Comparing confirmatory biopsy outcomes between MRI‐targeted biopsy and standard systematic biopsy among men being enrolled in prostate cancer active surveillance

Abstract

Objectives To evaluate the ability of magnetic resonance imaging (MRI)‐targeted biopsy combined with systematic biopsy (MRI‐biopsy) to reduce negative biopsies and detect clinically significant prostate cancer compared to systematic biopsy (SB) alone in the confirmatory biopsy setting using matched cohorts. Patients and Methods Patients were identified from an active surveillance database who had a previously positive transrectal ultrasonography‐guided SB followed by a confirmatory biopsy at a single institution between 2006 and 2019. Patients were divided into two cohorts based on confirmatory biopsy technique: SB alone or MRI‐biopsy (which included MRI‐targeted and systematic biopsies). Cohorts were then matched on age, prostate‐specific antigen (PSA) level, number of positive cores on initial biopsy and initial biopsy Gleason grade group (GG). Logistic regression was performed to identify associations with confirmatory biopsy upgrading. Results After matching, 514 patients were identified (257 per cohort). PSA, prostate volume and PSA density prior to initial biopsy, in addition to total number of initial biopsy positive cores and GG, were similar between the matched cohorts. After confirmatory biopsy, 118/257 patients (45.9%) in the MRI‐biopsy cohort were upgraded compared to 46/257 patients (17.9%) in the SB cohort (P < 0.001). The rate of negative confirmatory biopsy was 32/257 (12.5%) compared to 97/257 (37.7%) in the MRI‐biopsy and SB cohorts, respectively (P < 0.001). Confirmatory MRI‐biopsy was associated with greater odds of confirmatory biopsy upgrade from GG 1 to ≥GG 2 compared to SB alone (odds ratio 3.62, 95% confidence interval 1.97–6.63; P < 0.001). Conclusion The addition of MRI‐targeted biopsies to SB in the confirmatory biopsy setting among men with previously detected prostate cancer resulted in fewer negative confirmatory biopsies and detection of more clinically significant prostate cancer compared to SB alone.

Two Decades of Active Surveillance for Prostate Cancer in a Single-Center Cohort: Favorable Outcomes after Transurethral Resection of the Prostate

“…Given the breadth of our study duration, we employed both standardized template TRUS biopsies and targeted MRI/TRUS fusion biopsies. While reclassification rates were not significantly different between the two procedures, there was a trend towards a higher reclassification rate in the fusion biopsy group, which is congruent with the prior efforts that demonstrated increased Gleason grade progression with the more sensitive and specific fusion biopsies [ 26 , 27 , 28 , 29 , 30 ].…”

Machine Learning-Based Prediction of Pathological Upgrade From Combined Transperineal Systematic and MRI-Targeted Prostate Biopsy to Final Pathology: A Multicenter Retrospective Study

“…Clinicians are more concerned about the upgrade rates, as the only tissue sampled is from the needle biopsy. The confirmatory biopsy setting was upgraded with a range of 18%–30% of cases, who are previously detected to have PCa and were on active surveillance ( 31 ).…”

The utility of prostate MRI within active surveillance: description of the evidence

“…As MRI is increasingly included among the first line diagnostic tests for elevated PSA, it is likely that patients will continue to benefit from the increasing accuracy of prostate cancer risk stratification. However, if patients are diagnosed with GG1 prostate cancer using TRUS biopsy, clinicians should consider confirmatory biopsy using MRI guidance as this is associated with higher rates of reclassification [ 30 ] (Table 2 ).…”