Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

Medina, A. Artiles; Rodríguez, Rafael Rodríguez-Patrón; Hernández, Mercedes Ruíz; Alcaraz, M. Mata; Barreras, Silvia García; Conejo, G. Fernandez; Poblador, Agustín Fraile; Mayayo, E; Revilla, F.J. Burgos

doi:10.2147/rru.s323823

Cited by 8 publications

(5 citation statements)

References 36 publications

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“…Medina et al [ 21 ] highlighted a concern of 5ARI use being associated with MRI invisible prostate cancer. However, the study did not make a distinction between clinically significant and insignificant prostate cancer, and 65% of the prostate cancers detected yielded Gleason 3 + 3 histology.…”

Section: Discussionmentioning

confidence: 99%

5-alpha reductase inhibitors and MRI prostates: actively reducing prostate sizes and ambiguity

Wang

Ong

et al. 2023

BMC Urol

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Background Magnetic resonance imaging (MRI) scans are increasingly first-line investigations for suspected prostate cancer, and essential in the decision for biopsy. 5-alpha reductase inhibitor (5-ARI) use has been shown to reduce prostate size and prostate cancer risk. However, insufficient data exists on how 5-ARI use affects MRI findings and yield of biopsy. This study explores the differences in imaging and prostate cancer diagnoses between patients receiving and not receiving 5-ARI therapy. Methods From 2015 to 2020, we collected retrospective data of consecutive patients undergoing prostate biopsy at one centre. We included patients who were biopsy-naïve, had prior negative biopsies, or on active surveillance for low-grade prostate cancer. Clinical and pathological data was collected, including 5-ARI use, Prostate Imaging Reporting and Data System (PIRADS) classification and biopsy results. Results 351 men underwent saturation biopsy with or without targeted biopsies. 54 (15.3%) had a history of 5-ARI use. On mpMRI, there was no significant difference between the 5ARI and non-5-ARI groups in PIRADS distribution, number of lesions, and lesion location. Significantly fewer cancers were detected in the 5-ARI group (46.3% vs. 68.0%; p < 0.01). There were no significant differences in PIRADS distribution in 5-ARI patients with positive and negative biopsy. Conclusion Our study found significant differences in biochemical, imaging and biopsy characteristics between 5-ARI and non-5-ARI groups. While both groups had similar PIRADS distribution, 5-ARI patients had a lower rate of positive biopsies across all PIRADS categories, which may suggest that the use of 5ARI may confound MRI findings. Further studies on how 5-ARI therapy affects the imaging characteristics of prostate cancer should be performed.

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Section: Discussionmentioning

confidence: 99%

5-alpha reductase inhibitors and MRI prostates: actively reducing prostate sizes and ambiguity

Wang

Ong

et al. 2023

BMC Urol

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“…They concluded that the PI-RADS v.2.0 exhibited good accuracy in predicting csPCa [22]. In 2021, Artiles et al concluded that 5-ARI exposure was an independent predictor of csPCa after analyzing 34 men suspected of having PCa with negative mpMRI results who underwent saturation biopsies [29].…”

Section: Discussionmentioning

confidence: 99%

Effect of 5-Alpha Reductase Inhibitors on Magnetic Resonance Imaging and Prostate Cancer Detection

Morote,

Picola,

Muñoz-Rodriguez

et al. 2024

Biomolecules

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Concerns exist regarding the effects of 5-alpha reductase inhibitors (5-ARIs) on multipa-rametric magnetic resonance imaging (mpMRI) and clinically significant prostate cancer (csPCa) detection. Our objective is to analyze the effect of 5-ARI on the prostate imaging–reporting and data system (PI-RADS) distribution and csPCa and insignificant PCa (iPCa) detection. Among 2212 men with serum prostate-specific antigen levels of >3.0 ng/mL and/or suspicious digital rectal examinations who underwent mpMRI and targeted and/or systematic biopsies, 120 individuals exposed to 5-ARI treatment for over a year were identified. CsPCa was defined when the grade group (GG) was >2. The overall csPCa and iPCa detection rates were 44.6% and 18.8%, respectively. Since logistic regression revealed independent predictors of PCa, a randomized matched group of 236 individuals was selected for analysis. The PI-RADS distribution was comparable with 5-ARI exposure (p 0.685). The CsPCa detection rates in 5-ARI-naïve men and 5-ARI-exposed men were 52.6% and 47.4%, respectively (p 0.596). IPCa was detected in 37.6 and 62.5%, respectively (p 0.089). The tumor GG distribution based on 5-ARI exposure was similar (p 0.149) to the rates of csPCa and iPCa across the PI-RADS categories. We conclude that exposure to 5-ARI in suspected PCa men did not change the PI-RADS distribution and the csPCa and iPCa detection rates.

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“…Furthermore, a large prostate volume, one of the predictive factors of TB negativity, predicted greater biopsy needle tip deflection, thus affecting biopsy accuracy (21). Moreover, a large prostate volume significantly predicts the absence of CSPC on SB (22). Also, Phelps et al showed that patients who had a large prostate volume (p=0.016) were at increased risk of harboring CSPC that would be missed by TB but detected by SB (11).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Magnetic Resonance Imaging/Ultrasound-guided Target Biopsy in Detecting Clinically Significant Prostate Cancer

KUROKAWA,

MORI,

SASAKI

et al. 2024

Anticancer Res

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Background/Aim: To evaluate the effectiveness of magnetic resonance imaging/ultrasound (MRI-US)-guided fusion biopsy in the detection of clinically significant prostate cancer (CSPC) and analyze the clinical features of patients highly suspected of having prostate cancer (PCa) but shown to be negative in target biopsies (TB) among patients with prostate imaging reporting and data system (PI-RADS) 4 or 5 lesions on multiparametric MRI (mpMRI) evaluations. Patients and Methods: We retrospectively evaluated all patients who underwent MRI/transrectal ultrasound (TRUS)guided fusion biopsies at our institution between April 2018 and April 2022. All patients with at least one PI-RADS 3 or higher lesion and prostate-specific antigen (PSA) ≤20 ng/ml were enrolled in our study and subjected to TB in the region of interest (ROI). CSPC was defined as grade group (GG) ≥2 (equivalent to a Gleason score of 3+4). Results: The detection rates of CSPC were higher in patients who underwent systematic biopsy (SB) and TB (54%; 177/328) than in those who underwent SB alone (39%; 128/328). Significant differences were noted in the detection of CSPC depending on age, prostate volume, PI-RADS score, PSA density (PSAD), number of biopsies obtained, lesion location, and ROI. Conclusion: MRI/TRUS-guided fusion prostate biopsy increased the detection rate of CSPC. PCa was less

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Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

Cited by 8 publications

References 36 publications

5-alpha reductase inhibitors and MRI prostates: actively reducing prostate sizes and ambiguity

5-alpha reductase inhibitors and MRI prostates: actively reducing prostate sizes and ambiguity

Effect of 5-Alpha Reductase Inhibitors on Magnetic Resonance Imaging and Prostate Cancer Detection

Effectiveness of Magnetic Resonance Imaging/Ultrasound-guided Target Biopsy in Detecting Clinically Significant Prostate Cancer

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