Consensus on Targeted Prostate Biopsy at Panjiayuan by National Cancer Center

Editor’s Note: In recent years, the incidence and mortality rates of prostate cancer in China have been rapidly increasing. Early diagnosis and treatment are crucial, with prostate biopsy histopathology being the gold standard for diagnosis. However, differences in equipment and technical levels among medical institutions in China pose challenges for prostate biopsies, including issues with technique selection and operational standards. On January 6, 2024, the “2024 Beijing Genitourinary Tumor Youth Forum” was successfully held in Beijing, jointly hosted by the Urology Male Reproductive Tumor Professional Committee of the Beijing Anti-Cancer Association and the Beijing Medical Awards Foundation. Professor Gang Song from the National Cancer Center/Chinese Academy of Medical Sciences Cancer Hospital’s Department of Urology delivered a fascinating speech titled “Consensus on Targeted Prostate Biopsy at Panjiayuan by National Cancer Center (English)” and discussed the background, clinical significance, and challenges of the consensus in an interview with “Oncology Frontier.”

“Oncology Frontier”: Could you introduce the background and clinical significance of the “Consensus on Targeted Prostate Biopsy at Panjiayuan by National Cancer Center”?

Professor Gang Song: The “Consensus on Targeted Prostate Biopsy at Panjiayuan by National Cancer Center” is the first English version of expert consensus in the field of prostate targeted biopsy, familiar to urology. Panjiayuan is the location of our hospital (Chinese Academy of Medical Sciences Cancer Hospital), and it is common to name consensus after the location. We are all familiar with the famous “Pasadena Consensus” in the field of prostate cancer, named after the Pasadena area near Los Angeles. We named it after Panjiayuan, where the National Cancer Center/Chinese Academy of Medical Sciences Cancer Hospital is located, to commemorate the significance of the first consensus in the field of prostate targeted biopsy.

Why was this consensus developed? It is well known that while CT or MRI achieves a diagnostic accuracy of 90% to 95% for kidney cancer, the diagnosis of prostate cancer is more complex. The diagnostic accuracy of imaging in the early stage is only 20% to 30%, and now it is only 50% to 60%. Therefore, the majority of patients still need prostate biopsy for confirmation. Early prostate biopsies were mainly systematic biopsies of the prostate, with 10 to 12 needles evenly distributed, which could effectively detect whether patients had tumors. However, urologists found in practice that this seemingly evenly distributed systematic biopsy did not truly represent the overall condition of the patient’s prostate. Therefore, over the past decade, targeted prostate biopsies have gradually developed, especially with the development of multiparametric magnetic resonance imaging (MRI), including PI-RADS scoring, which has made the diagnosis more objective, providing urologists with a lot of guidance. Under the guidance of multiparametric MRI, we use various positioning methods to locate the lesions detected on MRI, which is targeted prostate biopsy. Of course, the principle and operation of targeted biopsy are very complex, and simple positioning is not enough. It requires continuous exploration of the integration of medicine and engineering.

In this context, we have conducted a lot of clinical practice and scientific research, raising many questions that were not encountered before, such as how many needles should be punctured for a target point, whether one needle is enough, or whether more needles are better. There is no consensus on this internationally. Therefore, our research team conducted corresponding studies on this issue, and we now have preliminary answers, which is the background for the discussion and formulation of the consensus. Under this background, 25 experts in the field of prostate cancer in China conducted online discussions and voting, leading to the formulation of the consensus on targeted prostate biopsy at Panjiayuan. This consensus was published in the inaugural issue of “Uro Precision,” edited by Director Xing Nianzeng (Deputy Director of the National Cancer Center/Chinese Academy of Medical Sciences Cancer Hospital and General Director of Shanxi Hospital of the Chinese Academy of Medical Sciences Cancer Hospital), and was announced to the world as the first English version of expert consensus in the field of targeted prostate biopsy, marking a milestone.

“Oncology Frontier”: What consensus has been reached in this guideline, and how can it provide guidance for clinical practice?

Professor Gang Song: The consensus on targeted prostate biopsy at Panjiayuan includes applications in imaging (including multiparametric MRI and novel PSMA PET/CT), selection of biopsy methods, three common targeted biopsy methods (including MRI-guided direct biopsy, cognitive fusion prostate cancer biopsy, MRI/TRUS fusion imaging), biopsy pathways (including transrectal pathways, transperineal pathways), the number of needles required for each target point, selection of free-arm biopsy, and the future direction of prostate cancer diagnosis, etc. Twenty-five experts in the field of prostate cancer discussed and anonymously voted on these 10 aspects and 14 questions through an online system, ultimately reaching a consensus on each question. These consensuses do not demand a standard answer but represent the views of experts in the field on a particular issue at present. These views will continue to be optimized and adjusted with the development of the times, with the expectation that the views and opinions in the expert consensus can standardize and guide the current diagnosis and treatment process of targeted prostate biopsy.

“Oncology Frontier”: Regarding “needle-free” prostate cancer diagnosis, what challenges do you think it faces, and how should “needle-free” diagnosis be implemented currently and in the future?

Professor Gang Song: “Needle-free” prostate cancer diagnosis is a very hot topic now, first proposed by Director Xing Nianzeng. He conducted some discussions and in-depth research on this concept several years ago, using diagnostic methods with higher accuracy such as prostate-specific antigen, multiparametric MRI, PSMA PET/CT, etc., combined with other diagnostic methods, to determine whether patients have tumors without undergoing a biopsy. On one hand, this concept can reduce the pain of patients undergoing biopsy, and on the other hand, it can save the waiting time for patients from biopsy to surgery for one month. It can improve the efficiency of biopsy or diagnosis without affecting the diagnostic accuracy, thus better serving the purpose of prostate cancer patients. Director Xing and his team have conducted a series of studies, including PSMA PET/CT, using the diagnostic accuracy SUV value to judge sensitivity and specificity, using different media such as blood and urine diagnostic markers to assist diagnosis, and many other aspects. We are also conducting multicenter studies across the country, attracting more and more teams to join us, striving to achieve our goals. However, there are still some difficulties in achieving our goals because medicine, especially clinical medicine, is an engineering subject, and the markers used for PSMA PET/CT in different medical institutions may have slight differences. How to find common ground in differences and find standardized criteria is our goal. We hope that in the future, standardized diagnostic methods can be developed for patients, sending out the voice of China.