Role of Systematic Biopsy in the Era of Targeted Biopsy: A Review

Overview

Journal Curr Oncol

Publisher MDPI

Specialty Oncology

Date 2024 Sep 27

PMID 39330011

Authors

Wojciech Malewski

Tomasz Milecki

Omar Tayara

Slawomir Poletajew

Piotr Kryst

Andrzej Tokarczyk

Lukasz Nyk

Affiliations

Soon will be listed here.

Abstract

Prostate cancer (PCa) is a major public health issue, as the second most common cancer and the fifth leading cause of cancer-related deaths among men. Many PCa cases are indolent and pose minimal risk, making active surveillance a suitable management approach. However, clinically significant prostate carcinoma (csPCa) can lead to serious health issues, including progression, metastasis, and death. Differentiating between insignificant prostate cancer (inPCa) and csPCa is crucial for determining appropriate treatment. Diagnosis of PCa primarily involves trans-perineal and transrectal systematic biopsies. Systematic transrectal prostate biopsy, which typically collects 10-12 tissue samples, is a standard method, but it can miss csPCa and is associated with some complications. Recent advancements, such as magnetic resonance imaging (MRI)-targeted biopsies, have been suggested to improve risk stratification and reduce overtreatment of inPCa and undertreatment of csPCa, thereby enhancing patient quality of life and treatment outcomes. Guided biopsies are increasingly recommended for their ability to better detect high-risk cancers while reducing identification of low-risk cases. MRI-targeted biopsies, especially when used as an initial biopsy in biopsy-naïve patients and those under active surveillance, have become more common. Utilization of MRI-TB alone can decrease septic complications; however, the combining of targeted biopsies with perilesional sampling is recommended for optimal detection of csPCa. Future advancements in imaging and biopsy techniques, including AI-augmented lesion detection and robotic-assisted sampling, promise to further improve the accuracy and effectiveness of PCa detection.

References

Cornford P, van den Bergh R, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J . EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024; 86(2):148-163. DOI: 10.1016/j.eururo.2024.03.027. View

Jahnen M, Amiel T, Kirchoff F, Buchler J, Herkommer K, Rothe K . Cotrimoxazole and targeted antibiotic prophylaxis for transrectal prostate biopsy: a single-center study. World J Urol. 2024; 42(1):260. PMC: 11045637. DOI: 10.1007/s00345-024-04969-4. View

Porpiglia F, Manfredi M, Mele F, Cossu M, Bollito E, Veltri A . Diagnostic Pathway with Multiparametric Magnetic Resonance Imaging Versus Standard Pathway: Results from a Randomized Prospective Study in Biopsy-naïve Patients with Suspected Prostate Cancer. Eur Urol. 2016; 72(2):282-288. DOI: 10.1016/j.eururo.2016.08.041. View

Thomson A, Li M, Grummet J, Sengupta S . Transperineal prostate biopsy: a review of technique. Transl Androl Urol. 2021; 9(6):3009-3017. PMC: 7807331. DOI: 10.21037/tau.2019.12.40. View

Cool D, Romagnoli C, Izawa J, Chin J, Gardi L, Tessier D . Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation. Can Urol Assoc J. 2016; 10(9-10):342-348. PMC: 5085915. DOI: 10.5489/cuaj.3831. View

Rai B, Mayerhofer C, Somani B, Kallidonis P, Nagele U, Tokas T . Magnetic Resonance Imaging/Ultrasound Fusion-guided Transperineal Versus Magnetic Resonance Imaging/Ultrasound Fusion-guided Transrectal Prostate Biopsy-A Systematic Review. Eur Urol Oncol. 2021; 4(6):904-913. DOI: 10.1016/j.euo.2020.12.012. View

Lee A, Yang X, Lee H, Law Y, Huang H, Sim A . Limitations of overlapping cores in systematic and MRI-US fusion biopsy. Urol Oncol. 2021; 39(11):782.e15-782.e21. DOI: 10.1016/j.urolonc.2021.02.027. View

Wolters T, Roobol M, van Leeuwen P, van den Bergh R, Hoedemaeker R, van Leenders G . A critical analysis of the tumor volume threshold for clinically insignificant prostate cancer using a data set of a randomized screening trial. J Urol. 2010; 185(1):121-5. DOI: 10.1016/j.juro.2010.08.082. View

Szabo R . "Free-Hand" Transperineal Prostate Biopsy Under Local Anesthesia: Review of the Literature. J Endourol. 2020; 35(4):525-543. DOI: 10.1089/end.2020.1093. View

10.

