Systematic prostate biopsy still matters: A comprehensive analysis of MRI/TRUS-fusion targeted prostate biopsies across different indications

Niklas Westhoff; Bettina Baeßler; Jost von Hardenberg; Svetlana Hetjens; Stefan Porubsky; Fabian Siegel; Thomas Martini; Maurice Stephan Michel; Ulrike Attenberger; Manuel Ritter

doi:10.1016/j.urolonc.2019.07.004

Systematic prostate biopsy still matters: A comprehensive analysis of MRI/TRUS-fusion targeted prostate biopsies across different indications

Urol Oncol. 2019 Oct;37(10):678-687. doi: 10.1016/j.urolonc.2019.07.004. Epub 2019 Jul 31.

Affiliations

¹ Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: niklas.westhoff@medma.uni-heidelberg.de.
² Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.
³ Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁴ Institute of Medical Statistics and Biometry, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁵ Institute of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁶ Department of Urology, University Hospital Ulm, Ulm, Germany.
⁷ Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

PMID: 31375340
DOI: 10.1016/j.urolonc.2019.07.004

Abstract

Objectives: To assess if a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TB) strategy is precise enough to replace systematic biopsies (SB) among men with different biopsy indications since an imaging-based pathway to guide indication and targeted prostate biopsy is currently under debate.

Materials and methods: Retrospective analysis was performed of 594 patients with one or more lesions according to Prostate Imaging and Reporting Data System (PI-RADS) receiving a consecutive TB and SB for one of the 3 indications: primary cancer suspicion (51.7%), persistent cancer suspicion after prior negative biopsy (35.4%), or control of a confirmed cancer (12.9%). Detection rates for overall cancer (CaP) and clinically significant cancer (csCaP, Gleason Score ≥3+4) were compared between TB and SB and to a combined approach for all patients and within the subgroups. Characteristics of cancers missed by one biopsy strategy were analyzed.

Results: TB detected less CaP (302 vs. 366, P < 0.001) and csCaP (204 vs. 210 patients, P = 0.409) compared to SB except for men with prior negative biopsies (65 vs. 64 csCaP, P = 0.363). Cancer detection by TB or SB was independent of cancer localization and imaging characteristics. Combined TB and SB outperformed the single approaches for CaP and csCaP detection in each subgroup.

Conclusions: A single mpMRI and TB approach leads to a substantial number of missed CaP and csCaP across biopsies with different indications. Ongoing improvements of imaging, reading standardization, and biopsy techniques are required before replacing SB.

Keywords: Biopsy; Cancer; Localization; Magnetic resonance imaging; Prostatic neoplasms; Ultrasound.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Humans
Image-Guided Biopsy / methods*
Magnetic Resonance Imaging, Interventional / methods*
Male
Middle Aged
Prostate / pathology
Prostate / surgery*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / surgery*
Retrospective Studies