title: Detection rate for significant cancer at confirmatory biopsy in men enrolled in Active Surveillance protocol: 20 cores vs 30 cores vs MRI/TRUS fusion prostate biopsy.
abstract: BACKGROUND
  The detection rate for significant prostate cancer of extended vs saturation vs mMRI/TRUS fusion biopsy was prospectively evaluated in men enrolled in active surveillance (AS) protocol. Mterials and methods: From May 2013 to September 2016 75 men aged 66 years (median) with very low risk PCa were enrolled in an AS protocol and elegible criteria were: life expectancy greater than 10 years, cT1C, PSA below 10 ng/ml, PSA density &lt; 0.20, 2 &lt; unilateral positive biopsy cores, Gleason score (GS) equal to 6, greatest percentage of cancer (GPC) in a core &lt; 50%. All patients underwent 3.0 Tesla pelvic mpMRI before confirmatory transperineal extended (20 cores) or saturation biopsy (SPBx; 30 cores) combined with mpMRI/TRUS fusion targeted biopsy (4 cores) of suspicious lesions (PI-RADS 3-5).
  
  
  RESULTS
  21/75 (28%) patients were reclassified by SPBx based on upgraded GS ≥ 7; mpMRI lesions PI-RADS 4-5 vs PI-RADS 3-5 diagnosed 9/21 (42.8%) vs 16/21 (76.2%) significant PCa with 2 false positives (6.5%). The detection rate for significant PCa was equal to 76.2% (mpMRI/TRUS fusion biopsy) vs 81% (extended) vs 100% (SPBx) (p = 0.001); mpMRI/TRUS targeted biopsy and extended biopsy missed 5/21 (23.8%) and 4/21 (19%) significant PCa which were found by SPBx (p = 0.001) being characterised by the presence of a single positive core of GS ≥ 7 with GPC &lt; 10%.
  
  
  CONCLUSIONS
  Although mpMRI improve the diagnosis of clinically significant PCa, SPBx is provided of the best detection rate for PCa in men enrolled in AS protocols who underwent confirmatory biopsy.
authors.affiliation: Urology Unit, Cannizzaro Hospital, Catania. piepepe@hotmail.com.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pepe
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cimino
authors.forename: Antonio
authors.initials: A
authors.lastname: Garufi
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Priolo
authors.forename: Giorgio Ivan
authors.initials: GI
authors.lastname: Russo
authors.forename: Raimondo
authors.initials: R
authors.lastname: Giardina
authors.forename: Giulio
authors.initials: G
authors.lastname: Reale
authors.forename: Michele
authors.initials: M
authors.lastname: Barbera
authors.forename: Paolo
authors.initials: P
authors.lastname: Panella
authors.forename: Michele
authors.initials: M
authors.lastname: Pennisi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D014463:Ultrasonography; D057832:Watchful Waiting