Cribriform morphology and intraductal carcinoma (IDC) in prostate cancer are significant adverse prognostic features that influence treatment decisions. This study evaluated the accuracy of prostate biopsies in detecting cribriform morphology and IDC by comparing biopsy results to matched radical prostatectomy specimens. The analysis included patients who underwent prostatectomy between 2015 and 2022, with detection sensitivity assessed using prostatectomy as the reference standard.
Among 287 men analyzed, cribriform morphology was identified in 241 cases (84%) and IDC in 161 cases (56%) in final pathology. However, biopsy sensitivity for detecting cribriform morphology was only 42.4% (95% CI 36–49%), and for IDC, it was 44.1% (95% CI 36–52%). Sensitivity improved slightly to 52.5% (95% CI 47–58%) when considering either IDC or cribriform morphology. Multiparametric MRI-guided biopsies offered marginal improvements, with sensitivities of 54% for cribriform morphology and 37% for IDC. Despite incorporating advanced imaging methods like ultrasound-guided techniques and multiparametric MRI, detection rates remain suboptimal, highlighting limitations in current biopsy methodologies.
These findings underscore the need for improved diagnostic tools, including biomarkers, to enhance the detection of aggressive histological patterns. While ultrasound-guided and MRI fusion biopsies have increased diagnostic precision, their limitations must be acknowledged in clinical decision-making. Incorporating these insights could refine treatment strategies and improve outcomes for patients with adverse prostate cancer features.
