Early Second Round Targeted Biopsy of PI-RADS Score 3 or 4 in 256 Men With Persistent Suspicion of Prostate Cancer

Pepe, Pietro; Garufi, Antonio; Priolo, Gian Domenico; Pennisi, Michele; Fraggetta, Filippo

doi:10.21873/invivo.11556

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…Therefore, it is in this group where legitimate concern exists for false negative biopsies. Several retrospective studies recommend early re-imaging following a negative mpMRI guided biopsy of PI-RADS 4 or 5 ROI providing the repeat mpMRI remains suspicious for csPCa [ 6 , 7 ]. Our observation that ipsilateral SB increases detection of csPCa missed by MR targeted biopsy suggests the real potential for false negative MRFTB due to mis-registration [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Axumin (18F-Fluciclovine) PET imaging in men exhibiting no clinically significant cancer on initial negative biopsy of PI-RADS 4 and 5 regions of interest

et al. 2022

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Purpose The objective of the study was to determine whether Axumin ( 18 F-Fluciclovine) PET/MRI informs the decision to perform an early repeat biopsy of PI-RADS 4/5 region of interest (ROI) exhibiting no clinically significant prostate cancer (csPCa) on initial biopsy. Methods This prospective study enrolled men with at least one PI-RADS 4/5 ROI on multi-parametric MRI and no csPCa on prior biopsy defined as Gleason grade group (GGG) > 1. All men underwent an Axumin PET/MRI and only-persistent PI-RADS > 2 ROI were advised to undergo a repeat biopsy. A PET cancer suspicion score (PETCSS) was internally developed to stratify PET avid lesions according to their suspicion of harboring csPCa. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of the PETCSS for predicting csPCa were assessed. Relative risk was calculated to analyze the association of baseline variables with csPCa on repeat biopsy. Results Thirty-eight ROI on 36 enrolled men were analyzed. Fourteen (36.8%) were downgraded to PI-RADS 1/2 and were not subjected to repeat biopsy. Thirteen (92.9%) of these downgraded scans also exhibited low-risk PETCSS. Overall, 18/22 (81.2%) subjects underwent a repeat per protocol biopsy. Of the 20 ROI subjected to repeat biopsy, eight (40%) were found to harbour csPCa. The sensitivity, specificity, PPV and NPV of the PETCSS were 50, 50, 40, and 60%, respectively. No predictor of csPCa was found in the risk analysis. Conclusion Our pilot study showed that both MRI and PET sequences have limited performance for identifying those persistently suspicious PI-RADS 4/5 ROI that are found to harbor csPCa on repeat biopsy. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04172-3.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, we routinely recommend initial biopsy for all PI-RADS 3-5 ROI. There is increasing evidence that MRI-targeted biopsy alone fails to detect csPCA in some PI-RADS 4 and 5 ROI [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Axumin (18F-Fluciclovine) PET imaging in men exhibiting no clinically significant cancer on initial negative biopsy of PI-RADS 4 and 5 regions of interest

et al. 2022

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“…Well, should the second round of fusion biopsy be performed on patients whose FPB histopathology is benign, but cancer continues to suspicious? Pepe et al reported that in patients with a negative FPB (transperineal saturation plus TB) history and PIRADS-3 lesion, approximately 2.5% cancer was detected with the second round of TB 17. In the future, we believe that with the increasing experience of fusion biopsy, clinicians performing PB will make a lot of effort to answer this question.Shakir et al evaluated CDR and histological PCa upgrading with targeted biopsy according to different PSA levels and reported that the PSA cutoff for histological PCa upgrading was 5.2 ng/mL.…”

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confidence: 94%

Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI‐RADS 3 lesions

Sönmez

Tombul

Demirtaş

et al. 2020

Asia-Pac J Clncl Oncology

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Aim: To determine clinical risk factors in patients with PI-RADS 3 lesions and prostate-specific antigen (PSA) < 10 ng/mL. Methods: In this prospective study, all patients underwent multiparametric magnetic resonance imaging. Following the 2-5 core fusion-targeted biopsy, standard 12-core prostate biopsy was performed in each patient (combined biopsy). The cutoff values were calculated with receiver-operating characteristic analysis. First, univariate logistic regression analysis was used to evaluate the relationship between total eight parameters and prostate cancer. Subsequently, multiple logistic regression analysis was performed to the parameters associated with prostate cancer. Results: Two hundred and eighty-eight patients were included in the study. Some clinical parameters are determined to be significant in univariate and multiple logistic regression analyses, including PSA, free/total PSA ratio, PSA density (PSA/total prostate volume), positive family history of PCa, and PI-RADS 3 lesion diameter. Patients were classified between 0 and 5 according to the number of risk factors. While the risk of cancer was 7.1% in patients with one or less risk factors, the PCA rate was 45.2% among patients with all risk factors. Conclusion: In patients with PI-RADS 3 lesion and PSA < 10 ng/mL, histopathological results of biopsy can be estimated with higher accuracy using some clinical parameters.

