Added value of systematic biopsy in men with a clinical suspicion of prostate cancer undergoing biparametric MRI-targeted biopsy: multi-institutional external validation study

Abstract

Purpose We aimed to develop and externally validate a nomogram based on MRI volumetric parameters and clinical information for deciding when SBx should be performed in addition to TBx in man with suspicious prostate MRI. Materials and methods Retrospective analyses of single (IMPROD, NCT01864135) and multi-institution (MULTI-IMPROD, NCT02241122) clinical trials. All men underwent a unique rapid biparametric magnetic resonance imaging (IMPROD bpMRI) consisting of T2-weighted imaging and three separate DWI acquisitions. Men with IMPROD bpMRI Likert scores of 3-5 were included. Logistic regression models were developed using IMPROD trial (n = 122) and validated using MULTI-IMPROD trial (n = 262) data. The model's performance was evaluated in the terms of PCa detection with Gleason Grade Group 1 (clinically insignificant prostate cancer, iPCa) and > 1 (clinically significant prostate cancer, csPCa). Net benefits and decision curve analyses (DCA) were compared. Combined biopsies were used for reference. Results The developed nomogram included age, PSA, prostate volume, MRI suspicion score (IMPROD bpMRI Likert or PIRADsv2.1 score), MRI-suspicion lesion volume percentage, and lesion location. All these variables were significant predictors of csPCa in SBx in multivariable analysis. In the validation cohort (n = 262) using different nomogram cutoffs, 19-43% of men would have avoided SBx while missing 1-4% of csPCa and avoiding detection of 9-20% of iPCa. Similar performance was found for nomograms using IMPROD bpMRI Likert score or v2.1. Conclusions The developed nomogram demonstrated potential to select men with a clinical suspicion of PCa who would benefit from performing SBx in addition to TBx. Public access to the nomogram is provided at:https ://petiv .utu.fi/multi impro d/.

Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy?

“…In line with this, Arabi et al [28] showed that standard biopsy increased the detection rate in those patients with PI-RADS 3 and 4 lesions, but not in those with PI-RADS 5 lesions. In terms of lesion location, recent data in cohorts that used a targeted plus a standard biopsy approach, as reported by Falagario et al [29], have shown that the probability of adding standard biopsy to targeted biopsy to detect csPCa in nonperipheral zone lesions is clearly inferior. One of the reasons for the additional csPCa detected by standard biopsy, specifically in the peripheral zone, and in smaller lesions, is not only mp-MRI missed diagnosis, but also targeting errors, as has been previously demonstrated [30].…”

Multivariable Models Incorporating Multiparametric Magnetic Resonance Imaging Efficiently Predict Results of Prostate Biopsy and Reduce Unnecessary Biopsy

“…The mpMRI improved the detection of CSPCa due to its anatomic detail, emerging accessibility, and addition of functional data. A growing body of literatures has validated the clinical utility of mpMRI in the detection and localization of CSPCa ( 16 , 27 , 28 ). In our study, the MRI-PCa also had the highest performance in PCa (AUC=0.78) and CSPCa (AUC=0.78) detection among mpMRI parameters.…”

Significance of the prostate central gland and total gland volume ratio in the diagnosis of prostate cancer patients in the prostate specific antigen grey zone

“…Novel prostate MRI protocols such as biparametric MRI are promising because they could make the acquisition time much shorter. 39 In this context, PVc/PV could be used as a quantitative parameter added to the MRI report. Furthermore, mpMRI also demonstrated similar accuracies irrespective of race when undergoing radical prostatectomy.…”