Outcomes and predictors of clinically significant prostate cancer detection by transperineal computer fusion biopsy during active surveillance.

Abstract

Introduction: Active surveillance (AS) is an option for management of low-risk and selected intermediate prostate cancer (PC) patients. Pathological progression confirmed on prostate biopsy (PB) is the most common reason for transitioning to radical treatment. The role and timing of repeat PB during AS is a topic of ongoing debate.The aim of the study was to determine the detection rate of clinically significant PC (csPC) during AS protocol by transperineal computer fusion PB in low-risk PC patients enrolled based on results of transrectal systematic PB, and to identify predictors that may impact csPC detection.

Material and methods: The study involved 95 patients with low-risk PC enrolled in AS, who underwent confirmatory or follow-up PB, proceeded by mpMRI.

Results: The reclassification rate to csPC was 38.9% and 43.9% for confirmatory and follow-up biopsies, respectively. Patients with csPC differed significantly from those without csPC in the following parameters: prostate-specific antigen (PSA) 10.5 ng/ml vs 7.3 ng/ml (p = 0.029), PSA density (PSAD) 0.27 ng/ml² vs 0.18 ng/ml² (p = 0.006), age - 68 years vs 66.5 years (p = 0.024), lesion size 16 mm vs 14 mm (p = 0.042), and PIRADS score (p = 0.004). Multivariable regression models showed that PIRADS score each one-category increase hazard ratio (HR) - 3.615 (1.599-8.172), PSAD >0.20 ng/ml²; HR - 2.760 (1.065-7.149) and age; HR - 1.085 (1.011-1.164) were independent factors increasing the probability of csPC detection in PB.

Conclusions: Confirmatory and repeat transperineal PB detect a significant rate of csPC in low-risk PC patients on AS. Higher PIRADS score and PSAD >0.20 ng/ml² increase the csPC detection rates during AS and should prompt immediate PB.