Predicting the Performance of Concurrent Systematic Random Biopsies during Image Fusion Targeted Sampling of Multi-Parametric MRI Detected Prostate Cancer. A Prospective Study (PRESET Study).

Saeed Alqahtani,Magdalena Szewczyk-Bieda,Cheng Wei,Xinyu Zhang,Yilong Zhang,Jennifer Wilson,Ghulam Nabi,Zhihong Huang

doi:10.3390/cancers14010001

Saeed Alqahtani, Magdalena Szewczyk-Bieda + Show 6 more

Open Access

https://doi.org/10.3390/cancers14010001

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Abstract

Simple SummaryThe study provides a predictive model by using clinical factors in selecting men who may benefit from the addition of systematic biopsies with an image fusion targeted approach. The approach is likely to improve the detection of csPCa and avoid unnecessary detection of indolent prostate cancers.The study was aimed to develop a predictive model to identify patients who may benefit from performing systematic random biopsies (SB) in addition to targeted biopsies (TB) in men suspected of having prostate cancer. A total of 198 patients with positive pre-biopsy MRI findings and who had undergone both TB and SB were prospectively recruited into this study. The primary outcome was detection rates of clinically significant prostate cancer (csPCa) in SB and TB approaches. The secondary outcome was net clinical benefits of SB in addition to TB. A logistic regression model and nomogram construction were used to perform a multivariate analysis. The detection rate of csPCa using SB was 51.0% (101/198) compared to a rate of 56.1% (111/198) for TB, using a patient-based biopsy approach. The detection rate of csPCa was higher using a combined biopsy (64.6%; 128/198) in comparison to TB (56.1%; 111/198) alone. This was statistically significant (p < 0.001). Age, PSA density and PIRADS score significantly predicted the detection of csPCa by SB in addition to TB. A nomogram based on the model showed good discriminative ability (C-index; 78%). The decision analysis curve confirmed a higher net clinical benefit at an acceptable threshold.

Highlights

Recent trends and evidence support pre-biopsy MRI with selective targeting of suspected malignant lesions using MRI/ultrasound (US) and targeted biopsies (TB) methods [1]
In a recent systematic review, used a mixed population to answer this question; image fusion methods were not used in all the cases of included studies, and the benefits of targeting suspicious areas with the image fusion approach, with or without addition of systematic biopsy sampling, remains unclear [5]
Several clinical variables included baseline information (age, Prostate specific antigen (PSA) level, PSA density and prostate volume), multi-parametric magnetic resonance imaging features (number of lesions seen on MRI, index lesion size) and PIRADS score

Summary

Introduction

Recent trends and evidence support pre-biopsy MRI with selective targeting of suspected malignant lesions using MRI/ultrasound (US) and TB methods [1]. The burgeoning interest in fusion imaging has arisen to address the main limitations of SB: overdetection of clinically insignificant cancers and possibly underdetection of csPCa. A number of recent reports support the utility of pre-biopsy multi-parametric magnetic resonance imaging (mpMRI) to address the limitations of SB, and the advantage of increased csPCa detection [2,3,4]. In a recent systematic review, used a mixed population (with or without image fusion targeting of suspicious areas) to answer this question; image fusion methods were not used in all the cases of included studies, and the benefits of targeting suspicious areas with the image fusion approach, with or without addition of systematic biopsy sampling, remains unclear [5]

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