Can we omit systematic biopsies in patients undergoing MRI fusion-targeted prostate biopsies?

Abstract

Magnetic resonance imaging (MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s) on MRI. The role of concurrent systematic in addition to targeted biopsies is currently unclear. Using our prospectively maintained database, we identified men with at least one Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesion who underwent targeted and/or systematic biopsies from May 2016 to May 2020. Clinically significant prostate cancer (csPCa) was defined as any Gleason grade group ≥2 cancer. Of 545 patients who underwent MRI fusion-targeted biopsy, 222 (40.7%) were biopsy naïve, 247 (45.3%) had previous prostate biopsy(s), and 76 (13.9%) had known prostate cancer undergoing active surveillance. Prostate cancer was more commonly found in biopsy-naïve men (63.5%) and those on active surveillance (68.4%) compared to those who had previous biopsies (35.2%; both P < 0.001). Systematic biopsies provided an incremental 10.4% detection of csPCa among biopsy-naïve patients, versus an incremental 2.4% among those who had prior negative biopsies. Multivariable regression found age (odds ratio [OR] = 1.03, P = 0.03), prostate-specific antigen (PSA) density ≥0.15 ng ml −2 (OR = 3.24, P < 0.001), prostate health index (PHI) ≥35 (OR = 2.43, P = 0.006), higher PI-RADS score (vs PI-RADS 3; OR = 4.59 for PI-RADS 4, and OR = 9.91 for PI-RADS 5; both P < 0.001) and target lesion volume-to-prostate volume ratio ≥0.10 (OR = 5.26, P = 0.013) were significantly associated with csPCa detection on targeted biopsy. In conclusion, for men undergoing MRI fusion-targeted prostate biopsies, systematic biopsies should not be omitted given its incremental value to targeted biopsies alone. The factors such as PSA density ≥0.15 ng ml −2 , PHI ≥35, higher PI-RADS score, and target lesion volume-to-prostate volume ratio ≥0.10 can help identify men at higher risk of csPCa.

Prostate Health Index Density Outperforms Prostate-specific Antigen Density in the Diagnosis of Clinically Significant Prostate Cancer in Equivocal Magnetic Resonance Imaging of the Prostate: A Multicenter Evaluation

“…25,26 Similarly in Singapore, PHI has been routinely offered to men with elevated PSA 4-10 ng/mL at the 2 hospitals in this paper since 2017; estimated charges ranged from USD $44-$109 depending on subsidies available. 27,28 The total health care cost could be reduced as more biopsies could be avoided by using PHID instead of PSAD, especially in men with PI-RADS 3 lesions.…”

“…25,26 Similarly in Singapore, PHI has been routinely offered to men with elevated PSA 4-10 ng/mL at the 2 hospitals in this paper since 2017; estimated charges ranged from USD $44-$109 depending on subsidies available. 27,28 The total health care cost could be reduced as more biopsies could be avoided by using PHID instead of PSAD, especially in men with PI-RADS 3 lesions. This is the largest PHI/PHID study on MRIguided biopsies, and therefore specific reference tables for various PI-RADS scores and cutoffs of each predictor (PSAD, PHI, PHID) can be defined at various sensitivity levels for csPCa.…”