Winner of EFSUMB Young Investigator Award 2023
Abb. 1 Adam Morrell, UK
Consultant Sonographer at Leeds Teaching Hospitals NHS Trust with a specialist interest
in interventional ultrasound and education.
Abstract
The first 5 targeted trans-perineal prostate biopsies diagnose the majority of PROMIS
criteria cancer in patients with a Likert 4 or 5 score on mpMRI
W. M. Stevens, E. Adiotomre, O. Hulson, A. Khan, R. Lapham, P. Melling, A. Morrell, S. Pierre, J. Smith
Department of Radiology, St James’s University Hospital, Leeds Teaching Hospitals
NHS Trust, Leeds, England
Introduction
Locally the total number of prostate biopsies taken by practitioners is variable and
this is reflected within the literature with no consensus. There is a trend towards
taking more biopsies in order to increase cancer detection rate and minimise need
for repeat biopsy however, this increases complication rates and the diagnosis of
clinically insignificant cancers. NICE guidelines suggest multiple prostate biopsies
for histological diagnosis of cancer in those patients with a Likert 4 or 5 score
on their mpMRI scan. Depending on the treatment planned, some patients need systematic
TP biopsy, but in frail patients, those with limited treatment options or extensive
disease, a cancer diagnosis may be all that is required.
Aims and Methods
To see if the first 2–5 targeted transperineal (TP) biopsies give a diagnosis of PROMIS
criteria cancer in patients with a likely prostate cancer on mpMRI. 375 patients had
an mpMRI for suspected prostate cancer between January and June of 2021 in a large
volume quaternary centre. 367 were given a Likert score of which 108 were scored Likert
4 or 5. Of these, 94 patients were sent for biopsy. 70 of the biopsied patients were
ultimately diagnosed with PROMIS criteria cancer. A separate pot was sent containing
the first 2–5 targeted biopsies in 69 of the 70.
Results
The median number of biopsies in all patients sent for biopsy was 12 (range 3–19).
The first 2–5 targeted biopsies showed PROMIS criteria cancer in 65 of the 69 (94.2 %)
Likert 4 and 5 patients diagnosed with cancer. 62/69 (89.9 %) showed the maximum length
or grade of cancer in the first 2–5 targeted biopsies. All 4 of the missed cancers
were ISUP 2 or less and located in the apex of the gland.
Conclusion
A cancer diagnosis is usually obtained in the first 2–5 targeted biopsies in patients
with a Likert score of 4 or 5. Further biopsies may be required for treatment planning
or for lesions in the apex of the gland where cancers can be missed.
