Serhat ÇETİN, Ahmet OLGUN, Ender Cem BULUT, Murat KOPARAL, Elbay BAYRAMLİ, İlker ŞEN, Sinan SÖZEN

Factors predicting transrectal ultrasound-guided systematic prostate biopsy failure

Objectives: To determine the factors that predict the failure of systematic prostate biopsy by examining the clinical, laboratory, and radiological parameters of patients for whom prostate cancer was detected by magnetic resonance imaging (MRI)-targeted biopsy but not by systematic biopsy. Methods: Patients were included in this study if they had undergone combined targeted and systematic biopsy and had cancer detected in the targeted biopsy. They were biopsy-naive patients and had lesions with a Prostate Imaging Reporting and Data System (PIRADS) score ≥ 3 in the peripheral zone on MRI. The clinical, biochemical, and radiological findings of the groups with and without cancer detected in the systematic biopsy were compared. Results: A total of 100 patients had an index lesion in the peripheral zone and cancer detected by MRI-targeted biopsy. In 43 (43%) of the patients, no cancer was detected in the systematic biopsy, whereas it was detected in the other 57 (57%). Statistically significant differences were found between the two groups in terms of prostate volume and PSA density (p < 0.001 and p < 0.001, respectively). Moreover, the findings of univariate and multivariate logistic regression analyses indicated that prostate volume and lesion size are independent predictors of systematic biopsy failure. Conclusions: The success of systematic biopsy may be lower in patients with high prostate volume and low peripheral zone index lesion size.

Keywords:

Prostate biopsy, systematic, failure, targeted biopsy,

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1. Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, et al. Early detection of prostate cancer: AUA Guideline. J Urol 2013;190:419-26.
2. Hegde JV, Mulkern RV, Panych LP, Fennessy FM, Fedorov A, Maier SE, et al. Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging 2013;37:1035-54.
3. Panebianco V, Barchetti F, Sciarra A, Ciardi A, Indino EL, Papalia R, et al. Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: a randomized study. Urol Oncol 2015;33:17.e1-17.e7.
4. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012;22:746-57.
5. Cornford P, van den Bergh RC, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Part II-2020 update: treatment of relapsing and metastatic prostate cancer. Eur Urol 2021;79:263-82.
6. Chang SD, Ghai S, Kim CK, Oto A, Giganti F, Moore CM. MRI Targeted Prostate Biopsy Techniques: AJR Expert Panel narrative review. AJR Am J Roentgenol 2021;217:1263-81.
7. Goldberg H, Ahmad AE, Chandrasekar T, Klotz L, Emberton M, Haider MA, et al. Comparison of magnetic resonance imaging and transrectal ultrasound informed prostate biopsy for prostate cancer diagnosis in biopsy naïve men: a systematic review and meta-analysis. J Urol 2020;203:1085-93.
8. Ung JO, San Francisco IF, Regan MM, DeWOLF WC, Olumi AF. The relationship of prostate gland volume to extended needle biopsy on prostate cancer detection. J Urol 2003;169:130-5.
9. Uzzo RG, Wei JT, Waldbaum RS, Perlmutter AP, Byrne JC, Vaughan ED, Jr. The influence of prostate size on cancer detection. Urology 1995;46:831-6.
10. De La Taille A, Antiphon P, Salomon L, Cherfan M, Porcher R, Hoznek A, et al. Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate. Urology 2003;61:1181-6.
11. Rosario DJ, Lane JA, Metcalfe C, Donovan JL, Doble A, Goodwin L, et al. Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ 2012;344:d7894.
12. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schröder FH, Roobol MJ. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 2012;61:1110-4.
13. Kandıralı E, Temiz MZ, Çolakerol A, Yürük E, Semerciöz A, Müslümanoğlu AY. Does the prostate volume always effect cancer detection rate in prostate biopsy? Additional role of prostate-specific antigen levels: A retrospective analysis of 2079 patients. Turk J Urol 2019;45:103-7.
14. Washino S, Okochi T, Saito K, Konishi T, Hirai M, Kobayashi Y, et al. Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naïve patients. BJU Int 2017;119:225-33.
15. Feng ZJ, Xue C, Wen JM, Li Y, Wang M, Zhang N. PSAD test in the diagnosis of prostate cancer: a meta-analysis. Clin Lab 2017;63:147-55.
16. Nordström T, Akre O, Aly M, Grönberg H, Eklund M. Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer. Prostate Cancer Prostatic Dis 2018;21:57-63.
17. Park MY, Park KJ, Lim B, Kim MH, Jeong IG, Kim JK. Comparison of biopsy strategies for prostate biopsy according to lesion size and PSA density in MRI-directed biopsy pathway. Abdom Radiol (NY) 2020;45:4166-77.
18. Özden E, Akpınar Ç, İbiş A, Kubilay E, Erden A, Yaman Ö. Effect of lesion diameter and prostate volume on prostate cancer detection rate of magnetic resonance imaging: Transrectal-ultrasonography-guided fusion biopsies using cognitive targeting. Turk J Urol. 2021;47:22-9.
19. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Eng J Med 2018;378:1767-77.