Reduced Core Targeted (RCT) biopsy: Combining multiparametric magnetic resonance imaging - transrectal ultrasound fusion targeted biopsy with laterally-directed sextant biopsies - An alternative template for prostate fusion biopsy

Purpose: To introduce and assess the efficacy of a Reduced Core Targeted (RCT) biopsy template (image-targeted + laterally directed sextant biopsy) to detect clinically-significant cancer in patients with elevated PSA and a previous negative biopsy or on active surveillance. The performance and added value of either targeted alone vs random sextant vs combined biopsy template was appraised. Methods: Data from 113 patients with a suspicious lesion on mpMRI and previous history of extended 10-12 core standard biopsy who subsequently had a RCT-biopsy were analyzed. These patients had at least one prior negative standard 10-12 core biopsy (n = 70) or were on active surveillance (n = 43). At least two samples were taken from each mpMRI lesion as a targeted biopsy together with the classic laterally-directed sextant biopsy. Results: In patients having previous negative biopsy (n = 70), the RCT biopsy detected any cancer versus clinically-significant cancer in 62.9% versus 32.9%, respectively. Targeted biopsy diagnosed more clinically-significant cancers than sextant biopsy (31.4% versus 25.7%, p < 0.01). In this cohort, the use of targeted fusion biopsy upgraded the biopsy grade group (GrGp) in 15 (21.4%) patients compared to sextant biopsy. In patients on active surveillance, the RCT biopsy identified any cancer versus clinically-significant cancer for detection rates of 74.4% versus 39.5%, respectively. Fusion targeted biopsy diagnosed more clinically-significant cancers than sextant biopsy did (37.2% versus 18.6%, p = 0.002). The use of targeted biopsy upgraded the biopsy GrGp in 12 (27.9%) patients. Conclusion: As a preliminary study, among men with MRI suspicious lesions and previous negative prostate biopsy or those under active surveillance, an image-targeted plus sextant biopsy platform can be associated with increased efficiency of detecting clinically-significant prostate cancer with fewer random cores. Future large series are needed to validate the clinical implication of this reduced core template in comparison with targeted fusion biopsy plus standard 12-core schema.