Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

Johannes Mischinger; Helmut Schöllnast; Hanna Zurl; Mark Geyer; Katja Fischereder; Gabriel Adelsmayr; Jasminka Igrec; Gerald Fritz; Martina Merdzo-Hörmann; Jörg Elstner; Johannes Schmid; Alfred Triebl; Viktoria Trimmel; Clemens Reiter; Jakob Steiner; Dominik Rosenlechner; Maximilian Seles; Georg P Pichler; Martin Pichler; Jakob Riedl; Stephanie Schöpfer-Schwab; Jakob Strobl; Georg C Hutterer; Richard Zigeuner; Karl Pummer; Herbert Augustin; Sascha Ahyai; Sebastian Mannweiler; Michael Fuchsjäger; Emina Talakic

doi:10.3389/fsurg.2022.1013389

Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

Front Surg. 2022 Oct 6:9:1013389. doi: 10.3389/fsurg.2022.1013389. eCollection 2022.

Authors

Johannes Mischinger¹, Helmut Schöllnast², Hanna Zurl¹, Mark Geyer¹, Katja Fischereder¹, Gabriel Adelsmayr¹, Jasminka Igrec², Gerald Fritz², Martina Merdzo-Hörmann², Jörg Elstner², Johannes Schmid², Alfred Triebl², Viktoria Trimmel², Clemens Reiter², Jakob Steiner², Dominik Rosenlechner¹, Maximilian Seles¹, Georg P Pichler¹, Martin Pichler³, Jakob Riedl³, Stephanie Schöpfer-Schwab¹, Jakob Strobl¹, Georg C Hutterer¹, Richard Zigeuner¹, Karl Pummer¹, Herbert Augustin¹, Sascha Ahyai¹, Sebastian Mannweiler⁴, Michael Fuchsjäger², Emina Talakic²

Affiliations

¹ Department of Urology, Medical University of Graz, Graz, Austria.
² Department of Radiology, Medical University of Graz, Graz, Austria.
³ Department of Oncology, Medical University of Graz, Graz, Austria.
⁴ Institute for Pathology, Medical University of Graz, Graz, Austria.

Abstract

Objective: Guidelines for previous negative biopsy (PNB) cohorts with a suspicion of prostate cancer (PCa) after positive multiparametric (mp) magnetic-resonance-imaging (MRI) often favour the fusion-guided targeted prostate-biopsy (TB) only approach for Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions. However, recommendations lack direct biopsy performance comparison within biopsy naïve (BN) vs. PNB patients and its prognostication of the whole mount pathology report (WMPR), respectively. We suppose, that the combination of TB and concomitant TRUS-systematic biopsy (SB) improves the PCa detection rate of PI-RADS 2, 3, 4 or 5 lesions and the International Society of Urological Pathology (ISUP)-grade predictability of the WMPR in BN- and PNB patients.

Methods: Patients with suspicious mpMRI, elevated prostate-specific-antigen and/or abnormal digital rectal examination were included. All PI-RADS reports were intramurally reviewed for biopsy planning. We compared the PI-RADS score substratified TB, SB or combined approach (TB/SB) associated BN- and PNB-PCa detection rate. Furthermore, we assessed the ISUP-grade variability between biopsy cores and the WMPR.

Results: According to BN (n = 499) vs. PNB (n = 314) patients, clinically significant (cs) PCa was detected more frequently by the TB/SB approach (62 vs. 43%) than with the TB (54 vs. 34%) or SB (57 vs. 34%) (all p < 0.0001) alone. Furthermore, we observed that the TB/SB strategy detects a significantly higher number of csPCa within PI-RADS 3, 4 or 5 reports, both in BN and PNB men. In contrast, applied biopsy techniques were equally effective to detect csPCa within PI-RADS 2 lesions. In case of csPCa diagnosis the TB approach was more often false-negative in PNB patients (BN 11% vs. PNB 19%; p = 0.02). The TB/SB technique showed in general significantly less upgrading, whereas a higher agreement was only observed for the total and BN patient cohort.

Conclusion: Despite csPCa is more frequently found in BN patients, the TB/SB method always detected a significantly higher number of csPCa within PI-RADS 3, 4 or 5 reports of our BN and PNB group. The TB/SB strategy predicts the ISUP-grade best in the total and BN cohort and in general shows the lowest upgrading rates, emphasizing its value not only in BN but also PNB patients.

Keywords: PI-RADS-Version-2; biopsy-naïve; combination of fusion and systematic biopsy; previous-negative biopsy; prostate cancer detection; uroNav; whole mount histopathology.

© 2022 Mischinger, Schöllnast, Zurl, Geyer, Fischereder, Adelsmayr, Igrec, Fritz, Merdzo-Hörmann, Elstner, Schmid, Triebl, Trimmel, Reiter, Steiner, Rosenlechner, Seles, Pichler, Pichler, Riedl, Schöpfer-Schwab, Strobl, Hutterer, Zigeuner, Pummer, Augustin, Ahyai, Mannweiler, Fuchsjaeger and Talakic.