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The Added Value of MRI-Based Targeted Biopsy in Biopsy-Naïve Patients: A Propensity-Score Matched Comparison

  • 0Department of Urology and Andrology, General Hospital Hall i.T., 6060 Hall in Tirol, Austria.
Journal of Clinical Medicine +

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April 9, 2024

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April 9, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Multiparametric MRI (mpMRI)-based combined biopsy (CB) significantly improves detection of clinically significant prostate cancer (csPCa) in biopsy-naïve patients compared to systematic-only biopsy (SOB). This approach avoids overdiagnosis of non-clinically significant prostate cancer.

Area Of Science

  • Urology
  • Oncology
  • Radiology

Background

  • Multiparametric MRI (mpMRI)-guided targeted biopsy aids in detecting clinically significant prostate cancer (csPCa) and avoiding non-clinically significant prostate cancer (ncsPCa) diagnosis.
  • The utility of mpMRI-based targeted biopsy in biopsy-naïve patients remains under investigation.

Purpose Of The Study

  • To compare the efficacy of mpMRI-based combined biopsy (CB) versus systematic-only biopsy (SOB) in diagnosing csPCa in biopsy-naïve patients.
  • To evaluate the impact of CB on the detection of ncsPCa and overall cancer diagnosis.

Main Methods

  • A propensity-score matched comparison between a systematic-only biopsy (SOB) cohort and a mpMRI-based combined (systematic + targeted) biopsy (CB) cohort.
  • Inclusion of only biopsy-naïve patients from two tertiary urologic centers.
  • Multivariate Logistic Regression Analysis (MLRA) to identify csPCa predictors, with g-computation used to estimate Average Treatment effect of the Treated (ATT).

Main Results

  • The CB group showed a significantly higher csPCa detection rate (46.4%) compared to the SOB group (31.4%) (RR 1.48, p=0.01).
  • CB demonstrated a trend towards reduced ncsPCa diagnosis (15.7% vs 23.6%, p=0.1) and a significant reduction in the odds of csPCa diagnosis when comparing SOB to CB (OR 0.56, p=0.003).
  • Targeted-only cores added 4.3% to csPCa detection, while systematic-only cores added 1.4%.

Conclusions

  • The combined biopsy approach (CB) is superior to systematic-only biopsy (SOB) for detecting csPCa in biopsy-naïve patients.
  • The CB approach does not lead to additional detection of ncsPCa.
  • mpMRI-guided biopsy is recommended for biopsy-naïve patients with suspected prostate cancer.

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