Comparison of systematic and combined biopsy for the detection of prostate cancer

Systematic prostate biopsy has limitations,such as overdiagnosis of clinically insignificant prostate cancer and underdiagnosis of clinically significant prostate cancer.Magnetic resonance imaging(MRI)-guided biopsy,a promising alternative,might improve diagnostic accuracy.To compare the cancer detection rates of systematic biopsy and combined biopsy(systematic biopsy plus MRI-targeted biopsy)in Asian men,we conducted a retrospective cohort study of men who underwent either systematic biopsy or combined biopsy at two medical centers(Queen Mary Hospital and Tung Wah Hospital,Hong Kong,China)from July 2015 to December 2022.Descriptive statistics were calculated,and univariate and multivariate logistic regression analyses were performed.The primary and secondary outcomes were prostate cancer and clinically significant prostate cancer.A total of 1391 participants were enrolled.The overall prostate cancer detection rates did not significantly differ between the two groups(36.3%vs 36.6%,odds ratio[OR]=1.01,95%confidence interval[CI]:0.81-1.26,P=0.92).However,combined biopsy showed a significant advantage in detecting clinically significant prostate cancer(Gleason score≥3+4)in patients with a total serum prostate-specific antigen(tPSA)concentration of 2-10 ng ml−1(systematic vs combined:11.9%vs 17.5%,OR=1.58,95%CI:1.08-2.31,P=0.02).Specifically,in the transperineal biopsy subgroup,combined biopsy significantly outperformed systematic biopsy in the detection of clinically significant prostate cancer(systematic vs combined:12.6%vs 24.0%,OR=2.19,95%CI:1.21-3.97,P=0.01).These findings suggest that in patients with a tPSA concentration of 2-10 ng ml−1,MRI-targeted biopsy may be of greater predictive value than systematic biopsy in the detection of clinically significant prostate cancer.

Outcomes of radical prostatectomy in a 20-year localized prostate cancer single institution series in China

The long-term survival outcomes of radical prostatectomy(RP)in Chinese prostate cancer(PCa)patients are poorly understood.We conducted a single-center,retrospective analysis of patients undergoing RP to study the prognostic value of pathological and surgical information.From April 1998 to February 2022,782 patients undergoing RP at Queen Mary Hospital of The University of Hong Kong(Hong Kong,China)were included in our study.Multivariable Cox regression analysis and Kaplan–Meier analysis with stratification were performed.The 5-year,10-year,and 15-year overall survival(OS)rates were 96.6%,86.8%,and 70.6%,respectively,while the 5-year,10-year,and 15-year PCa-specific survival(PSS)rates were 99.7%,98.6%,and 97.8%,respectively.Surgical International Society of Urological Pathology PCa grades(ISUP Grade Group)≥4 was significantly associated with poorer PSS(hazard ratio[HR]=8.52,95%confidence interval[CI]:1.42–51.25,P=0.02).Pathological T3 stage was not significantly associated with PSS or OS in our cohort.Lymph node invasion and extracapsular extension might be associated with worse PSS(HR=20.30,95%CI:1.22–336.38,P=0.04;and HR=7.29,95%CI:1.22–43.64,P=0.03,respectively).Different surgical approaches(open,laparoscopic,or robotic-assisted)had similar outcomes in terms of PSS and OS.In conclusion,we report the longest timespan follow-up of Chinese PCa patients after RP with different approaches.