In the world of prostate cancer (PCa), there is a dangerous cell pattern called cribriform (pronounced crib’ ri-form) or simply Cr. It has a distinctive appearance that looks similar to a sieve or a plate with lots of holes. Cr is associated with aggressive Gleason grade 4 cancer. Also, there is another PCa type called intraductal carcinoma or IDC. Whether found alone or together, both Cr and IDC are linked with tumor progression, biochemical recurrence and metastasis. Because Cr/IDC can grow quickly, the sooner these patterns are diagnosed and treated, the better the chances for successful cancer control.

Although Cr/IDC does not represent the majority of PCa cases, it is still quite prevalent. According to a 2023 paper, “Biopsies showed a cribriform pattern plus IDC?P in 13.2% cases and a cribriform pattern only in 25% cases.”^[i] The same study found that when their study patients went on to radical prostatectomy, the surgical specimens revealed Cr plus IDC in 34.2% of patients, while Cr only was found in 35.5%.

Although this publication did not specify the type of biopsy or number of needles, it is assumed that standard transrectal ultrasound (TRUS) guided systematic biopsy (TRUS biopsy) was performed since it was not specified otherwise. Note that TRUS biopsy does not target specific areas of the prostate. The authors emphasize that evaluating biopsy tissue for Cr/IDC is “a very important factor in considering future treatment strategies.” However, their TRUS biopsies underestimated the number of cases that were actually shown to have Cr/IDC once they had surgery. A better biopsy method is clearly needed.

MRI-targeted biopsy better than TRUS biopsy

Thankfully, a new 2024 paper reveals that mpMRI-targeted biopsy is indeed better because it identifies a higher rate of Cr/IDC than systematic TRUS biopsies. A Canadian research team published “Comparison of Multiparametric MRI-targeted and Systematic Biopsies for Detection of Cribriform and Intraductal Carcinoma Prostate Cancer” in the important journal Radiology^[ii].

What makes their work noteworthy was the number of patients they enrolled (453). Participants were randomly divided into either a TRUS biopsy arm (226) or multiparametric MRI (mpMRI) arm (227). Keep in mind that conventional TRUS biopsies typically consist of 12-14 needles, whereas mpMRI-guided biopsies target the suspicious area(s) visible on scans—thus requiring fewer needles. For this study, there were 196 TRUS samples available for assessment, compared with 132 mpMRI samples.

Here’s what the researchers found: “Identification of Cr/IDC PCa was lower in the systematic biopsy arm compared with the mpMRI arm (31 of 196 biopsies [16%] vs 33 of 132 biopsies [25%] …” They concluded that “…MRI-targeted biopsy showed increased detection of Cr/IDC histologic patterns compared with [TRUS] systematic biopsy.”

It goes without saying that if doctors and patients have a choice, and access to multiparametric MRI, the more accurate biopsy method is in-bore MRI-targeting. Studies repeatedly show that live targeting (not fusion targeting) has the highest rate of diagnosing clinically significant PCa, with or without Cr/IDC. The Sperling Prostate Center is proud to provide real-time, in-bore mpMRI-guided targeted biopsies. Our results give patients the confidence that diagnostic accuracy means the best treatment match for their individual situation.

Our team congratulates the Canadian authors and their clinical/academic centers on publishing their valuable research, which benefits patients around the world.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Shiomi E, Kato R, Kanehira M, Takata R et al. Cribriform pattern in prostate tissues: Predictor for intraductal carcinoma of the prostate based on biopsy and radical prostatectomy pathology. BJUI Compass. 2022 Oct 20;4(3):339-345.
[ii] Ghai S, Klotz L, Pond GR, Kebabdjian M et al. Comparison of Multiparametric MRI-targeted and Systematic Biopsies for Detection of Cribriform and Intraductal Carcinoma Prostate Cancer. Radiology. 2024 Jul;312(1):e231948.