Abstract
Objective The study investigates the prostate-specific antigen threshold for adding targeted, software-based, magnetic resonance imaging-ultrasound fusion biopsy during a standard 12-core biopsy in biopsy-naïve patients. It secondarily explores whether the targeted biopsy is necessary in setting of abnormal digital rectal examination. Methods 260 patients with suspected localized prostate cancer with no prior biopsy underwent prostate magnetic resonance imaging and were found to have Prostate Imaging Reporting and Data System score ≥ 3 lesion(s). All 260 patients underwent standard 12-core biopsy and targeted biopsy during the same session. Clinically significant cancer was Gleason ≥3 + 4. Results Percentages of patients with prostate-specific antigen 0–1.99, 2–3.99, 4–4.99, 5–5.99, 6–9.99, and ≥10 were 3.0%, 4.7%, 20.8%, 16.9%, 37.7%, and 16.9%, respectively. Cumulative frequency of clinically significant prostate cancer increased with the addition of targeted biopsy compared with standard biopsy alone across all prostate-specific antigen ranges. The difference in clinically significant cancer detection between targeted plus standard biopsy compared to standard biopsy alone becomes statistically significant at prostate-specific antigen >4.3 (p=0.031). At this threshold, combination biopsy detected 20 clinically significant prostate cancers, while standard detected 14 with 88% sensitivity and 20% specificity. Excluding targeted biopsy in setting of a positive digital rectal exam would save 12.3% magnetic resonance imaging and miss 1.8% clinically significant cancers in our cohort. Conclusions In biopsy-naïve patients, at prostate-specific antigen >4.3, there is a significant increase in clinically significant prostate cancer detection when targeted biopsy is added to standard biopsy. Obtaining standard biopsy alone in patients with abnormal digital rectal examinations would miss 1.8% clinically significant cancers in our cohort.
Highlights
While there is increasing utilization of multiparametric magnetic resonance imaging- ultrasound fusion biopsy in the detection of localized prostate cancer, this utilization is not uniform and the indications for mpMRI remain imperfectly defined
There is about 54% disagreement in the interpretation of the same prostate mpMRI between community settings and tertiary centers [5, 7]. ese challenges to the feasibility of widespread implementation of mpMRI for all patients presenting with suspicion for localized prostate cancer raises the question of whether there is a prostate-specific antigen (PSA) threshold beyond which adding mpMRI significantly increases detection of clinically significant prostate cancer. e current study aims to investigate potential PSA thresholds to obtain mpMRI in biopsy-naıve patients presenting with suspected localized prostate cancer
Indications for prostate mpMRI in our cohort included concerning PSA or PSA velocity, digital rectal exam (DRE), incidentally detected prostate cancer on transurethral resection of prostate, incidental Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 3 on MRI obtained for nonurologic indications, or incidental fluorodeoxyglucose positron emission tomography- (PET-) avid lesion of the prostate on PET-scan for nonurologic investigations
Summary
We assessed the association between prostate volume on mpMRI and the presence of clinically significant cancer on standard biopsy using Kendall’s tau-b. Ere was a statistically significant negative association between prostate volume on mpMRI and the presence of clinically significant cancer on standard biopsy, τb −0.177, p 0.001. The difference in csPCA detection between targeted plus standard biopsy compared to standard biopsy alone becomes statistically significant at PSA >4.3 (p 0.031). Ere were 32 patients who underwent targeted with concurrent standard biopsy with abnormal DRE. Us, omitting targeted biopsy when there is a positive DRE would save 32/260 (12.3%) mpMRI, miss 3/20 (15.0%) csPCA in the abnormal DRE subgroup, and miss 3/ 169 (1.8%) csPCA in the entire cohort 3/32 were found on targeted biopsy only, 2/32 on standard biopsy only, and 15 on both targeted and standard biopsy. us, omitting targeted biopsy when there is a positive DRE would save 32/260 (12.3%) mpMRI, miss 3/20 (15.0%) csPCA in the abnormal DRE subgroup, and miss 3/ 169 (1.8%) csPCA in the entire cohort
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
