The concordance rates of transperineal (TP) versus transrectal (TR) prostate biopsies with radical prostatectomy (RP) specimen have been assessed poorly in men diagnosed with magnetic resonance imaging (MRI)-targeted biopsy (TBx).
To evaluate International Society of Urological Pathology (ISUP) concordance rates between the final pathology at RP and MRI-TBx or MRI-TBx + random biopsy (RB) according to the biopsy approach.
A multi-institutional database included patients diagnosed with TP or TR treated with RP.
TP-TBx or TR-TBx of the prostate.
The ISUP grade at biopsy was compared with the final pathology. A multivariable logistic regression analysis (MVA) was performed to assess the association between the biopsy approach (TP-TBx vs TR-TBx) and ISUP upgrading, downgrading, concordance, and clinically relevant increase (CRI).
Overall, 752 (59%) versus 530 (41%) patients underwent TR versus TP. At the MVA, TP-TBx was an independent predictor of upgrading (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.9, p < 0.01) and improved concordance relative to the final pathology (OR 1.7, 95% CI 1.2-2.5, p < 0.01) after adjusting for age, cT stage, Prostate Imaging Reporting and Data System, number of targeted cores, prostate-specific antigen, and prostate volume. Moreover, TP-TBx was associated with a lower risk of CRI than TR-TBx (OR 0.7, p < 0.01). This held true when considering patients who underwent MRI-TBx + RB (OR 0.6, p < 0.01). The inclusion of men who had RP represents a potential selection bias.
The adoption of TP-TBx compared with TR-TBx may reduce the risk of upgrading and improve the concordance of biopsy grade with the final pathology. The TP approach decreases the odds of CRI with improved patient selection for the correct active treatment.
In this report, we evaluated whether transperineal (TP) targeted biopsy (TBx) may improve the concordance of clinically significant prostate cancer with the final pathology in comparison with transrectal (TR) TBx in a large worldwide population. We found that TP-TBx might increase concordance compared with TR-TBx. Adding random biopsies to target one increases accuracy; however, concordance with the final pathology is overall suboptimal even with the TP approach.
European urology focus. 2023 Feb 04 [Epub ahead of print]
Fabio Zattoni, Giancarlo Marra, Alberto Martini, Veeru Kasivisvanathan, Jeremy Grummet, Timothy Harkin, Guillaume Ploussard, Jonathan Olivier, Peter K Chiu, Massimo Valerio, Alessandro Marquis, Paolo Gontero, Hongqian Guo, Junlong Zhuang, Mark Frydenberg, Daniel Moon, Alessandro Morlacco, Alexander Kretschmer, Francesco Barletta, Isabel Heidegger, Derya Tilki, Roderick van den Bergh, Fabrizio Dal Moro, Alberto Briganti, Francesco Montorsi, Giacomo Novara, Giorgio Gandaglia, EAU-YAU Prostate Cancer Working Party
Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padova, Italy., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy., Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, 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, Hong Kong., Urology Department, Lausanne University Hospital, Lausanne, Switzerland., 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., Department of Surgery, Faculty of medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Cabrini Institute, Cabrini Health, Malvern, VIC, Australia., Royal Melbourne Clinical School, University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia., Department of Urology, University Hospital Munich, Campus Großhadern, Ludwig-Maximilians University, Munich, Germany., Department of Urology, Medical University Innsbruck, Innsbruck, Austria., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey., Department of Urology, St Antonius Hospital, Utrecht, The Netherlands.