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Objective To evaluate the number of needle cores combined with multiparametric magnetic resonance imaging (mpMRI) findings needed to diagnose all clinically significant cases of prostate cancer (csPCa) in men subject to transperineal saturation biopsy (SPBx; 30 cores). Methods From January 2016 to June 2019, 875 men (median age 63 years) underwent repeat SPBx (median 30 cores) for the suspicion of cancer. All of the patients underwent for the first time 3.0 Tesla pelvic mpMRI before SPBx, and the lesions with Prostate Imaging-Reporting and Data System category ≥3 underwent additional transperineal-targeted fusion prostate biopsies (TPBx). Results StageT1c PCa was found in 306/875 (34.5%), and 222/306 (72.5%) of them were classified as csPCa. SPBx missed 2/222 (1%) csPCa with International Society of Urologic Pathology Grade Group (GG) 3. TBPx missed 33/222 (14.9%) csPCa (21 vs 12 cases were GG1 vs GG3). The initial 20 needle SPBx cores obtained from the peripheric (16 cores) and anterior gland (4 cores) diagnosed all of the 222 (100%) csPCa only missing 84/129 (65.1%) indolent PCa thus presenting diagnostic accuracy, sensitivity, and specificity equal to 83.1%, 100%, and 65.1%, respectively. Conclusion In men subject to mpMRI and/or TPBx, a maximum of 20 systematic transperineal needle cores detected all cases of csPCa and minimized the diagnosis of indolent cancers.

To evaluate clinical complications after transperineal prostate biopsy in patients undergoing 12 vs 18 vs more than 24 cores.From February 2002 to December 2012, 3000 patients (median age, 66 years) underwent transperineal prostate biopsy after an abnormal result on a digital rectal examination, prostate-specific antigen (PSA) level10 ng/mL, PSA values between 4.1 and 10, 2.6 and 4, and 2.5 ng/mL with free/total PSA ≤25%, ≤20%, and ≤15%, respectively. Of these, 915 (30.5%), 1330 (48.5%), and 630 patients (21%) underwent 12, 18, and24 needle cores under antibiotic prophylaxis. Prostate biopsy-related complications were evaluated within 15 to 20 days after the prostate biopsy. The number of patients who needed hospital admission or an emergency department visit (EDV) was recorded.Prostate cancer was found in 1150 (38.3%) patients. Side effects after the biopsy occurred in 40.2% of the patients, and the complications were directly correlated with the number of needle cores: 31.5% with 12 cores, 41.8% with 18 cores, and 57.4% with24 cores (P = .001). Overall hospital admission and EDV were 1.2% and 9.1% and occurred, respectively, in 1% and 6% (12 cores) vs 1.3% and 9.6% (18 cores) vs 1.6% and 14.4% (24 cores) of the patients. The most frequent complication that needed hospital admission vs EDV was urinary tract infection (0.7%) vs acute urinary retention (6.7%), respectively. No patients developed sepsis.Clinical complications after transperineal prostate biopsy occurred in 40.2% of the patients, but only 1.2% required hospital admission. The number of needle cores (12 vs 18 vs24) significantly correlated with increased onset of side effects.

To evaluate the role of quantitative histologic findings in predicting nonorgan-confined (non-OC) prostate cancer (PCa) in patients undergoing saturation prostate biopsy (SPBx).A total of 69 patients who had undergone SPBx underwent radical retropubic prostatectomy. Their prostate-specific antigen level was10 ng/mL, and 49 and 20 patients had T1c and T2 PCa, respectively. The following biopsy variables from the quantitative histologic examination were evaluated as predictive of OC vs non-OC PCa: Gleason score (or=6 vs6), total percentage of PCa (or=20% vs20%), greatest percentage of PCa (or=50% vs50%), number of PCa-positive cores (or=2 vs2), presence of PCa-positive cores in both lateral margins (yes vs no), and PCa localization (unilateral vs bilateral). The results obtained from patients who had undergone SPBx were compared with those of 183 patients who had undergone 12-core prostate biopsy before radical retropubic prostatectomy.Overall, 32 patients had non-OC PCa. Among the men with Stage T1c PCa, the quantitative histologic findings were predictive of non-OC PCa in 12 of 17 cases. The area under the receiver operating characteristic curve was 0.935 +/- 0.29, supporting the high accuracy of quantitative histologic examination in predicting for non-OC PCa. The sensitivity in patients who underwent SPBx vs the 12-core biopsy was 78.1% and 89.4%, respectively. Also, although the specificity of each histologic parameter was significantly lower in the SPBx group, it was equivalent using quantitative histologic examination (85.6% vs 86.5%).In the preoperative staging of patients with clinical Stage T1c-T2 PCa and a prostate-specific antigen level10 ng/mL who had undergone SPBx, quantitative histologic examination demonstrated good accuracy in predicting for non-OC PCa only when all pathological variables were considered.

Objectives To evaluate the incidence of prostate cancer (PCa) in patients who underwent a saturation prostate biopsy (SPBx) as primary biopsy or in case of rebiopsy. Methods We assessed 189 patients (median age 60.3 years) submitted to a transrectal ultrasound–guided SPBx (range, 24 to 37 cores; median, 29). In 98 men the SPBx was performed as the primary procedure, in 75 as the second, and in 16 as the third biopsy set. Indications for biopsy were: abnormal DRE; total protate specific antigen (PSA) (tPSA) greater than 10 ng/mL; tPSA equal to 4 to 10, 2.6 to 3.9, less than or equal to 2.5 ng/mL; and percent free PSA (%-fPSA) 25% or less, 20% or less, and 15% or less, respectively. The PCa detection using an SPBx as initial biopsy was compared retrospectively with that found in 256 and 116 patients who underwent 12- and 18-core biopsy, respectively, according to the same protocol. The results obtained in 75 patients submitted to an SPBx as the second biopsy set were compared retrospectively with those found in 73 men who underwent an 18-core re-biopsy. Results The PCa detection rate with SPBx as primary biopsy was 46.9%, greater than the 12-core biopsy (39.8%; P = 0.3) but lower than the 18-core biopsy (49%; P = 0.6). In the case of second and third biopsy, the incidence of PCa when using an SPBx compared with 18-core biopsy was 22% versus 10.9% ( P = 0.003) and 6.2% versus 0%, respectively. The incidence of neoplastic microfoci was 34.7% at first and 45.5% at second biopsy set. In all patients who underwent a radical prostatectomy with a bioptic diagnosis of neoplastic microfocus, the pTNM revealed a clinically significant cancer (tumor volume greater than 0.5 mL or Gleason score of 6 or higher). Conclusions As primary biopsy, SPBx does not increase the PCa detection rate compared with an 18-core scheme; in the case of rebiopsy, the SPBx is a recommended method as the PCa detection rate is doubled compared with 12- or 18-core biopsy sets.