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Likelihood of sampling prostate cancer at systematic biopsy as a function of gland volume and number of cores

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Background

Pre-biopsy multiparametric magnetic resonance imaging (mpMRI) of the prostate is used to conduct targeted prostate biopsy (TB), guided by ultrasound and registered (fused) to the MRI. Systematic biopsy (SB) continues to be used together with TB or in mpMRI-negative patients. There is insufficient evidence on how to use SB to inform clinical decision-making in the mpMRI era. The purpose of this study was to estimate the effect of prostate volume and number of SB cores on sampling clinically significant prostate cancer (csPCa) using a simulation method based on clinical data.

Methods

SBs were simulated using data from 42 patients enrolled in a transrectal ultrasound robot-assisted biopsy trial. Linear mixed models were used to examine the relationship between the number of SB cores and prostate volume on 1) clinically significant cancer detection probability (csCDP) and 2) percent of mpMRI depicted regions of interest (ROIs) sampled with the SB.

Results

Median values and interquartile range (IQR) were 47.16 cm3 (35.61–65.57) for prostate volume, 0.57 cm3 (0.39–0.83) for ROI volume, and 4.0 (2–4) for PI-RADS v2.1 scores on MRI. csCDP increased with the increasing number of simulated SB cores and decreased substantially with larger prostate volume. Similarly, the percent of ROIs sampled increased with the increasing number of simulated SB cores and was lower for prostate volumes ≥60 cm3 compared to glands <60 cm3.

Conclusions

The effect of the number of SBs performed on detecting csPCa varies largely with gland volume. The common 12-core SB can achieve adequate cancer detection and sampling of ROIs in smaller glands, but not in larger glands. In addition to TB or in mpMRI-negative patients, the number of SB cores can be adjusted to prostate volume. Performing 12-core SB alone in ≥60 cm3 glands results in inadequate sampling and potential PCa underdiagnosis.

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Fig. 1: SB plan for one of the patients.
Fig. 2: Relationship between csCDP and the number of SB cores and prostate volume.
Fig. 3: ROI sampling rate versus the number of SB cores for prostate volumes within two groups <60 cm3 and >60 cm3).

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Data availability

Limited datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request and with the permission of Johns Hopkins Medicine.

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Acknowledgements

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA247959.

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Authors and Affiliations

  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael E. Rezaee, Bruce J. Trock, Amin Herati, Christian P. Pavlovich, Misop Han & Dan Stoianovici

  2. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Katarzyna J. Macura

  3. Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Bruce J. Trock

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Contributions

MER – Conducted prostate biopsies for clinical trial. Contributed to data analysis interpretation and development of manuscript. KJM – Reviewed prostate-related imaging for clinical trial. Contributed to development of manuscript. BJT – Performed statistical analysis, interpreted data analysis, and contributed to development of the manuscript. AH – Conducted prostate biopsies for clinical trial. Contributed to development of manuscript. CPP – Conducted prostate biopsies for clinical trial. Contributed to development of manuscript. MH – Conducted prostate biopsies for clinical trials. Conceived and supervised all aspects of the project, including development of the manuscript. DS – Conceived and supervised all aspects of the project, including development of the manuscript. Constructed all study figures.

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Correspondence to Dan Stoianovici.

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Under a license agreement between Eigen Health Services and Johns Hopkins University, author DS and the University are entitled to royalty distributions related to technology described in this article. This arrangement has been reviewed and approved by the JHU in accordance with its conflict-of-interest policies.

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Rezaee, M.E., Macura, K.J., Trock, B.J. et al. Likelihood of sampling prostate cancer at systematic biopsy as a function of gland volume and number of cores. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-023-00780-1

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