Updated prevalence of latent prostate cancer in Chinese population and comparison of biopsy results: An autopsy-based study

Prostate cancer detected by autopsy is named latent prostate cancer.As the repertoire of clinical prostate cancer,latent cancer may better reflect the disease burden.Unlike clinical prostate specimens,which are obtained exclusively from biopsy-positive cases,prostate specimens obtained through autopsy provide information on biopsy-negative cases,helping calculate the true sensitivity of prostate biopsy.From 2014 to 2021,we collected autopsy specimens of the prostate from body donors in China and performed transperineal and transrectal biopsies on specimens before step-sectioning and pathological measurements.We found that the crude prevalence of latent prostate cancer in middle-aged and elderly men was 35.1%(81/231),which was higher than previous estimates for Chinese populations.The overall per-patient sensitivities of transperineal and transrectal biopsies were not significantly different(33.3%vs.32.1%,p=0.82),but the two approaches differed in preferential sampling area along the proximal-distal axis of the prostate.Transperineal biopsy had a higher sensitivity for detecting clinically significant lesions in the distal third(34.7%vs.16.3%,p=0.02)and distal half(30.6%vs.18.1%,p=0.04),while transrectal biopsy had a higher sensitivity for lesions in the proximal half(25.0%vs.13.9%,p=0.046).Both transperineal and transrectal methods of biopsy missed most small lesions(<0.1 mL)and 35.3%(6/17)of large lesions(>0.5 mL).In conclusion,the prevalence of latent prostate cancer in China has increased over the past 2 decades.Systematic transperineal and transrectal methods of biopsy had comparable sensitivities but had different preferential sampling areas.Both approaches miss one-third of large lesions.

Indications,strategies,and development on prostate targeted biopsy:Report of the Panjiayuan Consensus Conference 2022

Prostate biopsy is the gold standard for diagnosing prostate cancer(PCa).Prostate targeted biopsy(TB)having a higher rate of detecting clinically significant PCa(csPCa)than traditional systematic biopsy(SB)is supported by high-quality evidence.However,the TB indications and strategies are controversial.The National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,invited a panel of recognized urology experts in PCa to address these topics at the Panjiayuan Consensus Conference 2022.The conference results on prostate TB are presented herein.The National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences identified 10 key areas of prostate biopsy:(1)selection of imaging examination;(2)indications of TB;(3)transperineal and transrectal prostate biopsy;(4)TB pathways;(5)TB and SB;(6)three techniques of TB;(7)the number of TB cores needed for one lesion;(8)core number for SB;(9)free-hand TB;(10)future development of TB/prostate diagnosis.Thus,a panel of 25 recognized urologists and 2 radiologists from China were invited to attend this conference.The panel voted anonymously on 14 predetermined questions.Voting was based on the panelists'clinical practice and opinion,rather than high-level evidence.The voting outcomes were supported by the panel unequally,and details of the voting results were reported.The voting results can help clinicians to decide on biopsy timing and proper strategies,for which guidelines are sparse.We also focused on the future development of TB and SB,such as the combined pathway of TB and SB,techniques of TB,biopsy cores,free-hand TB,and prostate-specific membrane antigen positron emission tomography/computed tomography.