Comparison of Transrectal Ultrasound Biopsy to Transperineal Template Mapping Biopsies Stratified by Multiparametric Magnetic Resonance Imaging Score in the PROMIS Trial

Abstract

In 41 months, 740 men at 11 centres were recruited; 576 underwent all three tests. Of 150 with MRI score 1-2, 8 (5.1%) had any Gleason >/=3+4 disease on TRUS-biopsy. In 75 where TRUS-biopsy showed Gleason 3+3 of any MCCL, 61/75 (81%) had Gleason 3+4, 8/75 (11%) Gleason 4+3 and 0/75 (0%) Gleason >/=4+5. For definition1 csPCa, TRUS-biopsy sensitivity remained stable and low across MP-MRI Likert scores (35%-52%). For definition2 csPCa and any cancer, sensitivity increased with higher MP-MRI score. Negative predictive value varied due to varying disease prevalence but for all cancer thresholds declined with increasing MP-MRI score. ConclusionsTRUS-biopsy in the setting of MP-MRI Likert scores 1-2 finds Gleason 3+4 disease in only 1 in 20 men. Further, for any csPCa definition, TRUS-biopsy had poor sensitivity and variable but low NPV across MP-MRI scores. Men undergoing TRUS-biopsy without targeting in the setting of MP-MRI score 3 to 5 should be advised to undergo a repeat (targeted) biopsy.

The characteristics and spatial distributions of prostate cancer in autopsy specimens

“…Small tumors usually originate from the peripheral zone and spread inwards as they enlarge. 28 The results in our study were basically consistent with those of 29 The peripheral zone can be well sampled by transrectal biopsy through the rectum and moving needle obliquely from the back of prostate. The transperineal procedure punctures parallelly to the urethra from the apex of the prostate, so that the prostate tissue can be evenly sampled on the cross-section.…”

“…Transrectal and transperineal prostate biopsies are both effective methods for the diagnosis of prostate cancer. How to compare the advantages and disadvantages of the two methods and how to improve the accuracy of these two methods in diagnosis are important research directions 29 . The peripheral zone can be well sampled by transrectal biopsy through the rectum and moving needle obliquely from the back of prostate.…”

This Month in Adult Urology

“…Significant findings have emerged from the PROMISÒ (Patient-Reported Outcomes Measurement Information System) study and in this secondary analysis Lovegrove et al (page 100) sought to address the important clinical question of the use of systematic transrectal ultrasound biopsies. 8 Only 1 in 20 men with a multiparametric magnetic resonance imaging Likert score of 1 or 2 had Gleason 3þ4 disease. Transrectal ultrasound biopsy provided poor sensitivity and low negative predictive value for detection of clinically significant disease.…”

Comparison of the diagnostic efficacy between transrectal prostate biopsy and transperineal cognitive fusion biopsy

“…Prostate cancer is a tumor with a high incidence of urinary system [1] , especially in the male of European and American area. Approximately 1276,106 new prostate cancer cases (7.1%) were diagnosed globally in 2018, making it the third most common of all tumors [2] .…”