Assess MRI-targeted, systematic, or combined prostate biopsy for diagnosing prostate cancer to identify opportunities for diagnostic accuracy improvement.
This Institutional Review Board-approved, retrospective study, performed at a large, quaternary hospital, included all men undergoing prostate MRI (mpMRI) 1/1/2015-12/31/2019 with PSA ≥4 ng/mL, biopsy target on mpMRI (PI-RADS 3-5 lesion), and combined targeted/systematic biopsy ≤6 months post-MRI. Analysis included the highest-grade lesion per patient. Primary outcome was prostate cancer diagnosis by grade group (GG: 1, 2, ≥3). Secondary outcomes were rates of cancer upgrading by biopsy type, and cancer proximity to the targeted biopsy site in patients upgraded by systematic biopsy.
267 biopsies (267 patients) were included; 94.4% (252/267) were biopsy naive. Most suspicious mpMRI lesion was PI-RADS-3 in 18.7% (50/267), PI-RADS-4 in 52.4% (140/267), and PI-RADS-5 in 28.8% (77/267). 68.5% (183/267) were diagnosed with prostate cancer: 22.1% (59/267) GG1, 16.1% (43/267) GG2, 30.3% (81/267) GG≥3. Combined biopsy (124/267) yielded more GG≥2 prostate cancer diagnoses than systematic (87/267) or targeted (110/267) biopsy alone. There were more GG≥2 cancers upgraded by targeted biopsy than systematic biopsy (p=0.0062). Systematic biopsy upgrades were in close proximity to the targeted biopsy site in 42.1% (24/57); GG≥3 cancers 62.5% (15/24) comprised most proximal misses.
In men with PSA ≥4 and PIRADS 3/4/5 lesion on mpMRI, combined biopsy led to more prostate cancer diagnoses than targeted or systematic biopsy alone. Cancers upgraded by systematic biopsy proximal and distant from the targeted biopsy site may indicate opportunities for biopsy and mpMRI improvement, respectively.
Journal of the American College of Radiology : JACR. 2023 Jun 12 [Epub ahead of print]
Kristine S Burk, Sachin Naik, Ronilda Lacson, Kemal Tuncali, Leslie K Lee, Clare Tempany, Alexander P Cole, Quoc-Dien Trinh, Adam S Kibel, Ramin Khorasani
Center for Evidence-Based Imaging; Departments of Radiology; Dana Farber Cancer Institute; Harvard Medical School, Boston, MA, USA. Electronic address: ., Center for Evidence-Based Imaging; Departments of Radiology; Harvard Medical School, Boston, MA, USA., Departments of Radiology; Dana Farber Cancer Institute; Harvard Medical School, Boston, MA, USA., Center for Evidence-Based Imaging; Departments of Radiology; Dana Farber Cancer Institute; Harvard Medical School, Boston, MA, USA., Urological Surgery, Brigham and Women's Hospital; Dana Farber Cancer Institute; Harvard Medical School, Boston, MA, USA.