Can we omit systematic biopsies in patients undergoing MRI fusion-targeted prostate biopsies?
Jeffrey J Leow1,2, Soon Hock Koh1,2, Marcus WL Chow1,2, Wayren Loke1, Rolando Salada1, Seok Kwan Hong1,2, Yuyi Yeow1,2, Chau Hung Lee2,3, Cher Heng Tan2,3, Teck Wei Tan1,2
1 Department of Urology, Tan Tock Seng Hospital, Singapore 308433, Singapore
2 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
3 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Teck Wei Tan,
Department of Urology, Tan Tock Seng Hospital, Singapore 308433; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232
Source of Support: None, Conflict of Interest: None
Magnetic resonance imaging (MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s) on MRI. The role of concurrent systematic in addition to targeted biopsies is currently unclear. Using our prospectively maintained database, we identified men with at least one Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesion who underwent targeted and/or systematic biopsies from May 2016 to May 2020. Clinically significant prostate cancer (csPCa) was defined as any Gleason grade group ≥2 cancer. Of 545 patients who underwent MRI fusion-targeted biopsy, 222 (40.7%) were biopsy naïve, 247 (45.3%) had previous prostate biopsy(s), and 76 (13.9%) had known prostate cancer undergoing active surveillance. Prostate cancer was more commonly found in biopsy-naïve men (63.5%) and those on active surveillance (68.4%) compared to those who had previous biopsies (35.2%; both P < 0.001). Systematic biopsies provided an incremental 10.4% detection of csPCa among biopsy-naïve patients, versus an incremental 2.4% among those who had prior negative biopsies. Multivariable regression found age (odds ratio [OR] = 1.03, P = 0.03), prostate-specific antigen (PSA) density ≥0.15 ng ml−2 (OR = 3.24, P < 0.001), prostate health index (PHI) ≥35 (OR = 2.43, P = 0.006), higher PI-RADS score (vs PI-RADS 3; OR = 4.59 for PI-RADS 4, and OR = 9.91 for PI-RADS 5; both P < 0.001) and target lesion volume-to-prostate volume ratio ≥0.10 (OR = 5.26, P = 0.013) were significantly associated with csPCa detection on targeted biopsy. In conclusion, for men undergoing MRI fusion-targeted prostate biopsies, systematic biopsies should not be omitted given its incremental value to targeted biopsies alone. The factors such as PSA density ≥0.15 ng ml−2, PHI ≥35, higher PI-RADS score, and target lesion volume-to-prostate volume ratio ≥0.10 can help identify men at higher risk of csPCa.