Aim: To improve an early diagnosis of prostate cancer (PCa) by clarifying indications for prostate biopsy.
Materials and methods: A prospective analysis of 251 primary prostate biopsies performed in Republican Specialized Scientific and Practical Medical Center of Urology to patients with LUTS during the period from 2018 to 2019 was carried out. All patients were divided into two groups. The group 1 included 189 patients who underwent standard systematic prostate biopsy; the group 2 consisted of 62 patients, who had had baseline multiparametric magnetic resonance tomography (mp-MRI) of the prostate with risk evaluation using PI-RADS v2 score, followed by systematic biopsy in combination with targeted biopsy. The ultrasound-guided biopsy was done under local anesthesia using lidocaine gel and periprostatic nerve block with a 2% lidocaine solution. Systematic biopsy was performed with 10 to 12 cores using biopsy gun. In the second group, in addition to systematic biopsy, from 2 to 6 targeted cores from suspicious areas were taken.
Results: In the group 1, PCa was diagnosed in 124 (65.6%) patients. In patients with a PSA level of less than 20 ng/ml, a total of 18 PCa were revealed (35.3%). A concordance between TRUS and DRE with the biopsy result was significantly less in patients with PSA level < 20 ng/ml (17.6%), than in patients with PSA level more than 20.1 ng/ml (61.6%; p<0.001). In the second group, PCa was diagnosed in 5 patients (17.9%) with PI-RADS v2 category 2 and 3 lesions, compared to 31 men (91.2%) with category 4 and 5 lesions. In patients with PSA level of less than 20 ng/ml, the proportion of positive biopsy results was 5.6% and 75.0%, respectively.
Conclusions: In all patients with PSA level of less than 20 ng/ml, mp-MRI of the prostate should be performed prior to biopsy. In men with PI-RADS v2 category 4-5 lesions, systematic biopsy in combination with targeted biopsy is recommended, while in case of category 2-3 lesions and negative TRUS and DRE, it is more appropriate to follow-up patients, instead of performing biopsy.
Keywords: PCa (prostate cancer); biopsy; early diagnosis; mpMRI.