Systematic Biopsy Does Not Contribute to Disease Upgrading in Patients Undergoing Targeted Biopsy for PI-RADS 5 Lesions Identified on Magnetic Resonance Imaging in the Course of Active Surveillance for Prostate Cancer

Arabi, Ahmad; Deebajah, Mustafa; Yaguchi, Grace; Pantelic, Milan; Williamson, Sean R.; Gupta, Nilesh; Park, Hakmin; Peabody, James O.; Menon, Mani; Dabaja, Ali; Alanee, Shaheen

doi:10.1016/j.urology.2019.08.035

Cited by 16 publications

(16 citation statements)

References 12 publications

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“…These findings suggest that additional systematic biopsy could be avoided in patients with PI-RADS 5 lesions, but is required for accurate risk stratification of prostate cancer in patients with PI-RADS 3-4 lesions. Previously, Ahmad et al's study also came to the similar findings in a repeated biopsy cohort study (29).…”

Section: Discussionsupporting

confidence: 72%

Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

Cheng

Chen

et al. 2021

Front. Oncol.

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PurposeTo determine whether additional systematic biopsy is necessary in all biopsy naïve patients with MRI visible lesions by taking PI-RADS score and prostate volume into consideration.Materials and MethodsPatients who underwent combined systematic biopsy (SB) and cognitive MRI-targeted biopsy (TB) in our hospital between May 2018 and June 2020 were retrospectively reviewed. The detection rate of clinical significant prostate cancer (csPCa), biopsy grade group (GG) concordance, and disease upgrading rate on radical prostatectomy were compared between SB and TB and further stratified by PI-RADS v2.0 category and prostate volume.ResultsA total of 234 patients were analyzed in this study. TB alone detected more csPCa and less clinically insignificant prostate cancer (cisPCa) than SB alone in the whole cohort (57.3 vs 53%, P = 0.041; 3.8 vs 7.7%, P = 0.049 respectively). The additional SB indicated only a marginal increase of csPCa detection but a remarkable increase of cisPCa detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012). As stratified by PI-RADS category, the difference of csPCa detection rate between TB and SB was not significant either in PI-RADS 5 subgroup (83.8 vs 76.3%, P = 0.07) or in PI-RADS 3–4 subgroup (43.5 vs 40.9%, P = 1.0). Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than TB alone in PI-RADS 3–4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0). When stratified by prostate volume (PV), TB alone detected more csPCa than SB in small prostate (PV < 30 ml) group (81.0 vs 71.0%, P = 0.021) but not in large prostate (PV ≥ 30 ml) group (44.0 vs 42.7%, P = 0.754). The additional SB did not significantly decrease the rate of disease upgrading on RP than TB alone in either small or large prostate (6.4 vs 8.5%, P = 1.0; 13.8 vs 22.4%, P = 0.063).ConclusionThe combination biopsy method was no superior than targeted biopsy alone in PI-RADS 5 or in small volume prostate subgroup.

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Section: Discussionsupporting

confidence: 72%

Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

Cheng

Chen

et al. 2021

Front. Oncol.

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“…From our data, there are two clear situations in which there is no role for the addition of the standard biopsy approach-PI-RADS 5 lesions and in those lesions with an anterior fibromuscular stroma location. In line with this, Arabi et al [28] showed that standard biopsy increased the detection rate in those patients with PI-RADS 3 and 4 lesions, but not in those with PI-RADS 5 lesions. In terms of lesion location, recent data in cohorts that used a targeted plus a standard biopsy approach, as reported by Falagario et al [29], have shown that the probability of adding standard biopsy to targeted biopsy to detect csPCa in nonperipheral zone lesions is clearly inferior.…”

Section: Discussionmentioning

confidence: 76%

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?

et al. 2021

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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.

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“…The combined use of MRI findings, clinical data, and biopsy results in active surveillance enrolment has been previously proposed, as early as 2010 [26]. According to previous studies, MRI-based models showed better results than clinical models (P<0,05) [26,27,33]. According to the current guidelines from the European Association of Urology (EAU) regarding men already on active surveillance and the treatment of patients with low-risk disease who qualified for active surveillance, there is a recommendation to perform multiparametric MRI before a confirmatory biopsy, if not done before the first biopsy [12].…”

Section: The Role Of Multiparametric Mri In Active Surveillance Of Prostate Cancermentioning

confidence: 99%

“…Studies have shown that MRI-guided prostate biopsy detects a further 52% of tumors in patients with prior negative serial biopsies [32,33]. MR-transrectal ultrasound (MR-TRUS) image fusion targeted biopsy can identify more cancers per core than serial transrectal ultrasound (TRUS)-guided biopsy, regardless of the location of the lesion (anterior or posterior).…”

Section: The Identification Of Significant Prostate Cancermentioning

confidence: 99%

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Active Surveillance of Prostate Cancer Using Multiparametric Magnetic Resonance Imaging: A Review of the Current Role and Future Perspectives

2020

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Departmental sourcesClinically, active surveillance involves continuous monitoring of patients who may be at risk for disease. Patients with low-grade and early-stage prostate cancer may benefit from active surveillance, rather than undergoing surgical and medical treatments that are associated with side effects. In these cases, the role of active surveillance is to ensure that there is no progression of the disease. However, active surveillance may be associated with a risk of under-diagnosis. Previously, the assignment of risk categories and patient monitoring were based on digital rectal examination, transrectal prostate biopsy, and monitoring of serum levels of prostatespecific antigen (PSA). Multiparametric magnetic resonance imaging (MRI) of the prostate gland has an estimated negative predictive value of 95% for the detection of prostate cancer, which makes this an effective imaging method for targeting biopsies and for monitoring patients over time. Also, multiparametric MRI-guided biopsy at the initial stage of the risk stratification for patients who are newly diagnosed with prostate cancer may reduce the number of underdiagnosed patients, improve long-term patient prognosis, and reduce the number of patients who are overtreated, which may reduce healthcare costs and reduce treatment morbidity. For these reasons, multiparametric MRI has become an accepted monitoring tool in patients who are enrolled in active surveillance programs. This review aims to present the current status of the use of multiparametric MRI in active surveillance of prostate cancer and to discuss future perspectives, supported by recent literature.

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Systematic Biopsy Does Not Contribute to Disease Upgrading in Patients Undergoing Targeted Biopsy for PI-RADS 5 Lesions Identified on Magnetic Resonance Imaging in the Course of Active Surveillance for Prostate Cancer

Cited by 16 publications

References 12 publications

Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

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?

Active Surveillance of Prostate Cancer Using Multiparametric Magnetic Resonance Imaging: A Review of the Current Role and Future Perspectives

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