Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

Xueqing Cheng; Jinshun Xu; Yuntian Chen; Zhenhua Liu; Guangxi Sun; Ling Yang; Jin Yao; Hao Zeng; Bin Song

doi:10.3389/fonc.2021.643051

Is Additional Systematic Biopsy Necessary in All Initial Prostate Biopsy Patients With Abnormal MRI?

Front Oncol. 2021 Feb 26:11:643051. doi: 10.3389/fonc.2021.643051. eCollection 2021.

Authors

Xueqing Cheng¹, Jinshun Xu², Yuntian Chen¹, Zhenhua Liu³, Guangxi Sun³, Ling Yang¹, Jin Yao¹, Hao Zeng³, Bin Song¹

Affiliations

¹ Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
² Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Urology, West China Hospital, Sichuan University, Chengdu, China.

Abstract

Purpose: To determine whether additional systematic biopsy is necessary in all biopsy naïve patients with MRI visible lesions by taking PI-RADS score and prostate volume into consideration.

Materials and methods: Patients who underwent combined systematic biopsy (SB) and cognitive MRI-targeted biopsy (TB) in our hospital between May 2018 and June 2020 were retrospectively reviewed. The detection rate of clinical significant prostate cancer (csPCa), biopsy grade group (GG) concordance, and disease upgrading rate on radical prostatectomy were compared between SB and TB and further stratified by PI-RADS v2.0 category and prostate volume.

Results: A total of 234 patients were analyzed in this study. TB alone detected more csPCa and less clinically insignificant prostate cancer (cisPCa) than SB alone in the whole cohort (57.3 vs 53%, P = 0.041; 3.8 vs 7.7%, P = 0.049 respectively). The additional SB indicated only a marginal increase of csPCa detection but a remarkable increase of cisPCa detection compared with targeted biopsy (59.4 vs 57.3%, P = 0.064; 3.8 vs 7.7%, P = 0.012). As stratified by PI-RADS category, the difference of csPCa detection rate between TB and SB was not significant either in PI-RADS 5 subgroup (83.8 vs 76.3%, P = 0.07) or in PI-RADS 3-4 subgroup (43.5 vs 40.9%, P = 1.0). Additional SB decreased the rate of disease upgrading on radical prostatectomy (RP) than TB alone in PI-RADS 3-4 subgroup (14.5 vs 25.5%, P = 0.031) other than PI-RADS 5 subgroup (6 vs 6%, P = 1.0). When stratified by prostate volume (PV), TB alone detected more csPCa than SB in small prostate (PV < 30 ml) group (81.0 vs 71.0%, P = 0.021) but not in large prostate (PV ≥ 30 ml) group (44.0 vs 42.7%, P = 0.754). The additional SB did not significantly decrease the rate of disease upgrading on RP than TB alone in either small or large prostate (6.4 vs 8.5%, P = 1.0; 13.8 vs 22.4%, P = 0.063).

Conclusion: The combination biopsy method was no superior than targeted biopsy alone in PI-RADS 5 or in small volume prostate subgroup.

Keywords: MRI; PI-RADS; prostate biopsy; prostate cancer; targeted biopsy.