Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study

While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patient...

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Published in:European urology oncology Vol. 5; no. 2; pp. 176 - 186
Main Authors: Ahdoot, Michael, Lebastchi, Amir H., Long, Lori, Wilbur, Andrew R., Gomella, Patrick T., Mehralivand, Sherif, Daneshvar, Michael A., Yerram, Nitin K., O’Connor, Luke P., Wang, Alex Z., Gurram, Sandeep, Bloom, Jonathan, Siddiqui, M. Minhaj, Linehan, W. Marston, Merino, Maria, Choyke, Peter L., Pinsky, Paul, Parnes, Howard, Shih, Joanna H., Turkbey, Baris, Wood, Bradford J., Pinto, Peter A.
Format: Journal Article
Language:English
Published: Netherlands Elsevier B.V 01.04.2022
Subjects:
Combined biopsy
Fusion biopsy
Humans
Image-Guided Biopsy - methods
Magnetic Resonance Imaging - methods
Male
Prostate - diagnostic imaging
Prostate - pathology
Prostate cancer
Prostate cancer diagnosis
Prostate Imaging-Reporting and Data System
Prostate magnetic resonance imaging
Prostatic Neoplasms - diagnostic imaging
Prostatic Neoplasms - pathology
Risk Assessment
Prostate magnetic resonance imaging
Combined biopsy
Fusion biopsy
Prostate Imaging-Reporting and Data System
Prostate cancer diagnosis
Prostate cancer
ISSN:2588-9311, 2588-9311
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Summary:While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa. To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC). Men with MRI-visible prostate lesions underwent combined TBx plus SBx. The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score. Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3–4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (8% vs 7.5%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%). While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3–4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3–4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%). Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544. For men found to have Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesions on prostate magnetic resonance imaging (MRI) it is reasonable to perform MRI-targeted biopsy only, as very few clinically significant cancers will be missed. However, for men with PI-RADS 3–4 lesions on MRI, a combined MRI-targeted and systematic biopsy should be used, as each biopsy method contributes substantially to detection of clinically significant cancer.
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Drafting of the manuscript: Ahdoot, Lebastchi, Long, Wilbur, Mehralivand, Gomella, Gurram, Yerram, O’Connor, Wang, Bloom, Siddiqui, Linehan, Merino, Choyke, Pinsky, Parnes, Shih, Turkbey, Wood, Pinto.
These authors contributed equally to this work.
Analysis and interpretation of data: Ahdoot, Lebastchi, Long, Wilbur, Mehralivand, Gomella, Gurram, Yerram, O’Connor, Wang, Bloom, Siddiqui, Linehan, Merino, Choyke, Pinsky, Parnes, Shih, Turkbey, Wood, Pinto.
Statistical analysis: Ahdoot, Long, Choyke, Pinsky, Parnes, Shih.
Other: None.
Study concept and design: Ahdoot, Lebastchi, Siddiqui, Linehan, Choyke, Pinsky, Parnes, Shih, Turkbey, Wood, Pinto.
Author contributions: Michael Ahdoot had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Administrative, technical, or material support: Ahdoot, Lebastchi, Long, Wilbur, Mehralivand, Gomella, Gurram, Yerram, O’Connor, Wang, Bloom, Siddiqui, Linehan, Merino, Choyke, Pinsky, Parnes, Shih, Turkbey, Wood, Pinto.
Critical revision of the manuscript for important intellectual content: Ahdoot, Lebastchi, Long, Wilbur, Mehralivand, Gomella, Gurram, Yerram, O’Connor, Wang, Bloom, Siddiqui, Linehan, Merino, Choyke, Pinsky, Parnes, Shih, Turkbey, Wood, Pinto.
Supervision: Linehan, Merino, Choyke, Shih, Wood, Pinto.
Acquisition of data: Ahdoot, Lebastchi, Long, Wilbur, Mehralivand, Gomella, Gurram, Yerram, O’Connor, Wang, Bloom, Siddiqui, Linehan, Merino, Choyke, Pinsky, Parnes, Shih, Turkbey, Wood, Pinto.
Obtaining funding: Linehan, Merino, Choyke, Wood, Pinto.
ISSN:2588-9311
2588-9311
DOI:10.1016/j.euo.2021.03.004