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“…This could either be explained by false positive MRI review or missed positive lesion at prostate biopsy. A recent mini-systematic review identi ed nine studies [4] [5][6] [7][8] [9] [10], including overall less than 500 patients in this clinical setting. On the whole, the systematic review demonstrated a highly variable detection rate of csPCA, ranging from 7.5-80% in PI-RADS 3 lesions, from 17-75% in PI-RADS 4 lesions, and over 80% in PI-RADS 5 lesions [11].…”

Section: Introductionmentioning

confidence: 99%

Follow-up on Patients with Initial Negative mpMRI Target and Systematic Biopsy for PI-RADS ≥3 Lesions – An EAU-YAU Study Enhancing Prostate Cancer Detection.

Zattoni,

Gandaglia,

Bergh

et al. 2024

Preprint

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Purpose To investigate the detection and predictors of prostate cancer (PCA) and clinically significant prostate cancer (csPCA) in patients with positive multiparametric MRI (mpMRI) followed by a negative MRI – guided target biopsy (TB) and systematic biopsy (SB). Materials and Methods This retrospective multicenter study included 694 patients from 10 tertiary referral centers with an initial positive mpMRI (PI-RADS ≥ 3) and negative results on both MRI-TB and SB. Patients were classified into three groups based on follow-up: Group 1 (prostate re-biopsy without new mpMRI), Group 2 (standardized second prostate mpMRI and subsequent re-biopsy), and Group 3 (follow-up with mpMRIs and biopsy based on clinical and radiological triggers). The primary outcomes were the detection of any PCA and csPCA during follow up. Study groups were compared according to their probability of PCA and csPCA assessed with the ERSPC-MRI risk calculator. Statistical analysis included Kaplan – Meier analysis, Cox regression, and multivariable analysis for the detection of (cs)PCa. Results The overall detection of PCA and csPCA was 26.8% and 19.3%, respectively, with varying rates in different PI-RADS groups. Group 3 had the highest 2 – year and 5 – year PCA – free survival (94% and 84%) and csPCA – free survival (96% and 86%). Multivariable analysis revealed a significantly higher risk of PCA and csPCA in Group 1 and 2 compared to Group 3. Clinical and radiological predictors for PCA and csPCA included higher age, prostate volume, PI-RADS score, the presence of atypical small acinar proliferation (ASAP), and a smaller number of TB and SB performed during the initial biopsy. Study limitations, include the retrospective design and reliance on clinical and radiological triggers for follow – up decisions. Conclusions Patients with positive mpMRI but negative TB and SB results exhibit varying rates of PCA and csPCA depending on the follow up scheme. Tailored follow-up strategies are essential for optimal management in this clinical scenario.

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Early Second Round Targeted Biopsy of PI-RADS Score 3 or 4 in 256 Men With Persistent Suspicion of Prostate Cancer

Abstract: Background/Aim: The aim of the study was to determine the rate of clinically significant prostate cancer (csPCa) cases in men submitted to early second round mpMRI/TRUS (multiparametric magnetic resonance imaging/transrectal ultrasound) fusion biopsy (TPBx).

Cited by 5 publications

References 30 publications

Axumin (18F-Fluciclovine) PET imaging in men exhibiting no clinically significant cancer on initial negative biopsy of PI-RADS 4 and 5 regions of interest

Axumin (18F-Fluciclovine) PET imaging in men exhibiting no clinically significant cancer on initial negative biopsy of PI-RADS 4 and 5 regions of interest

Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI‐RADS 3 lesions

Follow-up on Patients with Initial Negative mpMRI Target and Systematic Biopsy for PI-RADS ≥3 Lesions – An EAU-YAU Study Enhancing Prostate Cancer Detection.

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