A clinical available decision support scheme for optimizing prostate biopsy based on mpMRI

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Combined MRI/Ultrasound fusion targeted biopsy (TBx) and systematic biopsy (SBx) improve prostate cancer (PCa) detection but increase biopsy cores and detection of insignificant PCa.
• Multiparametric (mp) MRI assessment is crucial for optimizing prostate biopsy strategies.

Purpose of the Study:

• To develop and evaluate a decision support scheme for optimizing prostate biopsy using mpMRI assessment.
• To compare the cost-effectiveness of different biopsy strategies based on detection rates and number of cores.

Main Methods:

• Retrospective analysis of 229 patients with suspected PCa who underwent mpMRI before combined TBx/SBx.
• Evaluation of MRI characteristics (PI-RADS score, lesion size, location) impact on biopsy performance.
• Development of a triage test based on mpMRI to optimize the biopsy process.

Main Results:

• TBx achieved comparable detection rates for PCa and clinically significant PCa (csPCa) compared to combined TBx/SBx.
• TBx accurately detected PCa in PI-RADS 5 and larger PI-RADS 3-4 lesions, with minimal upgrading of csPCa when SBx was added.
• Combined TBx/SBx showed a higher detection rate but also a higher upgrading rate for smaller PI-RADS 3-4 lesions.

Conclusions:

• The benefit of adding SBx to TBx is primarily for smaller PI-RADS 3-4 lesions.
• A personalized strategy using solo TBx for PI-RADS 5 and larger PI-RADS 3-4 lesions can avoid excess SBx in a significant proportion of patients without compromising detection rates.