Targeted Biopsy Is Sufficient for Men on Active Surveillance for Early-Stage Prostate Cancer

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Serial biopsy is standard for prostate cancer active surveillance (AS).
• Multiparametric MRI (mpMRI) targeting is increasingly used.
• The necessity of systematic sampling alongside targeted biopsy remains unclear.

Purpose of the Study:

• To evaluate if MRI-targeted biopsy alone is sufficient for identifying the dominant lesion in early-stage prostate cancer patients on AS.
• To assess the role of systematic sampling in detecting clinically significant disease missed by targeted biopsy.

Main Methods:

• Retrospective analysis of 821 men with early-stage prostate cancer undergoing AS with MR fusion biopsies.
• Comparison of findings from MRI-targeted sampling versus systematic sampling for Gleason Grade Group (GG) and tumor location.
• Assessment of lesions detected uniquely by systematic biopsy.

Main Results:

• MRI-targeted biopsy identified the dominant Gleason Grade Group and tumor location in 95% of cases.
• Systematic biopsy uniquely detected higher-grade, low-volume disease in 5% of cases, with only 2% having aggressive features.
• 25% of dominant lesions were contiguous to the targeted area, suggesting improved detection with better targeting.

Conclusions:

• MRI-targeted biopsy alone is largely sufficient for monitoring men with prostate cancer on AS.
• Systematic sampling may be omitted in many cases, as few high-risk cancers are missed.
• Targeted biopsy reliably identifies dominant lesions, potentially obviating the need for extensive systematic sampling.