Re: Targeted Prostate Biopsy: Umbra, Penumbra, and Value of Perilesional Sampling

Anwar R. Padhani*, Ivo G. Schoots, Gianluca Giannarini

*Corresponding author for this work

Research output: Contribution to journalComment/Letter to the editorAcademicpeer-review

1 Citation (Scopus)
64 Downloads (Pure)


Background: Systematic prostate biopsies add to the cancer detection rate of targeted
biopsies, but the explanation for that increased sensitivity is not yet clear.
Objective: To determine and quantify the utility of perilesional biopsies in the detection
of clinically significant prostate cancer (csPCa).
Design, setting, and participants: Participants were 2048 men with magnetic resonance
imaging (MRI) lesions (grades 3–5) who underwent targeted and systematic prostate
biopsy via MRI/ultrasound fusion at University of California Los Angeles and Cornell
between 2011 and 2019. The study is a retrospective examination of prospectively
acquired data.
Outcome measurements and statistical analysis: All biopsy cores (30 191), locations of
which had been stored digitally in the image-fusion device, were analyzed for tissue
pathology and relationship with MRI lesions. A validated Matlab script was used to
determine the distance between MRI lesions and cores containing csPCa (3552 cores
from 927 men). Significance of distance measurements was determined by multilevel,
multivariable logistic regression to account for within patient-biopsy correlation and
control for patient characteristics.
Results and limitations: Overall, 90% (95% confidence interval [CI] = 89–91) of csPCa
cores (3206/3552) were located within a radius of 10 mm from the nearest lesion:
65% (95% CI = 63–67) within the region of interest (ROI) and 26% (95% CI = 24–27) outside the ROI but within the 10-mm ‘‘penumbra.’’ The width of the penumbra or concentric band, which enclosed 90% of csPCa, was primarily related to MRI grade of lesion:
grade 5, 5 mm; grade 4, 12 mm; grade 3, 16 mm. In 18% (95% CI = 15–20) of patients
(166/927), csPCa was diagnosed only by sampling outside the MRI lesion, the yield
decreasing with increasing distance. Limitations of MRI interpretation and fusion biopsy
performance could affect the utility of these data in individual patients.
Conclusions: Perilesional biopsies, that is, samples taken from a band of 10-mm radius
outside MRI lesions (the penumbra), contain most cores of csPCa that are not present within the lesion. These data may help increase the performance characteristics of targeted prostate biopsy.
Patient summary: We studied the locations of cancer within the prostate in men undergoing magnetic resonance imaging (MRI)-guided biopsy. We found that not all cancers
are located within the MRI lesion, but 90% (95% confidence interval = 89–91) of the cancers are within 1 cm of the lesions. Biopsies taken from both within and around MRI
lesions provide greater sensitivity for cancer detection than samples taken from the
lesion only.
Original languageEnglish
Pages (from-to)143-144
Number of pages2
JournalEuropean Urology
Issue number1
Publication statusPublished - Jul 2022


Dive into the research topics of 'Re: Targeted Prostate Biopsy: Umbra, Penumbra, and Value of Perilesional Sampling'. Together they form a unique fingerprint.

Cite this