Comparison of TRUS-biopsy to Transperineal Template Mapping biopsies stratified by MRI score within the PROMIS trial
BAUS ePoster online library. Lovegrove C. 06/24/19; 259548; P5-4
Dr. Catherine Lovegrove
Dr. Catherine Lovegrove
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PROMIS provided level 1 evidence for pre-biopsy MP-MRI as triage investigation for detection of clinically significant prostate cancer(csPCa). We aimed to further elaborate on performance characteristics of transrectal ultrasound-guided systematic(TRUS) biopsies compared to transperineal template mapping(TPM) biopsy with a 5mm sampling frame.


Biopsy-naïve men advised to undergo prostate biopsy for elevated PSA and/or abnormal rectal examination underwent standardised MP-MRI, TPM-biopsy and TRUS-biopsy with tests conducted and reported blind to the results of the others. csPCa was primarily defined as detection of Gleason>/=4+3 or maximum cancer core length(MCCL)>/=6mm of any grade, and secondarily defined as Gleason>/=3+4 or any grade with MCCL>/=4mm. All cancer was also evaluated.


Over 41 months, 740 men from 11 centres were recruited and 576 underwent all three tests. Of 150 men with MRI score 1-2, 8(5.3%) had any Gleason >/=3+4 disease. In 75 men in whom TRUS-biopsy showed Gleason 3+3 of any MCCL, 61/75(81%) had Gleason3+4 and 8/75 (11%) Gleason 4+3; none of 75 (0%) had Gleason>/=4+5.

For definition1 csPCa, sensitivity remains broadly stable and low across all Likert scores (35% to 52%) (Table 1). For definition2 csPCa and any cancer, TRUS-biopsy sensitivity increased with Likert score (Table 2). NPV was variable but in all cancer thresholds showed decreasing trends with increasing Likert score (Tables 1-3).

TRUS-biopsy for MRI scores 1 and 2 confers 1 in 20 chance of yielding Gleason >/=3+4. Further, for any definition of csPCa, TRUS-biopsy had poor sensitivity and variably low negative predictive values across all MRI score groups.
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