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?

Abstract

Introduction. Our aim was to assess the value of adding standard biopsy to targeted biopsy in cases of suspicious multiparametric magnetic resonance imaging (mp-MRI) and also to evaluate when a biopsy of a PI-RADS 3 lesion could be avoided. Methods: A retrospective study of patients who underwent targeted biopsy plus standard systematic biopsy between 2016–2019 was performed. All the 1.5 T magnetic resonance images were evaluated according to PI-RADSv.2. An analysis focusing on the clinical scenario, lesion location, and PI-RADS score was performed. Results. A total of 483 biopsies were evaluated. The mean age was 65 years, with a PSA density of 0.12 ng/mL/cc. One-hundred and two mp-MRIs were categorized as PI-RADS-3. Standard biopsy was most helpful in detecting clinically significant prostate cancer (csPCa) in patients in the active surveillance (AS) cohort (increasing the detection rate 12.2%), and in peripheral lesions (6.5%). Adding standard biopsy showed no increase in the detection rate for csPCa in patients with PI-RADS-5 lesions. Considering targeted biopsy in patients with PI-RADS 3 lesions, a higher detection rate was shown in biopsy-naïve patients versus AS and in patients with a previous negative biopsy (p = 0.002). Furthermore, in these patients, the highest rate of csPCa detection was in anterior lesions [42.9% (p = 0.067)]. Conclusions. Our results suggest that standard biopsy could be safely omitted in patients with anterior lesions and in those with PI-RADS-5 lesions. Targeted biopsy for PI-RADS-3 lesions would be less effective in peripheral lesions with a previous negative biopsy.

Individualized Decision Making in Transperineal Prostate Biopsy: Should All Men Undergo an Additional Systematic Biopsy?

“…When analysing predictors for the upgrading to sPC by additional SB, we found that men with PI-RADS 2-4 lesions were more likely to have their TB results upgraded by SB compared to PI-RADS 5 men. These results are in accordance with previous studies [ 7 , 18 , 19 , 20 ]. Ahdoot et al proposed the patient’s PI-RADS score as a promising tool to select the optimal biopsy strategy in terms of omitting SB in men harbouring a PI-RADS 5 lesion [ 10 ].…”

Combining targeted and systematic prostate biopsy improves prostate cancer detection and correlation with the whole mount histopathology in biopsy naïve and previous negative biopsy patients

“…Therefore, nowadays the classic SB approach precluding the mpMRI pathway has lost validity. Some authors conclude that the additional value of performing SB after TB is limited in patients with PI-RADS 5 lesions with or without a PSA density (PSAD) ≥0.15 or anterior lesions and thus could be omitted ( 41 ). In contrast, others proclaim that they failed to identify those patients who might safely benefit from TB alone and recommend SB since TB/SB have a higher detection rate of csPC ( 8 , 42 ) and false negative TB missing relevant PCa in 9%–27% of heterogenous cohorts ( 7 , 10 , 11 , 42 ).…”

The Role of Prostate Combination Biopsy Consisting of Targeted and Additional Systematic Biopsy

“…Gomez-Gomez et al reported that standard biopsy could be safely omitted in patients with an anterior lesion and in those with a PI-RADS 5 lesion. They also reported that targeted biopsy for PI-RADS 3 lesions would be less effective in detecting csPCa and thus omitted in patients with peripheral zone lesions and a previous negative biopsy [ 26 ]. In our study, though we could not find an association between G/S upgrade and biopsy methods (targeted vs. systematic), we found that regardless of the PI-RADS score and biopsy setting (initial and repeat), the detection rate of csPCa is higher in the targeted biopsy group compared with the systematic biopsy group.…”