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04-05-2022 | Prostate Cancer | Urogenital

Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy

Authors: Dominik Deniffel, Nathan Perlis, Sangeet Ghai, Stephanie Girgis, Gerard M. Healy, Neil Fleshner, Robert Hamilton, Girish Kulkarni, Ants Toi, Theodorus van der Kwast, Alexandre Zlotta, Antonio Finelli, Masoom A. Haider

Published in: European Radiology | Issue 11/2022

Abstract

Objectives

We aimed to develop and compare strategies that help optimize current prostate biopsy practice by identifying patients who may forgo concurrent systematic biopsy (SBx) in favor of MRI–targeted (TBx) alone.

Methods

Retrospective study on 745 patients who underwent combined MRI-TBx plus SBx. Primary outcome was the upgrade to clinically significant prostate cancer (csPCa; grade group ≥ 2) on SBx versus MRI-TBx. Variables (age, previous biopsy status, Prostate Imaging Reporting and Data System (PI-RADS) score, index lesion size/location, number of lesions, PSA, PSA density, prostate volume) associated with the primary outcome were identified by logistic regression and used for biopsy strategies. Clinical utility was assessed by decision curve analysis (DCA).

Results

SBx detected 47 (6%) additional men with csPCa. The risk of detecting csPCa uniquely on SBx was significantly lower in men with PI-RADS 5 (versus PI-RADS 3: OR 0.30, p = 0.03; versus PI-RADS 4: OR 0.33, p = 0.01), and previous negative biopsy (versus previous positive biopsy: OR 0.40, p = 0.007), and increased with age (per 10 years: OR 1.64, p = 0.016). No significant association was observed for other variables. DCA identified the following strategies as most useful: (a) avoid SBx in men with PI-RADS 5 and (b) additionally in those with previous negative biopsy, resulting in avoiding SBx in 201 (27%) and 429 (58%), while missing csPCa in 5 (1%) and 15 (2%) patients, respectively.

Conclusion

Not all men benefit equally from the combination of SBx and MRI-TBx. SBx avoidance in men with PI-RADS 5 and/or previous negative biopsy may reduce the risk of excess biopsies with a low risk of missing csPCa.

Key Points

• In men undergoing MRI-targeted biopsy, the risk of detecting clinically significant prostate cancer (csPCa) only on additional systematic biopsy (SBx) decreased in men with PI-RADS 5, previous negative biopsy, and younger age.

• Using these variables may help select men who could avoid the risk of excess SBx.

• If missing csPCa in 5% was acceptable, forgoing SBx in men with PI-RADS 5 and/or previous negative biopsy enabled the highest net reduction in SBx.

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Title: Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy
Authors: Dominik Deniffel
Nathan Perlis
Sangeet Ghai
Stephanie Girgis
Gerard M. Healy
Neil Fleshner
Robert Hamilton
Girish Kulkarni
Ants Toi
Theodorus van der Kwast
Alexandre Zlotta
Antonio Finelli
Masoom A. Haider
Publication date: 04-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Prostate Cancer
Published in: European Radiology / Issue 11/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08822-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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