Targeted prostate biopsies for a histogram of the index lesion

Abstract

Knowledge of the three-dimensional location and contour of the clinically significant cancer (index cancer), and its proximity to the critical anatomical structures (such as prostate capsule, external sphincter, neurovascular bundle) has significant impact on preoperative and intraoperative decision-making during radical prostatectomy and focal therapy treatments. Modern image-targeted biopsy techniques can provide increasingly accurate information about the location and other characteristics of the index cancer lesion. Although resolution of modern imaging may characterize glandular level differences between malignant and benign tissues, their accuracy is not yet at the cellular level. As such, imaging alone can likely overestimate or underestimate the volume of the index lesion. Superimposition of biopsy-proven histologic data can allow creation of a more precise histogram of the index lesion. Superimposing the recorded needle biopsy trajectories upon magnetic resonance/transrectal ultrasound images can provide a more accurate three-dimensional picture of the location and size of the histologically proven dominant cancer lesion. A virtual histogram of the index lesion can thus be created. This may have implications for radical surgery, focal therapy, and active surveillance on a 'per-lesion' strategy.