Targeted, Perilesional, and Distant Biopsies in Prostate Cancer

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Current guidelines recommend targeted plus perilesional biopsies for prostate lesions visible on MRI.
• Existing data are largely retrospective and lack standardized biopsy protocols.

Purpose of the Study:

• To prospectively evaluate the diagnostic outcomes of incorporating perilesional biopsies into the standard biopsy protocol.
• To assess the added value of perilesional and distant biopsies in detecting clinically significant prostate cancer.

Main Methods:

• Prospective, observational, multicenter study (MIRAGE) involving 912 men with PI-RADS ≥3 lesions.
• Mandated targeted and perilesional biopsies; distant biopsies were optional.
• Calculated detection rates for Gleason grade (GG) group ≥2 and GG group 1 lesions for each biopsy scheme.

Main Results:

• Targeted biopsy detected GG group ≥2 lesions in 41% of men.
• Perilesional sampling increased GG group ≥2 detection by 3.6% but also increased GG group 1 detection by 1%.
• The benefit of perilesional sampling was greatest in biopsy-naïve men and those with PI-RADS 4-5 lesions. Distant biopsies provided minimal additional detection of GG group ≥2 lesions.

Conclusions:

• The MIRAGE study provides prospective evidence supporting the omission of distant biopsies when using a targeted plus perilesional strategy.
• This approach optimizes diagnostic yield for clinically significant prostate cancer while minimizing unnecessary sampling.