The Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS<3

Abstract

BackgroundIn patients with multiparameter magnetic resonance imaging (mpMRI) low-possibility but highly clinical suspicion of prostate cancer, the biopsy core is unclear. Our study aims to introduce the biopsy density (BD; the ratio of biopsy cores to prostate volume) and investigates the BD-predictive value of prostate cancer and clinically significant prostate cancer (csPCa) in PI-RADS&amp;lt;3 patients.MethodsPatients underwent transperineal template–guided prostate biopsy from 2012 to 2022. The inclusion criteria were PI-RADS&amp;lt;3 with a positive digital rectal examination or persistent PSA abnormalities. BD was defined as the ratio of the biopsy core to the prostate volume. Clinical data were collected, and we grouped the patients according to pathology results. Kruskal–Wallis test and chi-square test were used in measurement and enumeration data, respectively. Logistics regression was used to choose the factor associated with positive biospy and csPCa. The receiver operating characteristic (ROC) curve was used to evaluate the ability to predict csPCa.ResultsA total of 115 patients were included in our study. Biopsy was positive in 14 of 115 and the International Society of Urological Pathology grade groups 2–5 were in 7 of all the PCa patients. The BD was 0.38 (0.24-0.63) needles per milliliter. Binary logistics analysis suggested that PSAD and BD were correlated with positive biopsy. Meanwhile, BD and PSAD were associated with csPCa. The ROC curve illustrated that BD was a good parameter to predict csPCa (AUC=0.80, 95% CI: 0.69-0.91, p&amp;lt;0.05). The biopsy density combined with PSAD increased the prediction of csPCa (AUC=0.90, 95% CI: 0.85-0.97, p&amp;lt;0.05). The cut-off value of the BD was 0.42 according to the Youden index.ConclusionIn PI-RADS&amp;lt;3 patients, BD and PSAD are related to csPCa. A biopsy density of more than 0.42 needles per millimeter can increase the csPCa detection rate, which should be considered as an alternative biopsy method when we perform prostate biopsy in patients with PI-RADS&amp;lt;3.

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

“…A total of 72 studies including 36 366 patients with suspected csPCa who underwent prostate MRI and subsequent biopsy were included (Figure 1). Details of the included study and patient characteristics are summarized in Table 1 and eTables 3 to 5 in Supplement 1. Studies were published between 2016 and 2022.…”

“…None of the included studies enrolled patients with prior csPCa. Among the 72 included studies, 19 solely included patients with low to moderate risk of csPCa (ie, PI-RADS≤3 and/or transitional zone index lesion and/or total PSA <10 ng/mL), 1 study solely included high-risk patients with PI-RADS 4 or greater, and the remaining 52 studies included all suspected patients regardless of the prostate MRI results or clinical parameters . The most frequently used imaging was 3.0 T (92.6%) and multiparametric MRI (80.3%).…”

“…Eight studies (11%) were judged to have a moderate risk of bias . No potential source of bias was identified for the other 64 (89%) studies . Retrospective study design and concern regarding the selection domain (ie, studies only noted that patients with suspected csPCa were included rather than providing detailed inclusion and/or exclusion criteria) were the main sources of bias.…”

“…As such, ancillary clinical data have been proposed to complement MRI to minimize the number of unnecessary biopsies. This concept has been recently expanded by numerous studies, and several MRI-based risk models and strategies have been developed to guide decisions on prostate biopsy . However, it has been challenging to integrate the proposed approaches into clinical practice owing to considerable inconsistencies among them.…”

“…This concept has been recently expanded by numerous studies, and several MRI-based risk models and strategies have been developed to guide decisions on prostate biopsy. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ,…”