Is systematic prostate biopsy an overkill in metastatic prostate carcinoma ? A prospective validation.

PURPOSE: To assess the efficacy of 2-core prostate biopsy in advanced prostate cancer patients. This included a retrospective analysis of 12-core prostate biopsies and a prospective validation that a reduced number of cores are sufficient for histopathological diagnosis.

METHODS: The first phase analyzed retrospective data from 12-core prostate biopsies between January 2013 and 2018. In the second phase, from January 2018 to January 2022, in a prospective setting, patients with PSA > 75 ng/dl underwent bone scans first. Those with positive bone scans underwent a 2-core biopsy. Cancer detection rate and complications were analyzed to validate the findings of the first phase.

RESULTS: In the retrospective analysis, the number of positive cores in metastatic disease was 12 in 93 (73.8%), 11 in 14 (11.1%), and 10 in 7 (5.6%) patients. Using probability analysis, 94% of patients with metastasis could be detected with a single core and 97.8% with a 2-core biopsy. In the prospective analysis, 52 patients with PSA > 75 were enrolled. 3/52 (5.7%) patients had a negative bone scan. 49 were assigned for 2-core biopsy, out of which 48 (97.9%) had a positive result. One patient underwent a repeat 12-core biopsy. The prospective cohort's complications (p = 0.003) and pain score (p = 0.03) were lower compared to patients who underwent standard 12-core biopsies during phase one of the study period.

CONCLUSION: A 2-core biopsy is adequate in almost all patients with metastatic prostate cancer with PSA > 75, and this avoids excess complications and morbidity associated with a systematic 12-core prostate biopsy.