Concordance with radical prostatectomy specimen of in-bore MRI-guided transperineal vs US-guided transrectal prostate biopsies: A propensity score matched analysis

Abstract

Introduction: The aim of the study was to examine the overall concordance of in-bore MRI-guided transperineal prostate biopsies (mriTP-PB) with ultrasound-guided transrectal prostate biopsies (usTR-PB) to the radical prostatectomy (RP) specimen.

Patients and methods: Three hundred twenty-four patients who underwent RP after mriTP-PB (25 patients) and usTR-PB (299 patients) were included in this retrospective single-center study from 2016 to 2024. To ensure comparability between the groups, we performed a 1:2 propensity score matching. The primary endpoint was overall concordance between mriTP- and usTR-PB compared with RP. The secondary endpoints were upgrading, downgrading and prediction of focal treatment between mriTP- and usTR-PB.

Results: After matching patients, the median age of patients was 61.44 years in the mriTP-PB group and 60.94 years in the usTR-PB group (P=0.731). Overall concordance were better in the mriTP-PB group than in the usTR-PB group (44.0% vs. 19.15% respectively, P=0.031). Pathological concordance, upgrading and downgrading rates were not statistically different between the 2 groups. The sensibility and the specificity for prediction to focal treatment of PCa was 100% and 85% respectively in the mriTP-PB group, and 100% and 75% in the usTR-PB group. The PPV and the NPV was 62.5% and 100% respectively in the mriTP-PB group, and 41.2% and 100% in the usTR-PB group.

Conclusion: In-bore mriTP-PB appear to be more efficient than usTR-PB in the diagnostic strategy for PCa, enabling better selection of patients for focal treatment. Nevertheless, prospective studies with a larger number of patients included will be needed to confirm our results.

Level of evidence: 1a, strength rating : Strong.

Keywords: Biopsies transpérinéales; Biopsies transrectales; Concordance; Focal therapy; Prostatectomie; Prostatectomy; Thérapie focale; Transperineal biopsy; Transrectal biopsy.