Influence of biopsy cores number performed with targeted prostate biopsy on the likelihood of a positive result in patients with clinically significant prostate cancer

Background. Targeted biopsy is proposed as a method of choice in the algorithm of prostate cancer diagnosis, but not all the features of method has been evaluated.
Objective: determine the rational number of targeted biopsy samples in patients with clinically significant prostate cancer.
Materials and methods. The magnetic resonance imaging and fusion biopsy data of 156 patients with suspected prostate cancer were retrospectively evaluated.
Results and conclusion. In the study statistically significant dependence of the positive histological results in patients with clinically significant prostate cancer from the number of biopsy samples was found. The potential probability of a false negative histological examination with an insufficient number of biopsy samples was noted. These results confirm the latest published data of potential targeted biopsy false in true positive patients after multiparametric magnetic resonance imaging. An increase in the number of biopsy samples in the target lesion reduces the likelihood of false-negative results. The main causes of such discrepancy are some technical laxity and the heterogeneous histological structure of prostate cancer. Increase the number of biopsy cores can reduce the likelihood of false-negative results.

1. Clinical guideline. Ministry of Health of the Russian Federation. Prostate cancer. Available at: http://www.oncology.ru/association/clinical-guidelines/2018/rak_predstatelnoy_zhelezy_pr2018.pdf. (In Russ.).

2. Padhani A.R., Barentsz J., Villeirs G. et al. PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway. Radiology 2019;292(2):464-74. DOI: 10.1148/radiol.2019182946.

3. Prostate cancer. Clinical Recommendations. Association of Oncologists of Russia. Russian Society of Oncourologists. Russian Society of Clinical Oncology. Russian Society of Urology. Moscow, 2020. Available at: https://oncology-association.ru/files/clinical-guidelines-2020/rak_predstatelnoj_zhelezy.pdf. (In Russ.).

4. Prostate Cancer. Recommendations European Society of Urology, 2020. Available at: https://uroweb.org/guideline/prostate-cancer/.

5. Kasivisvanathan V., Stabile A., Neves J.B. et al. Magnetic resonance imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer: a systematic review and meta-analysis. Eur Urol 2019;76(3):284-303. DOI: 10.1016/j.eururo.2019.04.043.

6. Rouviere O., Puech P., Renard-Penna R. et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2019;20(1):100-9. DOI: 10.1016/S1470-2045(18)30569-2.

7. Venderink W., van Luijtelaar A., Bomers J.G.R. et al. Results of targeted biopsy in men with magnetic resonance imaging lesions classified equivocal, likely or highly likely to be clinically significant prostate cancer. Eur Urology 2018;73 (3):353-60. DOI: 10.1016/j.eururo.2017.02.021.

8. Radtke J.P., Wiesenfarth M., Kesch C. et al. Combined clinical parameters and multiparametric magnetic resonance imaging for advanced risk modeling of prostate cancer - patient-tailored risk stratification can reduce unnecessary biopsies. Eur Urol 2017;72(6):888-96. DOI: 10.1016/j.eururo.2017.03.039.

9. Rosenkrantz A.B. MRI of the prostate. A practical Approach. 2017 by Thieme Medical Publishers, Inc.

10. Drost F.J.H., Osses D., Nieboer D. et al. Prostate magnetic resonance imaging, with or without magnetic resonance imaging-targeted biopsy, and systematic biopsy for detecting prostate cancer: a cochrane systematic review and metaanalysis. Eur Urol 2020;77(1):78-94. DOI: 10.1016/j.eururo.2019.06.023.

11. Yadav S.S., Stockert J.A., Hackert V. et al. Intratumor heterogeneity in prostate cancer. Urol Oncol Sem Orig Investig 2018;36(8):349-60. DOI: 10.1016/j.urolonc.2018.05.008.

12. Prostate Imaging Reporting & Data System (PI-RADS) 2019 v2.1 (full text document). American College of Radiology. Available at: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/PI-RADS.

13. Matoso A., Epstein J.I. Defining clinically significant prostate cancer on the basis of pathological findings. Histopatology 2019;74(1):135-45. DOI: 10.1111/his.13712.

14. Hansen N.L., Barrett T., Koo B. et al. The influence of prostate-specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7-10 prostate cancer in repeat biopsy setting. BJU Int 2017;119(5):724-30. DOI: 10.1111/bju.13619.