While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone.
However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa.
To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC).
Men with MRI-visible prostate lesions underwent combined TBx plus SBx.
The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score.
Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (7.5% vs 8%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%).
While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%).
Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544.
European urology oncology. 2021 Apr 10 [Epub ahead of print]
Michael Ahdoot, Amir H Lebastchi, Lori Long, Andrew R Wilbur, Patrick T Gomella, Sherif Mehralivand, Michael A Daneshvar, Nitin K Yerram, Luke P O'Connor, Alex Z Wang, Sandeep Gurram, Jonathan Bloom, M Minhaj Siddiqui, W Marston Linehan, Maria Merino, Peter L Choyke, Paul Pinsky, Howard Parnes, Joanna H Shih, Baris Turkbey, Bradford J Wood, Peter A Pinto, Trio Study Group
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: ., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, Bethesda, MD, USA., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Molecular Imaging Program, Center for Cancer Research, National Institute of Health, Bethesda, MD, USA., Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA., Translational Surgical Pathology Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Molecular Imaging Program, Center for Cancer Research, National Institute of Health, Bethesda, MD, USA., Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/33846112
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