Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study

Abstract

a on behalf of the Trio Study Group

Towards a judicious use of perilesional biopsy in the era of MRI-targeting, parting of the ways from systematic prostate biopsy

“…In men with prior negative systemic biopsies, an additional systematic biopsy was avoidable in 58%, while missing GG ≥ 2 cancer in 2%. These findings are concordant with the analysis of Ahdoot et al who showed a greater added value for MRTB men with PI-RADS 4-5 lesions and a greater added value of systemic biopsies for men with lower PI-RADS category scores [6]. Their analysis of the TRIO study confirmed that improved GG ≥ 2 detection of combined biopsies was restricted to only men with smaller (PI- RADS 4) or indeterminate (PI-RADS 3) MRI lesions.…”

“…Their analysis of the TRIO study confirmed that improved GG ≥ 2 detection of combined biopsies was restricted to only men with smaller (PI- RADS 4) or indeterminate (PI-RADS 3) MRI lesions. Not undertaking systemic biopsies in men with PI-RADS 5 category lesions would lead to missing GG ≥ 2 cancers in 1.3% [6].…”

“…However, biopsy complication rates are related to the number of biopsy cores taken [12] which needs to be remembered. RTB is also not applicable when multiple lesions are present, for diffuse and heterogenous lesions [5,6,10], in men with diffuse PI-RADS 3 lesions. Men with anterior lesions in larger glands may also require additional cores.…”

Individualized Decision Making in Transperineal Prostate Biopsy: Should All Men Undergo an Additional Systematic Biopsy?

“…Previous studies have identified the clinical setting (biopsy naïve, previous negative biopsy, active surveillance), age, prostate volume, MRI-lesion volume and the PI-RADS Score [ 7 , 8 , 9 ] predictive for upgrading to sPC by SB. A recent study proposed patients’ PI-RADS score as a promising tool to select the optimal biopsy strategy [ 10 ]. However, these findings are limited to a cohort who underwent transrectal prostate biopsy.…”

Welke tumoren worden gemist wanneer systematische biopten achterwege gelaten worden bij patiënten met de verdenking op prostaatcarcinoom? (‘DROPP-IT’)

“…Gecombineerde biopten geven ook een betere inschatting van prostatectomie-uitkomsten, alhoewel dit verschil beperkt is en met name wordt veroorzaakt door Gleason 3+4-tumoren [8]. Bij MRI PI-RADS 5-laesies is de toegevoegde waarde van systematische biopten relatief het kleinst [9].…”