Magnetic Resonance Imaging-Targeted Versus Systematic Prostate Biopsies: 2-year Follow-up of a Prospective Randomized...

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• The PRECISE trial previously showed MRI with targeted biopsy (TBx) noninferior to systematic biopsy (SBx) for detecting grade group (GG) ≥2 prostate cancer (PC).
• An open question concerns outcomes for patients who avoided biopsy due to negative MRI findings.

Purpose of the Study:

• To assess the 2-year rate of PC diagnosis in PRECISE participants who avoided initial biopsy based on MRI findings.
• To compare PC diagnosis rates in patients with negative or GG 1 results on TBx versus SBx.

Main Methods:

• Analysis of PRECISE trial participants not diagnosed with clinically significant PC (csPC) at baseline.
• Included 83 men with negative MRI and no biopsy, 120 with negative SBx/TBx, and 72 with GG 1 disease.
• Two-year follow-up included repeat MRI and biopsies for suspicious lesions or clinical suspicion.

Main Results:

• At 2 years, 56% of the MRI arm and 49% of the SBx arm had evaluable MRI scans.
• Negative 2-year MRIs were observed in 73% of the MRI arm and 67% of the SBx arm.
• Biopsies in the SBx arm revealed GG ≥2 PC in 7.9% of cases, while the MRI arm showed GG ≥2 PC in 5% of cases.

Conclusions:

• After 2-year follow-up with repeat MRI, no significant difference in csPC diagnosis rates was found between the MRI and SBx groups.
• This held true even though 38% of men in the MRI group initially avoided a biopsy.