Who Can Avoid Systematic Biopsy Without Missing Clinically Significant Prostate Cancer in Men Who Undergo Magnetic Resonance Imaging-Targeted Biopsy?

Nakanishi, Yasukazu; Ito, M.; Fukushima, Hiroshi; Yokoyama, Minato; Kataoka, Masao; Ikuta, Shuzo; Sakamoto, Kazumasa; Takemura, Kosuke; Suzuki, Hiroaki; Tobisu, Ken‐ichi; Koga, Fumitaka

doi:10.1016/j.clgc.2019.03.011

Cited by 9 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When analysing predictors for the upgrading to sPC by additional SB, we found that men with PI-RADS 2-4 lesions were more likely to have their TB results upgraded by SB compared to PI-RADS 5 men. These results are in accordance with previous studies [ 7 , 18 , 19 , 20 ]. Ahdoot et al proposed the patient’s PI-RADS score as a promising tool to select the optimal biopsy strategy in terms of omitting SB in men harbouring a PI-RADS 5 lesion [ 10 ].…”

Section: Discussionsupporting

confidence: 94%

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

Sigle

Suarez-Ibarrola

Benndorf

et al. 2022

Cancers

View full text Add to dashboard Cite

In the last few years, multiparametric magnetic resonance imaging (mpMRI) has been implemented in the diagnostic prostate cancer pathway for the identification of cancerous lesions, and consecutively, targeted fusion biopsy was implemented. In some cases, aggressive prostate cancer is missed by a targeted biopsy. To address this imperfection, additional systematic biopsy is recommended but may be harmful in terms of the additional diagnosis of indolent cancer, and the higher frequency of adverse events and resource expenditures. This study investigates whether all men should undergo an additional systematic biopsy within this clinically relevant trade-off. As a key finding, men with an mpMRI-lesion classified as PI-RADS 5 may obviate additional systematic biopsy. This was confirmed when we analyzed histopathological reclassification rates between biopsy and a subsequent radical prostatectomy.

show abstract

Section: Discussionsupporting

confidence: 94%

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

Sigle

Suarez-Ibarrola

Benndorf

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…The PIRADS 5 score is particularly associated with the highest probability of detecting csPC in TB. Recent studies have confirmed that in PIRADS 5, the risk of missing csPC with the TB-only approach may be even lower than in PIRADS 3 and 4 [19][20][21][22][23][24]. In a study by Nakanishi et al, TB only missed 4.6% of csPC in PIRADS 5 patients vs. 22% for the remaining men with PIRADS 3 and 4 scores [19].…”

Section: Discussionmentioning

confidence: 92%

“…Recent studies have confirmed that in PIRADS 5, the risk of missing csPC with the TB-only approach may be even lower than in PIRADS 3 and 4 [19][20][21][22][23][24]. In a study by Nakanishi et al, TB only missed 4.6% of csPC in PIRADS 5 patients vs. 22% for the remaining men with PIRADS 3 and 4 scores [19]. Similarly, in another study by Gomez et al, SB improved csPC detection in PIRADS 3 and 4 patients by 26.3% and 9.5%, respectively, but there was no improvement in PIRADS 5 patients [20].…”

Section: Discussionmentioning

confidence: 94%

Prostate Biopsy in the Case of PIRADS 5—Is Systematic Biopsy Mandatory?

