Simultaneous Prostate Target Biopsy Integrated With Radical Prostatectomy: A Pilot Study Omitting Preoperative Systematic Biopsy

• Published in: Journal of Urologic Oncology Vol. 22; no. 3; pp. 196 - 200
• Main Authors: Park, Tae Young, Hwang, Jae Young, Yun, Seong Woo, Hyun, Chang Wan, Yoon, Sung Goo, Kim, Seung Bin, Noh, Tae Il, Shim, Ji Sung, Park, Min Goo, Kang, Seok Ho, Kang, Sung Gu
• Format: Journal Article
• Language: English
• Published: Korean Urological Oncology Society 01.11.2024; 대한비뇨기종양학회
• Subjects: biopsy; frozen sections; prostatectomy; prostatic neoplasms; 비뇨기과학
• ISSN: 2951-603X; 2982-7043
• DOI: 10.22465/juo.244800240012

Purpose: This study evaluates the viability of a new method that employs transperineal targeted biopsy with frozen section analysis immediately followed by robot-assisted radical prostatectomy (RARP), bypassing the traditional systematic biopsy deemed essential by current guidelines.Materials and Methods: Patient selection was based on the following inclusion criteria: those who underwent magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy with frozen section analysis and concurrent RARP. Eligibility also required features indicative of Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion on multiparametric MRI, along with one of these additional criteria: (1) MRI evidence suggesting extracapsular extension (ECE) with a prostate-specific antigen (PSA) level >10 ng/mL, or (2) a PSA level > 20 ng/mL.Results: Twelve patients were enrolled in this study according to inclusion criteria. The median age (interquartile range) was 73.5 (69.5–75.3) years and PSA was 22.9 (17.0–29.9) ng/mL. Three patients had PI-RADS 5 lesions, and 9 had PI-RADS 5 lesions with findings of ECE. In all cases, the diagnosis based on frozen sections confirmed adenocarcinoma. Following confirmation, each patient underwent immediate RARP. According to the final pathology report, 2 patients had International Society of Urological Pathology (ISUP) grade 2 disease, 7 patients had ISUP grade 3, 1 had ISUP grade 4, and 2 had ISUP grade 5 disease. Four patients had stage pT2 disease, 3 had stage pT3a, and 5 had stage pT3b. The median immediate reporting time of the target biopsy frozen section was 20 (19.3–24.5) minutes. No perioperative complications related to target biopsy were observed.Conclusion: For patients with a strong suspicion of prostate cancer and a PI-RADS 5 lesion, integrating simultaneous prostate frozen target biopsy with radical prostatectomy may offer a feasible treatment alternative, obviating the necessity for a preoperative systematic biopsy.