Briganti A, Blute M, Eastham J, Graefen M, Heidenreich A, Karnes J . Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009; 55(6):1251-65. DOI: 10.1016/j.eururo.2009.03.012. View

11.

Magheli A, Hinz S, Hege C, Stephan C, Jung K, Miller K . Prostate specific antigen density to predict prostate cancer upgrading in a contemporary radical prostatectomy series: a single center experience. J Urol. 2009; 183(1):126-31. DOI: 10.1016/j.juro.2009.08.139. View

12.

Stabile A, Delloglio P, De Cobelli F, Esposito A, Gandaglia G, Fossati N . Association Between Prostate Imaging Reporting and Data System (PI-RADS) Score for the Index Lesion and Multifocal, Clinically Significant Prostate Cancer. Eur Urol Oncol. 2019; 1(1):29-36. DOI: 10.1016/j.euo.2018.01.002. View

13.

Pradere B, Veeratterapillay R, Dimitropoulos K, Yuan Y, Omar M, MacLennan S . Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis. J Urol. 2020; 205(3):653-663. DOI: 10.1097/JU.0000000000001399. View

14.

van der Leest M, Cornel E, Israel B, Hendriks R, Padhani A, Hoogenboom M . Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naïve Men with Elevated Prostate-specific Antigen: A Large.... Eur Urol. 2018; 75(4):570-578. DOI: 10.1016/j.eururo.2018.11.023. View

15.

Urkmez A, Demirel C, Altok M, Bathala T, Shapiro D, Davis J . Freehand versus Grid-Based Transperineal Prostate Biopsy: A Comparison of Anatomical Region Yield and Complications. J Urol. 2021; 206(4):894-902. DOI: 10.1097/JU.0000000000001902. View

16.

Borkowetz A, Hadaschik B, Platzek I, Toma M, Torsev G, Renner T . Prospective comparison of transperineal magnetic resonance imaging/ultrasonography fusion biopsy and transrectal systematic biopsy in biopsy-naïve patients. BJU Int. 2017; 121(1):53-60. DOI: 10.1111/bju.14017. View

17.

Bott S, Ahmed H, Hindley R, Abdul-Rahman A, Freeman A, Emberton M . The index lesion and focal therapy: an analysis of the pathological characteristics of prostate cancer. BJU Int. 2010; 106(11):1607-11. DOI: 10.1111/j.1464-410X.2010.09436.x. View

18.

Ghafoori M, Velayati M, Ghasabeh M, Shakiba M, Alavi M . Prostate Biopsy Using Transrectal Ultrasonography; The Optimal Number of Cores Regarding Cancer Detection Rate and Complications. Iran J Radiol. 2015; 12(2):e13257. PMC: 4457971. DOI: 10.5812/iranjradiol.13257. View

19.

Ravery V, Goldblatt L, Royer B, Blanc E, Toublanc M, Boccon-Gibod L . Extensive biopsy protocol improves the detection rate of prostate cancer. J Urol. 2000; 164(2):393-6. View

20.

Lee A, Chen K, Tan Y, Lee H, Shutchaidat V, Fook-Chong S . Reducing the number of systematic biopsy cores in the era of MRI targeted biopsy-implications on clinically-significant prostate cancer detection and relevance to focal therapy planning. Prostate Cancer Prostatic Dis. 2022; 25(4):720-726. PMC: 9705237. DOI: 10.1038/s41391-021-00485-3. View