What is the ideal number of biopsy cores per lesion in targeted prostate biopsy?

Abstract

Background The number of cores to be obtained in targeted biopsy (TB) is important. This study aimed to evaluate the TB outcomes in suspicious prostate lesions classified according to the Prostate Imaging Reporting and Data System (PI-RADS) and to determine the ideal number of biopsy cores per lesion. Methods This retrospective study included patients who underwent multiparametric magnetic resonance imaging–guided fusion prostate biopsy owing to increased serum prostate-specific antigen (PSA) levels and suspicious digital rectal examination outcomes in our institute. Patients with PI-RADS <3 lesions, PSA levels >10 ng/ml, and a prior diagnosis of prostate cancer (PCa) (active surveillance) were excluded from the study. The number of biopsy cores to be obtained from each lesion was determined by the clinician. Results The study included a total of 418 patients and 684 lesions. Among PI-RADS 3 lesions, clinically significant PCa (sPCa) detection rate was similar in the lesions from which 2 and 3 cores were obtained (9.1% and 10.0%, respectively), whereas it was relatively higher in the lesions from which 4 biopsy cores were obtained (18.5%). Among PI-RADS 4 lesions, sPCa detection rate was similar in the lesions from which 3 and 4 cores were obtained (35.6% and 32.3%, respectively), whereas it was relatively lower in the lesions from which 2 biopsy cores were obtained (17.9%). Among PI-RADS 5 lesions, however, sPCa detection rate was similar in the lesions from which 2, 3, or 4 cores were obtained (47.6%, 46.0%, 48.9%, respectively). Conclusion The results indicated that the ideal number of cores to be obtained from each suspicious lesion in TB depends on the characteristics of the lesions. Accordingly, while obtaining 2–3 biopsy cores could be adequate in PI-RADS 4 and 5 lesions, which have a serious risk of cancer, a minimum of 4 biopsy cores should be obtained from PI-RADS 3 lesions to ensure accurate histopathological results. Clinical trial number ( ClinicalTrials.gov ) NCT03936296 .

Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study

“…Since MRI-targeted biopsies were performed before systematic biopsies, there is a possibility that the physician performing the systematic biopsy may have been influenced by ultrasound-visible changes when performing systematic prostate biopsies, even though attempts were made to reduce this possibility. Furthermore, while the use of two biopsy cores per MRI-visible target resulted in detection of substantially more clinically significant cancer than with systematic biopsy, some recent studies have suggested that a higher number of biopsy cores may result in an increase in the detection of clinically significant cancer [10,[34][35][36]. This study used transrectal biopsy to diagnose prostate cancer and these findings may not apply for transperineal biopsy, as a transperineal approach may provide superior access to the apical and anterior regions of the prostate.…”

Single center results of magnetic resonance imaging ultrasound guided fusion prostate biopsy obtained patients

“…They specified that there might also be a patient group that would benefit from more core sampling (29). Sonmez et al reported that 2 or 3 cores could be efficient for PI-RADS 4 and 5 lesions, while at least 4 cores should be obtained from PI-RADS 3 lesions (30). In our study, the mean number of cores per lesion in MRI-US FPBx was 4 (3-5) and we believe that it is sufficient for the effectiveness of our biopsy results.…”

Robotic Assisted MRI-US Fusion Guided Target Saturation Biopsy of the Prostate – Diagnostic Accuracy and Clinical Implications

“…Our data indicate that this approach is superior in terms of detection of clinically signi cant cancer as compared to up to three targeted biopsies (78.3% vs 67.4%). Some authors claim that two to three biopsy cores may be su cient in PI-RADS 4 and 5 lesions 15 . However, our data indicate that the application of target saturation biopsies -with a median number of 6 biopsies per lesion in this study -can reduce the number of missed cancer in a statistically signi cant manner, and can provide a more accurate characterization in terms of assigned Gleason score for PCa detected within the lesion.…”

“…However, up to 70% of PCa lesions display intralesional tumor heterogeneity 10 , and targeted biopsy strategies do not yet adequately account for this nding, as the number of targeted biopsies varies signi cantly [11][12][13][14] and no standard has been de ned. Some authors have assessed the impact of the number of targeted biopsy per lesion 11,12,15 , and the combination of sampling the center and the periphery has been proposed 10 . However, there are no reports of targeted saturation biopsy strategies to speci cally cover a lesion comprehensively.…”