Abstract
PurposeTo describe the predictive value of information on previous benign biopsy for the outcome of MRI-targeted biopsies.MethodsAn exploratory analysis was conducted using data from a prospective, multicenter, paired diagnostic study of 532 men undergoing diagnostics for prostate cancer during 2016–2017. All men underwent 1.5 T MRI; systematic prostate biopsies; and MRI-targeted biopsies to MRI lesions with Prostate Imaging Reporting and Data System version 2, PI-RADS ≥ 3. The main outcome was numbers of detected prostate cancer characterized by grade group (GG) where GG ≥ 2 defined clinically significant cancer (csPCa).ResultsMen with previous biopsies had significantly more often negative MRI (26% vs. 17%, p < 0.05) compared to men without previous biopsies. Men with previous biopsies showed higher rates of benign biopsies (41% vs. 26%, p < 0.05) and lower rates of GG2 (17% vs. 30%, p < 0.05) and GG ≥ 3 (5% vs. 10%, p < 0.05) cancer. Biopsy-naïve men had higher proportions of highly suspicious MRI lesions (PIRADS 5; p < 0.05) and a higher proportion of significant cancer in those lesions (p = 0.05). In multivariate regression analysis, a previous benign prostate biopsy was associated with less than half the odds of csPCa (OR 0.38; 95% CI 0.20–0.71).ConclusionIn this large prospective multicenter trial, we showed that men with a previous prostate biopsy had higher proportions of MRIs without lesions and lower proportion of highly suspicious lesions than biopsy-naïve men. Further, biopsy-naïve men showed higher detection of clinically significant cancer when using MRI-targeted biopsies. Also, in the era of MRI-targeted biopsy strategies, biopsy history should be carefully considered in biopsy decisions.Trial registrationNCT02788825 (ClinicalTrials.gov). Date of registration June 2, 2016.
Highlights
Several studies have shown that MRI-targeted biopsy is superior to systematic transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer [1,2,3]
We recently published results from the paired design STHLM3MRI study where men without prior diagnosis of prostate cancer scheduled for prostate biopsy underwent both magnetic resonance imaging, systematic and two to three targeted fusion biopsies to any significant lesion defined as PIRADSv2 ≥ 3 at any of the three Scandinavian sites [6]
We modelled the primary outcome in a univariate and a multivariate logistic regression including biopsy status, age, PSA, PSA density, PI-RADS score and pathological finding on digital rectal examination (DRE; yes/no) as predictors
Summary
Several studies have shown that MRI-targeted biopsy is superior to systematic transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer [1,2,3]. It was further demonstrated that a combined procedure combining targeted and systematic biopsies in men with visible MRI lesions enhances cancer detection and decreases risk of disease misclassification [4]. This supports the statement in EAU guidelines that this combined approach might be a suggested clinical standard [5]. We recently published results from the paired design STHLM3MRI study where men without prior diagnosis of prostate cancer scheduled for prostate biopsy underwent both magnetic resonance imaging, systematic and two to three targeted fusion biopsies to any significant lesion defined as PIRADSv2 ≥ 3 at any of the three Scandinavian sites [6]. We found that a combination of a blood-based risk prediction tool and MRI-targeted biopsies can be used to inform biopsy decision making
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