Analysis of prostate cancer localization toward improved diagnostic accuracy of transperineal prostate biopsy

Abstract

PurposeDelineating the precise localization of prostate cancer is important in improving the diagnostic accuracy of prostate biopsy.MethodsIn Juntendo University Nerima Hospital, initial 12-core or repeat 16-core biopsies were performed using a transrectal ultrasound guided transperineal prostate biopsy method. We step-sectioned prostates from radical prostatectomy specimens at 5-mm intervals from the urethra to the urinary bladder and designated five regions: the (1) Apex, (2) Apex-Mid, (3) Mid, (4) Mid-Base, and (5) Base. We then mapped prostate cancer localization on eight zones around the urethra for each of those regions.ResultsProstate cancer was detected in 93 cases of 121 cases (76.9%) in the Apex, in 115 cases (95.0%) in the Apex-Mid, in 101 cases (83.5%) in the Mid, in 71 cases (58.7%) in the Mid-Base, and in 23 cases (19.0%) in the Base. In 99.2% of all cases, prostate cancers were detected from the Apex to Mid regions. For this reason, transperineal prostate biopsies have routinely been prioritized in the Apex, Apex-Mid, and Mid regions, while the Base region of the prostate was considered to be of lesser importance. Our analyses of prostate cancer localization revealed a higher rate of cancer in the posterior portion of the Apex, antero-medial and postero-medial portion of the Apex-Mid and antero-medial and postero-lateral portion of the Mid. The transperineal prostate biopsies in our institute performed had a sensitivity of 70.9%, a specificity of 96.6%, a positive predictive value (PPV) of 92.2% and a negative predictive value (NPV) of 85.5%.ConclusionsThe concordance of prostate cancer between prostatectomy specimens and biopsies is comparatively favorable. According to our study, the diagnostic accuracy of transperineal prostate biopsy can be improved in our institute by including the anterior portion of the Apex-Mid and Mid regions in the 12-core biopsy or 16-core biopsy, such that a 4-core biopsy of the anterior portion is included.

Detection of anterior prostate cancer using a magnetic resonance imaging-transrectal ultrasound fusion biopsy in cases with initial biopsy and history of systematic biopsies

“…Generally, the boundary between the anterior and posterior regions of the prostate is mainly determined by the position of the urethra. 22 , 23 , 24 However, in this study, a line 20 mm from the rectal side, approximately the length of the biopsy needle, was set as the boundary because our objective was to verify the detection rate of anterior lesions in patients who had previously undergone SBxs. 13 However, for cases with multiple target lesions on MRI, the target with the highest PI-RADS v2 score was identified as the target site.…”

Prediction of recovery time of urinary incontinence following robot‐assisted laparoscopic prostatectomy

“…In addition, to predict the position of the lesion before the operation, analysis was performed using a site with a score of ≥3 on the Prostate Imaging Reporting and Data System (PI‐RADS) 6 . The prostate imaged with a sagittal section was divided into five regions from the apex of the urethra to the base of the bladder, and the region on the urethral side was defined as the apex region 11 . This retrospective clinical study protocol conformed to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the institution's human research committee.…”

“…6 The prostate imaged with a sagittal section was divided into five regions from the apex of the urethra to the base of the bladder, and the region on the urethral side was defined as the apex region. 11 This retrospective clinical study protocol conformed to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the institution's human research committee. This study involved clinical data comparisons with informed consent provided by all participants and was approved by the Institutional Review Board of the Juntendo University Nerima Hospital (N21-0013).…”

Accuracy of Diagnosis with Non-contrast Magnetic Resonance Imaging/Transrectal Ultrasound Fusion-Guided Transperineal Prostate Biopsy

“…The volume of the target tumor was calculated based on the tumor diameter measured on MRI T2WI images. For comparison purposes, 16-core random biopsies were performed by one experienced urologist (detailed method was based on the report of Sakamoto et al 16) ). Histopathological parameters in all SB and FB were analyzed.…”