The Detection of Prostate Cancer with Magnetic Resonance Imaging-Targeted Prostate Biopsies is Superior with the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-Institutional Study

• Published in: The Journal of urology Vol. 208; no. 4; pp. 830 - 837
• Main Authors: Zattoni, Fabio, Marra, Giancarlo, Kasivisvanathan, Veeru, Grummet, Jeremy, Nandurkar, Rohan, Ploussard, Guillaume, Olivier, Jonathan, Chiu, Peter K., Valerio, Massimo, Gontero, Paolo, Guo, Hongqian, Zhuang, Junlong, Barletta, Francesco, Leni, Riccardo, Frydenberg, Mark, Moon, Daniel, Hanegbi, Uri, Landau, Adam, Snow, Ross, Apfelbeck, Maria, Kretschmer, Alexander, van den Bergh, Roderick, Novara, Giacomo, Briganti, Alberto, Dal Moro, Fabrizio, Gandaglia, Giorgio
• Format: Journal Article
• Language: English
• Published: 01.10.2022
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1097/JU.0000000000002802

PURPOSEOur aim was to evaluate whether transperineal (TP) MRI-targeted prostate biopsy (TBx) may improve the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology ≥2, in comparison to transrectal (TR) TBx. MATERIALS AND METHODSA multicenter retrospective cohort study comprising patients who underwent MRI-guided prostate biopsy was conducted. To address possible benefits of TP-TBx in the detection of prostate cancer (PCa) and csPCa, a cohort of patients undergoing TP-TBx were compared to patients undergoing TR-TBx. Multivariable logistic regression analyses were performed to assess predictors of PCa and csPCa detection. RESULTSOverall, 1,936 and 3,305 patients who underwent TR-TBx vs TP-TBx at 10 referral centers were enrolled. The rate of PCa and csPCa diagnosed was higher for TP-TBx vs TR-TBx (64.0% vs 50%, p <0.01 and 49% vs 35%, p <0.01). At multivariable analysis adjusted for age, biopsy naïve/repeated biopsy, cT stage, Prostate Imaging-Reporting and Data System®, prostate volume, PSA, and number of biopsy cores targeted, TP-TBx was an independent predictor of PCa (odds ratio [OR] 1.37, 95% CI 1.08-1.72) and csPCa (1.19, 95% CI 1.12-1.50). When considering the approach according to the site of the index lesion, TP-TBx had a significantly higher likelihood than TR-TBx to detect csPCa in the apex (OR 4.81, 95% CI 1.03-6.27), transition/central zone (OR 2.67, 95% CI 1.42-5.00), and anterior zone (OR 5.62, 95% CI 1.74-8.13). CONCLUSIONSThe use of TP-TBx allows a better cancer grade definition and PCa risk assessment. This has important implication in the decision-making process and in patient counseling for further therapies.