Malewski,

Milecki,

Szempliński

et al. 2023

JCM

View full text Add to dashboard Cite

Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically significant prostate cancer (csPC) detection in TB. Potentially, omitting SB in the case of PIRADS 5 may have a marginal impact on the csPC detection rate. The aim of this study was to determine whether SB can be avoided in the case of PIRADS 5 and to identify potential factors allowing for performing TB only. This cohort study involved n = 225 patients with PIRADS 5 on mpMRI (PIRADS 2.0/2.1) who underwent transperineal or transrectal combined biopsy (CB). CsPC was diagnosed in 51.6% (n = 116/225) of cases. TB and SB resulted in the detection of csPC in 48% (n = 108/225) and 20.4% (n = 46/225) of cases, respectively (TB vs. SB, p < 0.001). When the TB was positive, SB detected csPC in n = 38 of the cases (38/108 = 35%). SB added to TB significantly improved csPC detection in 6.9% of cases in absolute terms (n = 8/116) (TB vs. CB, p = 0.008). The multivariate regression model proved that the significant predictors of csPC detection via SB were the densities of the prostate-specific antigen—PSAD > 0.17 ng/mL2 (OR = 4.038, 95%CI: 1.568–10.398); primary biopsy setting (OR = 2.818, 95%CI: 1.334–5.952); and abnormal digital rectal examination (DRE) (OR = 2.746, 95%CI: 1.328–5.678). In a primary biopsy setting (n = 103), SB detected 10% (n = 6/60) of the additional cases of csPC (p = 0.031), while in a repeat biopsy setting (n = 122), SB detected 3.5% (n = 2/56) of the additional cases of csPC (p = 0.5). In the case of PSAD > 0.17 ng/mL2 (n = 151), SB detected 7.4% (n = 7/95) of additional cases of csPC (p = 0.016), while in the case of PSAD < 0.17 ng/mL2 (n = 74), SB detected 4.8% (n = 1/21) of the additional cases of csPC (p = 1.0). The omission of SB had an impact on the csPC diagnosis rate in patients with PIRADS 5 score lesions. Patients who have already undergone prostate biopsy and those with low PSAD are at a lower risk of missing csPC when SB is avoided. However, performing TB only may result in missing other csPC foci located outside the index lesion, which can alter treatment decisions.

show abstract

“…However, there remains concern over TB missing or undergrading csPCa, particularly in the Likert/PI-RADS 3–4 population. Some studies in this group suggest up to 22% of csPCa could be missed by four core TB alone 82 and perilesional biopsies (5 mm spaced around lesion perimeter) found higher grade group PCa than the TB in 8% of cases. 83 Using a combined approach in PI-RADS 4–5 lesions was found to have a detection of Gleason 7–10 cancer of 71%, superior to the 59% for TB only and 61% for SB only.…”

Section: Introductionmentioning

confidence: 90%

Optimal biopsy approach for detection of clinically significant prostate cancer

Ippoliti

Fletcher

Orecchia

et al. 2021

The British Journal of Radiology

View full text Add to dashboard Cite

Prostate cancer (PCa) diagnostic and therapeutic work-up has evolved significantly in the last decade, with pre-biopsy multiparametric MRI now widely endorsed within international guidelines. There is potential to move away from the widespread use of systematic biopsy cores and towards an individualised risk-stratified approach. However, the evidence on the optimal biopsy approach remains heterogeneous, and the aim of this review is to highlight the most relevant features following a critical assessment of the literature. The commonest biopsy approaches are via the transperineal (TP) or transrectal (TR) routes. The former is considered more advantageous due to its negligible risk of post-procedural sepsis and reduced need for antimicrobial prophylaxis; the more recent development of local anaesthetic (LA) methods now makes this approach feasible in the clinic. Beyond this, several techniques are available, including cognitive registration, MRI–Ultrasound fusion imaging and direct MRI in-bore guided biopsy. Evidence shows that performing targeted biopsies reduces the number of cores required and can achieve acceptable rates of detection whilst helping to minimise complications and reducing pathologist workloads and costs to health-care facilities. Pre-biopsy MRI has revolutionised the diagnostic pathway for PCa, and optimising the biopsy process is now a focus. Combining MR imaging, TP biopsy and a more widespread use of LA in an outpatient setting seems a reasonable solution to balance health-care costs and benefits, however, local choices are likely to depend on the expertise and experience of clinicians and on the technology available.

show abstract

Who Can Avoid Systematic Biopsy Without Missing Clinically Significant Prostate Cancer in Men Who Undergo Magnetic Resonance Imaging-Targeted Biopsy?

Cited by 9 publications

References 23 publications

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

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

Prostate Biopsy in the Case of PIRADS 5—Is Systematic Biopsy Mandatory?

Optimal biopsy approach for detection of clinically significant prostate cancer

Contact Info

Product

Resources

About