MRI-Guided Targeted and Systematic Prostate Biopsies as Prognostic Indicators for Prostate Cancer Treatment Decisions

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Prostate cancer diagnosis typically relies on systematic biopsies (SBx).
• MRI-guided targeted biopsies (TBx) show promise in improving detection rates of clinically significant prostate cancer (csPCa).

Purpose of the Study:

• To evaluate the predictive value of TBx results for interdisciplinary tumor board treatment decisions.
• To determine the extent to which TBx alone can accurately classify tumors and guide therapy recommendations.
• To assess the continued importance of SBx in treatment planning.

Main Methods:

• Analysis of SBx and TBx data from 150 prostate cancer patients.
• Review of interdisciplinary tumor board recommendations for active surveillance or intervention (prostatectomy, radiotherapy).
• Comparison of tumor classification and risk stratification between TBx and SBx findings.

Main Results:

• TBx identified the majority of clinically significant prostate cancer (csPCa).
• TBx alone were sufficient for guiding treatment decisions in many cases.
• Underestimation of tumor size and risk occurred in some favorable and intermediate-risk tumors with TBx, highlighting the role of SBx.
• High-risk PCa were accurately detected and classified by TBx in 92% of cases.

Conclusions:

• TBx are highly effective in detecting csPCa and often sufficient for treatment decision-making.
• SBx remain essential for accurate risk stratification, particularly for ISUP grade 1 tumors, and for informing active surveillance follow-up.
• Integrating both TBx and SBx provides comprehensive information for optimal prostate cancer management.