Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

Abstract

ObjectivesTo determine whether modified transperineal template prostate mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value equal to full 5mm TTPM. Materials and MethodsRetrospective analysis of an institutional registry including treatment-naïve men undergoing 5mm TTPM analysed in 20 zones fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5mm TTPM.Strategy 1 did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was employed to calculate reliable estimates of sensitivity and negative predictive value of these three strategies with respect to detection of clinically significant disease (maximum cancer core length >/= 4mm and/or Gleason score >/= 3+4).Results 391 men with median age 62 years (IQR 58-67) were included. Median PSA and PSA density were 6.9 ng/ml (IQR 4.8-10) and 0.17 (IQR 0.12-0.25), respectively. A median of 6 cores (IQR 2-9) out of 48 taken per man (IQR 33-63) were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low, intermediate and high risk disease was identified in 78 (20%), 80 (21%) and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% (95% CI 73-84%), 85% (95% CI 80-90%) and 84% (95% CI 79-89%), respectively. The negative predictive values of the three strategies was at 73% (95% CI 67-80%), 80% (95% CI 74-86%) and 79% (95% CI 72-84%), respectively. ConclusionAltering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM to rule out clinically significant disease. This should be considered when modified TTPM strategies are performed to select men for tissue-preserving approaches, and when modified TTPM are employed to validate new diagnostic tests.

Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review

“…Also, new biopsy techniques could lead to a further increase in the assessment of a focal recurrence, without missing possible significant multifocal recurrent disease. TPM biopsies could lead to increased accuracy over systematic TRUS-guided biopsies alone, while MRI-guided biopsies might decrease the detection of insignificant disease further [ 47 , 48 ]. However, TPM biopsies were only adopted by Ahmed et al [ 10 ], and MRI-guided biopsies by Baco et al [ 11 ].…”

Cancer Detection Rates of Systematic and Targeted Prostate Biopsies after Biparametric MRI

“…TPM has an area under the curve of 90%. It is, therefore, superior compared to TRUS or any other biopsy technique [13,14]. Taking the burden of general or epidural anaesthesia and transperineal biopsy into account, this reference test should, therefore, be considered when comparing diagnostics of PCa.…”

Focal salvage high‐intensity focused ultrasound in radiorecurrent prostate cancer

“…Further, there is still some debate in the literature about radiation effect, delayed tumour regression and timing of biopsy after radiotherapy. Whilst there is some uncertainty, our team consists of expert uro‐pathologists whose published work on clinically significant prostate cancer includes the use of different biopsy strategies in primary and radiorecurrent settings . Our experts only report a Gleason score when there is minimal radiation effect seen on the biopsies, and so feel that they are able to identify recurrent prostate cancer, when present, in radiation‐affected tissues with a high degree of accuracy and to assign a grade to these.…”