Abstract
Introduction. Our aim was to assess the value of adding standard biopsy to targeted biopsy in cases of suspicious multiparametric magnetic resonance imaging (mp-MRI) and also to evaluate when a biopsy of a PI-RADS 3 lesion could be avoided. Methods: A retrospective study of patients who underwent targeted biopsy plus standard systematic biopsy between 2016–2019 was performed. All the 1.5 T magnetic resonance images were evaluated according to PI-RADSv.2. An analysis focusing on the clinical scenario, lesion location, and PI-RADS score was performed. Results. A total of 483 biopsies were evaluated. The mean age was 65 years, with a PSA density of 0.12 ng/mL/cc. One-hundred and two mp-MRIs were categorized as PI-RADS-3. Standard biopsy was most helpful in detecting clinically significant prostate cancer (csPCa) in patients in the active surveillance (AS) cohort (increasing the detection rate 12.2%), and in peripheral lesions (6.5%). Adding standard biopsy showed no increase in the detection rate for csPCa in patients with PI-RADS-5 lesions. Considering targeted biopsy in patients with PI-RADS 3 lesions, a higher detection rate was shown in biopsy-naïve patients versus AS and in patients with a previous negative biopsy (p = 0.002). Furthermore, in these patients, the highest rate of csPCa detection was in anterior lesions [42.9% (p = 0.067)]. Conclusions. Our results suggest that standard biopsy could be safely omitted in patients with anterior lesions and in those with PI-RADS-5 lesions. Targeted biopsy for PI-RADS-3 lesions would be less effective in peripheral lesions with a previous negative biopsy.
Highlights
Our aim was to assess the value of adding standard biopsy to targeted biopsy in cases of suspicious multiparametric magnetic resonance imaging and to evaluate when a biopsy of a PI-RADS 3 lesion could be avoided
14.9% of targeted lesions on multiparametric magnetic resonance imaging (mp-MRI) were re-classified with a different PI-RADS score by the expert radiologist, revealing a kappa agreement of 0.76; p < 0.001
Despite the reports on the value mp-MRI for prostate cancer diagnosis and biopsy guidance, there remain areas of debate, how best do we deal with PI-RADS 3 lesions, and when should standard biopsies be added to targeted biopsies
Summary
Our aim was to assess the value of adding standard biopsy to targeted biopsy in cases of suspicious multiparametric magnetic resonance imaging (mp-MRI) and to evaluate when a biopsy of a PI-RADS 3 lesion could be avoided. Standard biopsy was most helpful in detecting clinically significant prostate cancer (csPCa) in patients in the active surveillance (AS) cohort (increasing the detection rate 12.2%), and in peripheral lesions (6.5%). Adding standard biopsy showed no increase in the detection rate for csPCa in patients with PI-RADS-5 lesions. The diagnosis of prostate cancer has evolved in the last several years, due to the low accuracy of the classic PSA pathway: digital rectal examination (DRE) and standard biopsy [2] Different tools, such as risk calculators that combine different clinical variables, have been shown to outperform the classic pathway [3,4]. Clear and high-quality evidence has emerged, which shows that the introduction of multiparametric magnetic resonance (mpMR) further improves the classic pathway, with a higher detection rate of csPCa when targeting lesions described as positive with mpMR (PI-RADS or LIKERT ≥ 3) [6,7,8]. Depending on the patient’s clinical picture, incrementally increased detection rate that results from adding standard biopsies or the over-diagnosis of insignificant tumours may vary and more data are needed to be able to clarify the best recommendations in each setting
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