Systematic Biopsy of the Prostate can Be Omitted in Men with PI-RADS™ 5 and Prostate Specific Antigen Density Greater than 15%

Abstract

Purpose: We evaluated the prostate cancer and clinically significant prostate cancer detection on systematic biopsy (SB), target biopsy (TB) alone and combined SB and TB in men with Prostate Imaging Reporting and Data SystemÔ (PI-RADSÔ) 5 lesion. Materials and Methods: From a prospectively maintained prostate biopsy database, we identified consecutive patients with PI-RADS 5 lesion on multiparametric magnetic resonance imaging. The patients underwent multiparametric magnetic resonance imaging followed by transrectal TB of PI-RADS 5 lesion and 12-core SB. The prostate cancer and clinically significant prostate cancer (Grade Group, GG 2) detection on SB, TB and SBDTB were determined for all men and accordingly to prostate specific antigen density. Statistic significant was set a p <0.05. Results: Overall, 112 patients met inclusion criteria. The detection rate of prostate cancer for SB, TB and SBDTB was 89%, 93% and 95%, respectively, and for clinically significant prostate cancer it was 72%, 81% and 85%, respectively. SB added 2% prostate cancer and 4% clinically significant prostate cancer detection to TB. A total of 78 patients had prostate specific antigen density >0.15 ng/ml 2 , and the detection rate of PCa for SB, TB and SBDTB was 92%, 97% and 97%, respectively, and for clinically significant prostate cancer it was 79%, 91% and 95%, respectively. In this population, if SB was omitted, 0 prostate cancer and only 4% (3) of clinically significant prostate cancer would be missed. The clinically significant prostate cancer detection rate improved with increased prostate specific antigen density for SB (p[0.01), TB (p <0.0001) and combined SBDTB (p[0.002).

Re: Targeted Prostate Biopsy: Umbra, Penumbra, and Value of Perilesional Sampling

“…Lahoud et al [9] found that perilesional biopsies yielded csPCa even when the target was negative. Finally, Tafuri et al [20] found that for PI-RADS 5 lesions with a PSA density of >0.15, systematic samples did not provide additional diagnostic yield. A compilation of evidence led the PI-RADS Committee to recommend targeted biopsy of the ROI and a 5-mm penumbra for PI-RADS 4 and 5 lesions [11].…”

Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy

“…We selected different thresholds of mPSAD to obtain similar performance in our series of PI-RADS 3 than that of Görtz et al [22,81]. The use of appropriate thresholds in different populations has been previously described for mPSAD [19][20][21][82][83][84][85][86][87][88][89][90][91][92][93][94][95].…”

MRI-Derived Apparent Diffusion Coefficient of Peri-Prostatic Adipose Tissue Is a Potential Determinant of Prostate Cancer Aggressiveness in Preoperative Setting: A Preliminary Report

“…Considering the combination of MRI lesions and serum markers in PCa diagnosis, a recent report showed a detection rate in CS PCa detection for TB of 81% in PIRADS 5 patients. When the authors focused on PSA density > 0.15ng/mL 2 sub-population, TB had a detection rate of 91%, and only three CS PCa patients were missed if SB was omitted [ 32 ]. Similarly, Lee et al found in the same patients’ category that only 4 (5%) patients with any cancer and 6 (8%) patients with CS PCa would be missed if SB was omitted [ 33 ].…”