There Is No Way to Avoid Systematic Prostate Biopsies in Addition to Multiparametric Magnetic Resonance Imaging Targeted Biopsies

ObjectivesTo evaluate if the blood biomarker, 4Kscore, in addition to multiparametric magnetic resonance imaging information could identify patients who would benefit from undergoing only a targeted biopsy.MethodsWe retrospectively analyzed a population of 256 men with positive multiparametric magnetic resonance imaging who underwent standard + targeted biopsy at Mount Sinai Hospital, New York, NY, USA. 4Kscore (OPKO Health, Miami, FL, USA) was sampled from all patients before biopsy. Uni‐ and multivariable binary logistic regression analyses were carried out to predict clinically significant prostate cancer, defined as International Society of Urological Pathology grade group ≥2, in standard biopsy cores. The model with the best area under the curve was selected and internal validation was carried out using the leave‐one‐out cross‐validation.ResultsThe developed model showed an area under the curve of 0.86. Carrying out only targeted biopsy in patients with a model‐derived probability <12.5% resulted in 39.5% (n = 101) fewer standard biopsies and a 33.9% (n = 20) reduction of detecting grade group 1 disease, while missing grade group ≥2 in 5.2% (n = 4) using standard biopsy only and 1.1% (n = 1) using standard biopsy + targeted biopsy.Conclusions4Kscore in combination with multiparametric magnetic resonance imaging can help to reduce unnecessary standard biopsy and decrease detection of clinically insignificant prostate cancer.

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“…Conversely, Stabile et al . in a multicenter study failed to identify those men who might safely benefit of MRI‐TBx alone 5 …”

Section: Discussionmentioning

confidence: 99%

“…The risks of infection, bleeding and pain associated with additional cores sampling should be considered when trying to maximize the detection of csPCa 3,4 . Avoiding SBx would reduce the number of biopsy cores and detection of low‐grade disease 5 . In contrast, TBx alone could miss up to 15% of csPCa 6 .…”

Section: Introductionmentioning

confidence: 99%

Using biomarkers in patients with positive multiparametric magnetic resonance imaging: 4Kscore predicts the presence of cancer outside the index lesion

et al. 2020

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“…Similar to our risk calculator, the model developed by Stabile et al predicts csPCa in SBx. Their model ultimately included age, PSA, Prostate volume, number of MRI lesions, PIRADS score and the biopsy setting (biopsy naive vs previous negative biopsy patients) [10]. However, the DCA showed modest clinical benefit in the external validation cohort and the authors concluded that the number of systematic biopsies spared compared with the number of aggressive PCa missed is negligible.…”

Section: Risk Calculatormentioning

confidence: 99%

“…Several multivariable models to predict negative SBx have been developed to avoid systematic cores at the time of target biopsy [10,11]. None of these models showed excellent accuracy, and their clinical benefit is questionable.…”

Section: Introductionmentioning

confidence: 99%

Added value of systematic biopsy in men with a clinical suspicion of prostate cancer undergoing biparametric MRI-targeted biopsy: multi-institutional external validation study

et al. 2020

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Purpose We aimed to develop and externally validate a nomogram based on MRI volumetric parameters and clinical information for deciding when SBx should be performed in addition to TBx in man with suspicious prostate MRI. Materials and methods Retrospective analyses of single (IMPROD, NCT01864135) and multi-institution (MULTI-IMPROD, NCT02241122) clinical trials. All men underwent a unique rapid biparametric magnetic resonance imaging (IMPROD bpMRI) consisting of T2-weighted imaging and three separate DWI acquisitions. Men with IMPROD bpMRI Likert scores of 3-5 were included. Logistic regression models were developed using IMPROD trial (n = 122) and validated using MULTI-IMPROD trial (n = 262) data. The model's performance was evaluated in the terms of PCa detection with Gleason Grade Group 1 (clinically insignificant prostate cancer, iPCa) and > 1 (clinically significant prostate cancer, csPCa). Net benefits and decision curve analyses (DCA) were compared. Combined biopsies were used for reference. Results The developed nomogram included age, PSA, prostate volume, MRI suspicion score (IMPROD bpMRI Likert or PIRADsv2.1 score), MRI-suspicion lesion volume percentage, and lesion location. All these variables were significant predictors of csPCa in SBx in multivariable analysis. In the validation cohort (n = 262) using different nomogram cutoffs, 19-43% of men would have avoided SBx while missing 1-4% of csPCa and avoiding detection of 9-20% of iPCa. Similar performance was found for nomograms using IMPROD bpMRI Likert score or v2.1. Conclusions The developed nomogram demonstrated potential to select men with a clinical suspicion of PCa who would benefit from performing SBx in addition to TBx. Public access to the nomogram is provided at:https ://petiv .utu.fi/multi impro d/.

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“…Several studies have confirmed the additional value of multi parametric magnetic resonance imaging (mpMRI) guided biopsies and recent guidelines support mpMRI-based targeted biopsies in biopsy naïve patients [1] [2]. mpMRI-guided biopsy while omitting random biopsies will be at cost of missing 5% -10% of significant cancer [3] [4]. Sensitivity of mpMRI is lowest for lesions located ventrally in the prostate in the transition zone.…”

Section: Introductionmentioning

confidence: 99%

Detection and Local Staging of Prostate Cancer by 68Ga-PSMA-PET/CT, Comparison with mpMRI and Histopathology

Intema¹,

Kooistra²,

Vermeulen³

et al. 2020

AMI

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Introduction: 68Ga-PSMA-PET/CT has proven its value in prostate cancer with high positive predictive value for lymph node metastasis and superior detection of distant metastasis. There is growing evidence that 68Ga-PSMA-PET/CT has high sensitivity for detection of tumor lesions in the prostate as well. Studies thus far have mainly been performed in patients prior to prostatectomy. Aim of this study is to evaluate diagnostic accuracy in a mixed population of men with increased risk of prostate cancer and evaluate diagnostic possibilities with respect to extra-capsular extension and seminal vesicle invasion. Methods: The population consisted of a retrospectively included sequential cohort of 69 patients with 68Ga-PSMA-PET/CT and mpMRI available. 68Ga-PSMA-PET/CT was re-evaluated by two readers blinded for mpMRI and clinical information. Likelihood of tumour presence, extra-prostatic extension and seminal vesicle invasion was scored on 5-point Likert scale and localized schematically. Results were compared with mpMRI. Available pathological outcome served as gold standard. SUVmax of index lesions was measured and correlated to index tumor Gleason grade. Results: Clinically significant prostate cancer (Gleason ≥ 3 + 4) was detected in 57 (83%) of 69 patients. Diagnostic accuracy was 89% for PET reader 1, 93% for PET reader 2 and 86% for mpMRI. Lesion concordance of 68Ga-PSMA-PET/CT and mpMRI was 97%. SUVmax of the index lesion correlated to Gleason grade.

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There Is No Way to Avoid Systematic Prostate Biopsies in Addition to Multiparametric Magnetic Resonance Imaging Targeted Biopsies

Cited by 42 publications

References 30 publications

Using biomarkers in patients with positive multiparametric magnetic resonance imaging: 4Kscore predicts the presence of cancer outside the index lesion

Using biomarkers in patients with positive multiparametric magnetic resonance imaging: 4Kscore predicts the presence of cancer outside the index lesion

Added value of systematic biopsy in men with a clinical suspicion of prostate cancer undergoing biparametric MRI-targeted biopsy: multi-institutional external validation study

Detection and Local Staging of Prostate Cancer by 68Ga-PSMA-PET/CT, Comparison with mpMRI and Histopathology

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