Multiparametric MRI targeted prostate biopsy: When omit systematic biopsy?

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Prostate cancer (PCa) diagnosis relies on accurate biopsy techniques.
• Multiparametric magnetic resonance imaging (mpMRI) improves localization of suspicious lesions.

Purpose of the Study:

• To evaluate the detection rate of PCa using mpMRI fusion targeted biopsy (TPBx) combined with ipsilateral systematic prostate biopsy (SPBx).

Main Methods:

• 495 men with suspected PCa underwent transperineal SPBx and TPBx for PI-RADS score lesions ≥ 3.
• Data collected from January 2023 to December 2023.

Main Results:

• PCa was detected in 50.5% of men; 14.4% had negative mpMRI.
• SPBx diagnosed more indolent PCa (38.5% vs 5.8%), while TPBx showed higher rates for clinically significant PCa (csPCa) in ISUP Grade Group 2 (97.3% vs 85.4%).
• SPBx and TPBx diagnosed 100% of csPCa in GG5 tumors; 89.4% of csPCa cases were found on the negative mpMRI side.

Conclusions:

• Combined SPBx and TPBx maximize csPCa diagnosis.
• A reduced biopsy scheme limited to the ipsilateral side of mpMRI lesions missed 11.6% of csPCa.
• Both SPBx and TPBx diagnosed 100% of csPCa in PI-RADS score 5 lesions.