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Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study - Beyond the Abstract

Over the last several decades the diagnosis of prostate cancer has been fraught with uncertainty with traditional systematic biopsies resulting in 30 to 40% rates of upgrading at the time of prostatectomy and failing to diagnose many high-grade cancers. In the modern age, however, we have found that MRI targeted biopsy can lead to substantial improvements in clinically significant cancer detection but it too has some shortcomings. In somewhat of a surprise, in recent years we found that the combination of MRI targeted biopsy and systematic biopsy at the same time leads to a rather dramatic improvement in the diagnostic accuracy of prostate biopsy but subjects patients to substantially more biopsy cores than they would have had if they underwent MRI targeted biopsy only.

Ultimately, I believe the goal of the field is to move towards imaging-directed biopsy methods such as MRI targeted biopsy for all patients but our data, unfortunately, does not support it at this time. However, with a recent study, we are getting closer.

Our group was able to demonstrate that a strategy of MRI targeted biopsy only in PIRADS 5 men can result in nearly the same cancer detection rates as a combined biopsy. However in men with PIRADS 3 and 4 lesions we found that biopsies were far more accurate when systematic biopsy and MRI targeted biopsy were done at the same time. Effectively what we are doing is providing personalized medicine where we personalize our biopsy strategy based on a person's MRI findings.

I'm optimistic that as our technologies improve and further sub-analysis are performed we may be able to expand the use of MRI targeted biopsy alone to more men who are at risk of prostate cancer. It's my hope that this is another step in the evolution of our field to move increasingly towards imaging-guided prostate cancer diagnosis.

Our research was the result of a 10+ year collaboration between the National Institutes of Health physicians, Drs. Peter Pinto(urology), Brad Wood(interventional radiology), and Baris Turkbey(radiology), at the NIH. Their dedicated efforts have helped to advance the field of prostate cancer diagnosis and laid the foundation for the findings discussed here.

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Written by: Michael Ahdoot, MD, Urologic Oncologist, Cedars-Sinai Health System, Los Angeles, California

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