Prostate cancer (PCa) is the second most common cancer in men. Diagnosis primarily relies on prostate biopsy, which includes both systematic biopsies (SB) and targeted biopsies (TBx) directed at suspicious lesions detected by MRI. Although the transrectal approach has been preferred over the years, the transperineal approach is now considered the gold standard in many centers due to its increased accuracy in sampling the entire prostate. The present study aims to investigate, using a transperineal approach (TPx), the detection rate of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) for each site of systematic biopsies (SB) and targeted biopsies (TBx). The secondary aim is to understand the clinical and instrumental predictors of PCa and csPCa in patients with tumor lesions detected by MRI-guided biopsy but not by random biopsy, and in those with tumor lesions detected by random biopsy but not by MRI-guided biopsy. This monocentric observational study included a cohort of 277 biopsy-naive patients who underwent prostate biopsy from January to December 2023 at the Urological Unit of the Azienda Ospedaliera di Padova. Patient history, the report of the biopsy procedure, and the histological examination of biopsy samples were collected. Patients underwent MRI before the biopsy to identify suspicious lesions. The biopsy was performed using a transperineal free-hand approach; 14 random biopsies and 3 targeted biopsies for the index lesion were carried out. Our data revealed that TPx can optimally sample the prostate. When stratifying histological results by zones (apex, mid, base) and regions (anterior, posterior), no significant differences were found in the detection of PCa and csPCa. Furthermore, our study confirmed the efficacy of TBx in detecting tumor lesions, though they should always be combined with SB to identify lesions in areas different from those detected by MRI. Concerning predictive factors, it was observed that zone and region are not predictors of PCa; age is a predictive factor associated with PCa detected solely by SB, while age and PSA are associated with PCa detected only by TBx; finally, age, a positive DRE, PIRADS > 3, and a large lesion are associated with csPCa detected only by TBx. MRI-guided TPx allows for adequate sampling of the entire prostate. TBx is essential for diagnosing PCa; our analyses found only a small percentage of patients with tumors not detected by TBx but identified by SB alone. Currently, there are no effective predictors for identifying these patients.

Limiti della biopsia prostatica transperineale MRI-guidata nell'individuazione di carcinomi prostatici clinicamente significativi

TOFFOLETTO, ELEONORA MARTINA
2023/2024

Abstract

Prostate cancer (PCa) is the second most common cancer in men. Diagnosis primarily relies on prostate biopsy, which includes both systematic biopsies (SB) and targeted biopsies (TBx) directed at suspicious lesions detected by MRI. Although the transrectal approach has been preferred over the years, the transperineal approach is now considered the gold standard in many centers due to its increased accuracy in sampling the entire prostate. The present study aims to investigate, using a transperineal approach (TPx), the detection rate of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) for each site of systematic biopsies (SB) and targeted biopsies (TBx). The secondary aim is to understand the clinical and instrumental predictors of PCa and csPCa in patients with tumor lesions detected by MRI-guided biopsy but not by random biopsy, and in those with tumor lesions detected by random biopsy but not by MRI-guided biopsy. This monocentric observational study included a cohort of 277 biopsy-naive patients who underwent prostate biopsy from January to December 2023 at the Urological Unit of the Azienda Ospedaliera di Padova. Patient history, the report of the biopsy procedure, and the histological examination of biopsy samples were collected. Patients underwent MRI before the biopsy to identify suspicious lesions. The biopsy was performed using a transperineal free-hand approach; 14 random biopsies and 3 targeted biopsies for the index lesion were carried out. Our data revealed that TPx can optimally sample the prostate. When stratifying histological results by zones (apex, mid, base) and regions (anterior, posterior), no significant differences were found in the detection of PCa and csPCa. Furthermore, our study confirmed the efficacy of TBx in detecting tumor lesions, though they should always be combined with SB to identify lesions in areas different from those detected by MRI. Concerning predictive factors, it was observed that zone and region are not predictors of PCa; age is a predictive factor associated with PCa detected solely by SB, while age and PSA are associated with PCa detected only by TBx; finally, age, a positive DRE, PIRADS > 3, and a large lesion are associated with csPCa detected only by TBx. MRI-guided TPx allows for adequate sampling of the entire prostate. TBx is essential for diagnosing PCa; our analyses found only a small percentage of patients with tumors not detected by TBx but identified by SB alone. Currently, there are no effective predictors for identifying these patients.
2023
Limits of MRI-guided transperineal prostate biopsy in detecting clinically significant prostate carcinomas
MRI
Prostate
Cancer
Biopsy
Location
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12608/72100