overall, 1,936 and 3,305 patients who underwent TR-TBx vs TP-TBx at 10 referral centers were enrolled. The rate of PCa and csPCa diagnosed was higher for TP-TBx vs TR-TBx (64.0% vs 50%, p <0.01 and 49% vs 35%, p <0.01). At multivariable analysis adjusted for age, biopsy naïve/repeated biopsy, cT stage, Prostate Imaging-Reporting and Data System®, prostate volume, PSA, and number of biopsy cores targeted, TP-TBx was an independent predictor of PCa (odds ratio [OR] 1.37, 95% CI 1.08-1.72) and csPCa (1.19, 95% CI 1.12-1.50). When considering the approach according to the site of the index lesion, TP-TBx had a significantly higher likelihood than TR-TBx to detect csPCa in the apex (OR 4.81, 95% CI 1.03-6.27), transition/central zone (OR 2.67, 95% CI 1.42-5.00), and anterior zone (OR 5.62, 95% CI 1.74-8.13).

The use of TP-TBx allows a better cancer grade definition and PCa risk assessment. This has important implication in the decision-making process and in patient counseling for further therapies.

The Journal of urology. 2022 Sep 09 [Epub]

Fabio Zattoni, Giancarlo Marra, Veeru Kasivisvanathan, Jeremy Grummet, Rohan Nandurkar, Guillaume Ploussard, Jonathan Olivier, Peter K Chiu, Massimo Valerio, Paolo Gontero, Hongqian Guo, Junlong Zhuang, Francesco Barletta, Riccardo Leni, Mark Frydenberg, Daniel Moon, Uri Hanegbi, Adam Landaumailto, Ross Snow, Maria Apfelbeck, Alexander Kretschmer, Roderick van den Bergh, Giacomo Novara, Alberto Briganti, Fabrizio Dal Moro, Giorgio Gandaglia

Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padua, Italy., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Division of Surgery and Interventional Science, University College London, London, UK., Department of Surgery, Monash University, Melbourne, Australia., Department of Urology, La Croix du Sud Hospital, Toulouse, France., Department of Urology, Lille University, Lille, France., Division of Urology, Department of Surgery, The Chinese University of Hong Kong., University of Turin, Molinette Hospital, Turin, Italy., Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China., Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia., University of Melbourne, Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia., Department of Urology, Eastern Health, Melbourne, Australia., Department of Urology, The Alfred Hospital, Prahran, Australia., Department of Urology, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians University, Munich, Germany., Department of Urology, St Antonius Hospital, Utrecht, the Netherlands.