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Randomized Controlled Trial
. 2025 Sep:9:e2500468.
doi: 10.1200/PO-25-00468. Epub 2025 Sep 17.

Optimized Biopsy Strategy for Transition Zone Prostate Cancer With Enhanced Perilesional Sampling: A Retrospective Analysis and Clinical Trial Validation

Xin Chen  1   2 , Chen Huang  1 , Chenchao Zhou  1 , Yu Li  1 , Renpeng Huang  3 , Jie Bao  4 , Yuxin Lin  1 , Michael C Truß  5 , Jianquan Hou  1   2 , Yuhua Huang  1 , Xuedong Wei  1
Affiliations
Randomized Controlled Trial

V体育安卓版 - Optimized Biopsy Strategy for Transition Zone Prostate Cancer With Enhanced Perilesional Sampling: A Retrospective Analysis and Clinical Trial Validation

Xin Chen et al. JCO Precis Oncol. 2025 Sep.

Abstract

Purpose: Prostate biopsy (PBx) is crucial for diagnosing prostate cancer (PCa). This study aims to identify potential underdiagnosis of transition zone (TZ) PCa compared with peripheral zone (PZ) tumors and validate a novel PBx strategy to improve TZ tumor detection VSports手机版. .

Materials and methods: This study comprised two components: a retrospective analysis and a randomized clinical trial. The retrospective study included 217 patients who underwent radical prostatectomy after 8PZ + 4TZ + X transperineal transrectal ultrasound-magnetic resonance imaging-fusion PBx between 2018 and 2021. The clinical trial investigated biopsy efficacy in 400 patients who underwent either modified 8PZ + 10TZ + X PBx for the TZ lesion or 8PZ + 4TZ + X PBx after block random assignment between 2022 and 2023 at our center V体育安卓版. .

Results: Retrospective analysis reveals identical TZ clinically significant prostate cancer (csPCa) detection rates for 8PZ + 4TZ + X and 4TZ + X PBx, both of which were insufficient for detecting TZ csPCa compared with PZ tumors. Based on these findings, 8PZ + 10TZ + X PBx was constructed. In the trial, the 10TZ + X and 8PZ + 10TZ + X PBx demonstrated identical TZ csPCa detection rates and biopsy positivity rate, outperforming the 4TZ + X and 8PZ + 4TZ + X PBx without increasing complications. The self-controlled comparison showed equivalent results for 8TZ + X and 8PZ + 10TZ + X PBx V体育ios版. .

Conclusion: Our study found that PZ biopsies offer no additional benefit for TZ lesion tumors, and increasing the number of cores in the TZ region can compensate for the current limitations of TZ biopsies VSports最新版本. These findings provide potential avenues for optimizing biopsy strategies for TZ lesions. .

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V体育平台登录 - Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript V体育平台登录. For more information about ASCO's conflict of interest policy, please refer to www. asco. org/rwc or ascopubs. org/po/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Yu Li

Employment: The First Affiliated Hospital of Soochow University

Honoraria: The First Affiliated Hospital of Soochow University

No other potential conflicts of interest were reported.

V体育2025版 - Figures

FIG 1.
FIG 1.
The CONSORT diagram of prospective clinical trials. ciPCa, clinically insignificant prostate cancer; csPCa, clinically significant prostate cancer; Mp-MRI, multiparametric magnetic resonance imaging; PCa, prostate cancer; PI-RADS, prostate imaging reporting and data system; PSA, prostate-specific antigen; PZ, peripheral zone; RP, radical prostatectomy; TZ, transition zone.
FIG 2.
FIG 2.
TRUS-MRI-fusion prostate biopsy schematic. (A) 8PZ-core PBx and 8-core biopsy in PZ. (B) 4TZ-core PBx and 4-core biopsy in TZ. (C) X-core PBx and 3-5 cores targeting MRI lesions. (D) 10TZ-core PBx and 10-core biopsy in TZ. (E) 8TZ-core PBx and 8-core biopsy in TZ. (F) 6TZ-core PBx and 6-core biopsy in TZ. PBx, prostate biopsy; PZ, peripheral zone; TZ, transition zone; TZa, transitional zone anterior; TZp, transitional zone posterior.
FIG 3.
FIG 3.
Comparison of csPCa occurrence and detection between TZ patients and PZ patients. (A) The incidence of csPCa detected by biopsy in TZ lesions is lower than that in PZ patients. (B) The incidence of csPCa determined by RP pathology is similar between TZ and PZ lesions. (C) The incidence of csPCa detected by biopsy is lower than that determined by RP pathology in TZ patients. (D) No significant difference in the incidence of csPCa between biopsy and RP pathology in PZ patients. (E) No statistically significant difference in the csPCa detection rate for TZ tumors between 8PZ + 4TZ + X and 4TZ + X. (F) The lesion volume ratio in TZ patients with upgrading was smaller than those without upgrading. (G) The incidence of lesions in the left and right TZa was higher than that in the TZp region. *P < .05,**P < .01. ciPCa, clinically insignificant prostate cancer; csPCa, clinically significant prostate cancer; PZ, peripheral zone; RP, radical prostatectomy; TZ, transition zone; TZa, transitional zone anterior; TZp, transitional zone posterior.
FIG 4.
FIG 4.
Comparison of biopsy efficacy between different biopsy strategies in the self-control group (see the Data Supplement for details). ciPCa, clinically insignificant prostate cancer; csPCa, clinically significant prostate cancer; PZ, peripheral zone; RP, radical prostatectomy; TZ, transition zone.
See this image and copyright information in PMC

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