Early Second Round Targeted Biopsy of PI-RADS Score 3 or 4 in 256 Men With Persistent Suspicion of Prostate Cancer

Pepe, Pietro; Garufi, Antonio; Priolo, Gian Domenico; Pennisi, Michele; Fraggetta, Filippo

doi:10.21873/invivo.11556

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…The detection rates for overall PC were 80% (4/5), 53% (10/19), and 86% (6/7), respectively. In a study by Pepe et al [38], 256 patients with PI-RADS 3/4 lesions on mpMRI underwent early repeat prostate biopsy 6-9 months after an initial negative MRI/TRUS-guided fusion biopsy. The PC detection rate in repeat TB was 14% (36/256) and the sPC detection rate was 10% (26/256).…”

Section: Discussionmentioning

confidence: 99%

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy

Görtz,

Huber,

Linz

et al. 2023

Diagnostics

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A negative multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy in patients with suspected prostate cancer (PC) results in clinical uncertainty, as the biopsy can be false negative. The clinical challenge is to determine the optimal follow-up and to select patients who will benefit from repeat biopsy. In this study, we evaluated the rate of significant PC (sPC, Gleason score ≥7) and PC detection in patients who received a follow-up mpMRI/ultrasound-guided biopsy for persistent PC suspicion after a negative mpMRI/ultrasound-guided biopsy. We identified 58 patients at our institution that underwent repeat targeted biopsy in case of PI-RADS lesions and systematic saturation biopsy between 2014 and 2022. At the initial biopsy, the median age was 59 years, and the median prostate specific antigen level was 6.7 ng/mL. Repeat biopsy after a median of 18 months detected sPC in 3/58 (5%) patients and Gleason score 6 PC in 11/58 (19%). Among 19 patients with a downgraded PI-RADS score at the follow-up mpMRI, none had sPC. In conclusion, men with an initial negative mpMRI/ultrasound-guided biopsy had a high likelihood of not harboring sPC at repeat biopsy (95%). Due to the small size of the study, further research is recommended.

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Section: Discussionmentioning

confidence: 99%

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy

Görtz,

Huber,

Linz

et al. 2023

Diagnostics

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“…Therefore, it is in this group where legitimate concern exists for false negative biopsies. Several retrospective studies recommend early re-imaging following a negative mpMRI guided biopsy of PI-RADS 4 or 5 ROI providing the repeat mpMRI remains suspicious for csPCa [ 6 , 7 ]. Our observation that ipsilateral SB increases detection of csPCa missed by MR targeted biopsy suggests the real potential for false negative MRFTB due to mis-registration [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we routinely recommend initial biopsy for all PI-RADS 3-5 ROI. There is increasing evidence that MRI-targeted biopsy alone fails to detect csPCA in some PI-RADS 4 and 5 ROI [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Axumin (18F-Fluciclovine) PET imaging in men exhibiting no clinically significant cancer on initial negative biopsy of PI-RADS 4 and 5 regions of interest

et al. 2022

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Purpose The objective of the study was to determine whether Axumin ( 18 F-Fluciclovine) PET/MRI informs the decision to perform an early repeat biopsy of PI-RADS 4/5 region of interest (ROI) exhibiting no clinically significant prostate cancer (csPCa) on initial biopsy. Methods This prospective study enrolled men with at least one PI-RADS 4/5 ROI on multi-parametric MRI and no csPCa on prior biopsy defined as Gleason grade group (GGG) > 1. All men underwent an Axumin PET/MRI and only-persistent PI-RADS > 2 ROI were advised to undergo a repeat biopsy. A PET cancer suspicion score (PETCSS) was internally developed to stratify PET avid lesions according to their suspicion of harboring csPCa. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of the PETCSS for predicting csPCa were assessed. Relative risk was calculated to analyze the association of baseline variables with csPCa on repeat biopsy. Results Thirty-eight ROI on 36 enrolled men were analyzed. Fourteen (36.8%) were downgraded to PI-RADS 1/2 and were not subjected to repeat biopsy. Thirteen (92.9%) of these downgraded scans also exhibited low-risk PETCSS. Overall, 18/22 (81.2%) subjects underwent a repeat per protocol biopsy. Of the 20 ROI subjected to repeat biopsy, eight (40%) were found to harbour csPCa. The sensitivity, specificity, PPV and NPV of the PETCSS were 50, 50, 40, and 60%, respectively. No predictor of csPCa was found in the risk analysis. Conclusion Our pilot study showed that both MRI and PET sequences have limited performance for identifying those persistently suspicious PI-RADS 4/5 ROI that are found to harbor csPCa on repeat biopsy. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04172-3.

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“…Well, should the second round of fusion biopsy be performed on patients whose FPB histopathology is benign, but cancer continues to suspicious? Pepe et al reported that in patients with a negative FPB (transperineal saturation plus TB) history and PIRADS-3 lesion, approximately 2.5% cancer was detected with the second round of TB 17. In the future, we believe that with the increasing experience of fusion biopsy, clinicians performing PB will make a lot of effort to answer this question.Shakir et al evaluated CDR and histological PCa upgrading with targeted biopsy according to different PSA levels and reported that the PSA cutoff for histological PCa upgrading was 5.2 ng/mL.…”

mentioning

confidence: 94%

Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI‐RADS 3 lesions

Sönmez

Tombul

Demirtaş

et al. 2020

Asia-Pac J Clncl Oncology

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Aim: To determine clinical risk factors in patients with PI-RADS 3 lesions and prostate-specific antigen (PSA) < 10 ng/mL. Methods: In this prospective study, all patients underwent multiparametric magnetic resonance imaging. Following the 2-5 core fusion-targeted biopsy, standard 12-core prostate biopsy was performed in each patient (combined biopsy). The cutoff values were calculated with receiver-operating characteristic analysis. First, univariate logistic regression analysis was used to evaluate the relationship between total eight parameters and prostate cancer. Subsequently, multiple logistic regression analysis was performed to the parameters associated with prostate cancer. Results: Two hundred and eighty-eight patients were included in the study. Some clinical parameters are determined to be significant in univariate and multiple logistic regression analyses, including PSA, free/total PSA ratio, PSA density (PSA/total prostate volume), positive family history of PCa, and PI-RADS 3 lesion diameter. Patients were classified between 0 and 5 according to the number of risk factors. While the risk of cancer was 7.1% in patients with one or less risk factors, the PCA rate was 45.2% among patients with all risk factors. Conclusion: In patients with PI-RADS 3 lesion and PSA < 10 ng/mL, histopathological results of biopsy can be estimated with higher accuracy using some clinical parameters.

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Early Second Round Targeted Biopsy of PI-RADS Score 3 or 4 in 256 Men With Persistent Suspicion of Prostate Cancer

Abstract: Background/Aim: The aim of the study was to determine the rate of clinically significant prostate cancer (csPCa) cases in men submitted to early second round mpMRI/TRUS (multiparametric magnetic resonance imaging/transrectal ultrasound) fusion biopsy (TPBx).

Cited by 8 publications

References 30 publications

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy

Axumin (18F-Fluciclovine) PET imaging in men exhibiting no clinically significant cancer on initial negative biopsy of PI-RADS 4 and 5 regions of interest

Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI‐RADS 3 lesions

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