The Utility of Combined Target and Systematic Prostate Biopsies in the Diagnosis of Clinically Significant Prostate Cancer Using Prostate Imaging Reporting and Data System Version 2 Based on Biparametric Magnetic Resonance Imaging

Abstract

This study aimed to determine the predictive value of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) based on biparametric magnetic resonance imaging (bpMRI) with combined target biopsy (TBx) and systematic biopsy (SBx) in patients with suspicion of having clinically significant prostate cancer (csPCa). In this retrospective study, we reviewed the clinical and pathological records of 184 consecutive patients who underwent bpMRI before prostate biopsy. We focused on patients with PI-RADS v2 scores ≥ 3. MRI was performed using a 3-Tesla clinical scanner with a 32-channel phased-array receiver coil. PI-RADS v2 was used to describe bpMRI findings based on T2-weighted imaging and diffusion-weighted imaging scores. The primary endpoint was the diagnostic accuracy rate of PI-RADS v2 based on bpMRI for patients with prostate cancer (PCa) who underwent combined TBx and SBx. A total of 104 patients were enrolled in this study. Combined TBx and SBx was significantly superior to either method alone for PCa detection in patients with suspicious lesions according to PI-RADS v2. TBx and SBx detected concordant csPCa in only 24.1% of the patients. In addition, the rate of increase in the Gleason score was similar between SBx (41.5%) and TBx (34.1%). The diagnostic accuracy of bpMRI is comparable to that of standard multiparametric MRI for the detection of csPCa. Moreover, combined TBx and SBx may be optimal for the accurate determination of csPCa diagnosis, the International Society of Urological Pathology grade, and risk classification.

Prostate Cancer Lesions by Zone and Race: Does Multiparametric MRI Demonstrate Racial Difference in Prostate Cancer Lesions for African American Men?

“…The use of mpMRI in combination with MRI/US fusion biopsy has increased in prevalence and has consistently illustrated many advantages for both the patient and the clinician. In working towards tools to help urologists detect clinically significant prostate cancer, MRI fusion has shown itself to be a modality to combat overdiagnosis and overtreatment [ 5 , 6 , 7 , 8 , 9 ]. Establishing which patients are the most likely to benefit from definitive therapies in the form of radical prostatectomy or radiotherapy is of primary concern.…”

Clinical Predictors of Grade Group Upgrading for Radical Prostatectomy Specimens Compared to Those of Preoperative Needle Biopsy Specimens

“…Furthermore, there was no significant difference in the GG concordance rate between TBx and SBx in surgical specimens (38.2% vs. 39.5%) in this study. Thus, this may not reflect the pathophysiology of PCa status, even though TBx may detect malignant neoplasms of the prostate with high sensitivity [ 9 , 10 ]. To date, evidence regarding their predictors remains scarce, even though many studies have evaluated the discrepancies in GG between NB and RP specimens [ 23 ].…”

“…The prostate biopsy method at our institution has been previously reported [ 10 ]. Briefly, TRUS-guided transrectal and transperineal tissue biopsies were performed under spinal anesthesia using an 18G automated biopsy gun.…”

“…GG was accepted by the World Health Organization for the 2016 edition of Pathology and Genetics, and the GG 1–5 terms were proposed as the new grading system by the 2014 International Society of Urological Pathology (ISUP) consensus conference [ 8 ]. Additionally, according to several guidelines, the combination of targeted biopsy (TBx) of suspicious lesions on multiparametric magnetic resonance imaging (MRI) and transrectal ultrasound-guided (TRUS) systematic biopsy (SBx) for the prostate has produced more favorable PCa detection rates than was previously possible [ 2 , 3 , 4 , 9 , 10 ].…”

“…However, discrepancies between needle biopsy (NB) specimens and radical prostatectomy (RP) specimens often occur due to sampling errors in NB or the multifocal features of PCa [ 9 , 10 , 11 ]. Several investigators reported that the discordance in GG between NB and RP specimens was observed at frequencies of 31.0–62.8% [ 12 , 13 ].…”