European Radiology: Application of prostate biopsy in the era of MRI-targeted therapy

At this stage, multiparametric magnetic resonance imaging (mpMRI) has been increasingly used for visualization and targeted examination
of prostate cancer (PCa) biopsies.
MRI-targeted biopsy (TBx) increases the detection of clinically significant PCa (csPCa) while reducing the rate
of false negatives compared to standard transrectal ultrasound (TRUS)-guided 12-core systematic biopsy (SBx).
However, the combination of these two techniques results in a higher detection rate of csPCa and a lower
escalation risk for radical prostatectomy compared to MRI-TBx alone.

Therefore, most clinical guidelines advocate MRI-targeted biopsy in combination
with SBx.
However, the increased diagnostic accuracy of combined biopsy (CBx) is offset
by a higher number of biopsy cores and a higher risk of complications.

A study published today in the journal European Radiology explored clinical and MRI-derived parameters associated with the risk of detection of csPCa by SBx in order to further reduce the number of clinical biopsies and overdiagnosis of indolent PCa while maintaining high diagnostic accuracy
for csPCa.

This study conducted a retrospective study of 745 patients who received a combination of MRI-TBx and SBx
.
The primary outcome was SBx's escalation to clinically significant prostate cancer (csPCa; Rank group ≥2).

Variables relevant to the primary outcome (age, prior biopsy status, prostate imaging reporting and data system (PI-RADS) score, index lesion size/location, number of lesions, PSA, PSA density, prostate volume) were determined by logistic regression and used in biopsy strategies
.
Clinical utility
was assessed by decision curve analysis (DCA).

SBx detected 47 (6%) men
with csPCa.
In men with PI-RADS 5 (relative to PI-RADS 3:OR 0.
30, p = 0.
03; relative to PI-RADS 4:OR 0.
33, p = 0.
01) and previous negative biopsy (relative to previous positive biopsy: OR 0.
40, p = 0.
007), the risk of detecting csPCa was significantly reduced by SBx alone and increased with age (every 10 years: OR).
1.
64，p = 0.
016）
。 No clear correlations
were observed for other variables.
DCA has added value in the development of strategies :(a) avoiding SBx in men with PI-RADS 5 and (b) avoiding SBx in people with previously negative biopsies, resulting in 201 (27%) and 429 (58%) avoiding SBx compared to 5 (1%) and 15 (2%), respectively CSPCa
was missed.

Table Univariate analysis of the relationship between combined biopsy and MRI-targeted biopsy escalation to csPCa 

This study showed that MRI-TBx alone missed 6% of men's CSPCa lesions
compared to the combination of MRI-TBx and SBx.
For PI-RADS 5 and previously negative biopsy men, a biopsy strategy that omits SBx will avoid excess biopsies in 58% of men, while only 2% of men miss CSPCa
.
This study shows that supplementation of MRI-TBx and SBx in patients provides an important reference for further improving diagnostic accuracy, reducing the risk of biopsy complications and overdiagnosis of PCa
.

Original source:

Dominik Deniffel,Nathan Perlis,Sangeet Ghai,et al.
Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy.
DOI:10.
1007/s00330-022-08822-3