Refining the risk-stratification of transrectal biopsy-detected prostate cancer by elastic fusion registration transperineal biopsies
To evaluate image-guided Transperineal Elastic-Registration biopsy (TPER-B) in the risk-stratification of low–intermediate risk prostate cancer detected by Transrectal-ultrasound biopsy (TRUS-B) when estimates of cancer grade and volume discorded with multiparametric Magnetic Resonance Imaging (MRI).
All patients referred for active surveillance or organ-conservative management were collegially reviewed for consistency between TRUS-B results and MRI. Image-guided TPER-B of the index target (IT) defined as the largest Prostate Imaging-Reporting Data System-v2 ≥ 3 abnormality was organized for discordant cases. Pathology reported Gleason grade, maximum cancer core length (MCCL) and total CCL (TCCL).
Of 237 prostate cancer patients (1–4/2018), 30 were required TPER-B for risk-stratification. Eight cores were obtained [Median and IQR: 8 (6–9)] including six (IQR: 4–6) in the IT. TPER-B of the IT yielded longer MCCL [Mean and (95%CI): 6.9 (5.0–8.8) vs. 2.6 mm (1.9–3.3), p < 0.0001] and TCCL [19.7 (11.6–27.8) vs. 3.6 mm (2.6–4.5), p = 0.0002] than TRUS-B of the gland. On TPER-B cores, longer MCCL [Mean and (95%CI): 8.7 mm (6.7–10.7) vs. 4.1 mm (0.6–7.6), p = 0.002] were measured in Gleason score-7 cancers. TPER-B cores upgraded 13/30 (43.3%) patients. 14/30 (46.7%) met University College London-definition 1 and 18/30 (60.0%) definition 2, which correlate with clinically significant cancers > 0.5 mL and > 0.2 mL, respectively. 7/16 (43.8%) patients under active surveillance were re-allocated toward prostatectomy (n = 5) or radiation therapy (n = 2). In 14 patients not yet assigned, TPER-B risk-stratification spurred the selection (13/14, 92.9%) of treatments with curative intent.
Image-guided TPER-B of the index target provided more cancer material for pathology. Subsequent re-evaluation of cancer volume and grade switched a majority of patients towards higher-risk groups and treatments with curative intent.
KeywordsProstatic Neoplasms Endoscopy Diagnostic imaging Biopsy
Ms. Aurélie Chambon for dedicated management of the Prostate Cancer multidisciplinary meeting and Ms. Falek Zaidi (MSc.) for her assistance in data collection and pathology.
BC: data collection, and manuscript review; MR: data collection, data analysis, and manuscript review. M-LQ-R: data collection, and manuscript review. PG: data analysis, and manuscript review. JK: manuscript review. RA: data collection, and manuscript review. GP: data analysis, and manuscript review. DP: Study development, data analysis, and manuscript review. BM: Study development, data collection, data analysis, manuscript writing.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
Research involving human participants
The study was approved by institutional ethics committee and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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