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Eur Urol. 2017 Feb 28. pii: S0302-2838(17)30110-0. doi: 10.1016/j.eururo.2017.02.021. [Epub ahead of print]

Results of Targeted Biopsy in Men with Magnetic Resonance Imaging Lesions Classified Equivocal, Likely or Highly Likely to Be Clinically Significant Prostate Cancer.

Author information

1
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Wulphert.Venderink@radboudumc.nl.
2
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
3
Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
4
Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

The Prostate Imaging Reporting and Data System (PI-RADS) is the most commonly used scoring system in prostate magnetic resonance imaging (MRI). One of the available techniques to target suspicious lesions is direct in-bore MRI-guided biopsy (MRGB).

OBJECTIVE:

To report on the experience and results of MRGB in a large cohort of patients with lesions classified as equivocal (PI-RADS 3), likely (PI-RADS 4), or highly likely (PI-RADS 5) to be clinically significant (cs) prostate cancer (PCa).

DESIGN, SETTING, AND PARTICIPANTS:

We retrospectively included 1057 patients having MRGB, between January 2012 and September 2016, of lesions classified as PI-RADS≥3 on multiparametric MRI. Biopsy-naïve patients, patients with prior negative systematic transrectal ultrasound-guided biopsy, and patients in active surveillance were included.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

The primary outcome measurement is the detection rate of csPCa. Descriptive statistics and chi-square tests were used to calculate the differences in proportions. We considered a Gleason score of ≥3+4 as csPCa.

RESULTS AND LIMITATIONS:

PCa was diagnosed in 35% (55/156), 60% (223/373), and 91% (479/528), and csPCa in 17% (26/156), 34% (128/373), and 67% (352/528) of patients with PI-RADS 3, 4, and 5 lesions, respectively. Follow-up of patients with negative biopsy findings resulted in csPCa in 1.7% (5/300) after a median period of 41 (interquartile range 25-50) mo. The evaluation of prostate-specific antigen density (PSAD) to predict csPCa resulted in 42% of patients with a PI-RADS 3 lesion who could avoid biopsy in case a PSAD of ≥ 0.15ng/ml/ml would be used. In 6% (95% confidence interval, 2-15), csPCa would then be missed. The study is limited because of its retrospective character.

CONCLUSIONS:

MRGB in lesions scored PI-RADS≥3 yields high detection rates of csPCa in daily clinical practice in cases with previous negative biopsy.

PATIENT SUMMARY:

In daily clinical practice, direct in-bore magnetic resonance imaging-guided biopsy of suspicious lesions reported according to the Prostate Imaging Reporting and Data System yields high detection rates of clinically significant prostate cancer.

KEYWORDS:

In-bore biopsy; Magnetic resonance imaging; Prostate Imaging Reporting and Data System; Prostate cancer

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