Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Concurrent Scientific Session IV: Oncology II 40 Unilateral ROI on MRI, Do We Really Need to Sample the Contralateral Gland? Esther L. Finney, MD 1 , Nathanaelle O. Ibeziako, BS 2 , Alireza Moinzadeh, MD, MBA 1 , Daneil Kuftinec, MD 1 , Manuel Merino, MD 1 , WilliamFaust, MD 1 1 Lahey Hospital and Medical Center, Burlington, MA, USA; 2 Tufts University School of Medicine, Boston, MA, USA Introduction: Debate exists regarding the added utility of performing systematic biopsy at the time of MRI targeted prostate biopsy. Existing literature suggests that a number of patients with clinically-significant prostate cancer (csPCa), defined as Gleason Grade Group 2 or above, would be missed if only targeted biopsy is performed. Whether this represents the sampling of discrete MRI invisible lesions, or is merely a field effect around the target lesion, remains unknown. We aim to assess the cancer detection rate (CDR) and clinically-significant cancer detection rate (csCDR) in the contralateral gland for patients with unilateral lesions on MRI undergoing targeted and concomitant 12-core systematic prostate biopsy. Materials & Methods: We performed a retrospective chart review of all patients who have undergone TRUS-guided fusion prostate biopsy at a single institution from 2015-2020. All patients had been found to have at least one PIRADS-3, -4, or -5 lesion on MRI prior to undergoing subsequent UroNav® targeted fusion biopsy. Number of targeted cores obtained were at the discretion of the urologist performing the biopsy. A standard 12-core systematic biopsy was performed simultaneously on all patients. Biopsies were performed by two senior urologists and cores evaluated by a dedicated genitourinary pathologist. Lesions were retrospectively categorized as right or left and anterior or posterior. Results: Of 736 patients identified, 514 (74%) had unilateral lesions on MRI. The indication for MRI was cancer screening in 367/514 (71%) patients and active surveillance for 141/514 (27%). Amedian of three targeted cores were obtained per lesion. The overall CDR in the contralateral gland was 15% for PIRADS-3, 21% for PIRADS-4, and 29% for PIRADS-5 lesions. The csCDR in the contralateral gland was 5% for PIRADS-3, 9% for PIRADS-4, and 12% for PIRADS-5. Only one percent of patients (7/514) had clinically-significant cancer detected in the contralateral gland only (i.e not detected on targeted or ipsilateral cores). For patients with unilateral PIRADS-5 lesions, there was no added detection of csPCa from biopsying the contralateral gland. Conclusions: For patients with unilateral lesions on MRI, there was a 1% detection rate of csPCa in the contralateral gland only. The added yield of systematic biopsy of the contralateral gland for patients with unilateral lesions undergoingMRI-TRUS fusion prostate biopsy may be extremely low. Transperineal Multiparametric Magnetic Resonance Imaging-ultrasound Fusion Targeted Prostate Biopsy Improves Cancer Detection Over In-office Transperineal Template Biopsy Michelle Kim, MD PHD, ShulinWu, MD, Sharon Lin, PhD, Rory Crotty, MD, Mukesh Harisinghani, MD, Chin-Lee Wu, MD PhD, Douglas Dahl, MD MGH, Boston, MA, USA Introduction: Transperineal (TP) prostate biopsy provides an effective approach to prostate cancer detection. The improvement over the standard template with multiparametric MRI (mpMRI) imaging guidance for TP prostate biopsy has yet to be examined in a large cohort of patients. Materials & Methods: We identified all men who underwent in-office transperineal biopsy with mpMRI fusion guided software from September 2019 to February 2021 using the Precision Point device and UroNav guidance platform. We assessed clinicopathological factors, MRI and biopsy characteristics. We compared pathological results between standard transperineal biopsy template and targeted biopsies. Results: Three hundred and one (n=301) men underwent concomitant standard template and targeted biopsy procedures. The median age was 67(IQR, 62-73), and the median PSAwas 6.0 ng/mL (IQR, 4.4-8.8). The median prostate volume by MRI was 45 cc (IQR, 33-61), and the median PSAdensity was 0.14 ng/mL/cc (IQR, 0.09-0.20). Twenty cores constituted the standard template biopsy set. Target lesions onMRI were sampledwith 3 targeted cores per patient (IQR 3–4). The overall prostate cancer detection rate was 74.1%and 63.5% by standard template and targeted biopsy, respectively, of which 52.5% and 59.9% were clinically significant prostate cancer, respectively. Targeted biopsies missed 19.8%of cancer cases while templated biopsies missed 6.3%of cancer cases (p<0.001). Templated biopsies showed significantly higher cancer detection rate than the target biopsy (p<0.001) but slightly lower clinically significant cancer detection rate (p=0.662). Of 176 cases with combined overall cancer diagnosis, 18.8% had an upgraded Gleason score (GS) with targeted biopsies while 18.2% cases were upgraded with the standard template. Conclusions : Transperineal MRI guided fusion biopsy combined with the standard template provides a higher detection rate of clinically significant prostate cancer in men with suspicious lesions than the standard template alone and should be included as part of the biopsy procedure. 39 21