Followup of Men with PI-RADS™ 4 or 5 Abnormality on Prostate Magnetic Resonance Imaging and Nonmalignant Pathological Findings on Initial Targeted Prostate Biopsy

Meng, Xiaosong; Chao, Brian; Chen, Fei; Huang, Richard; Taneja, Samir S.; Deng, Fang

doi:10.1097/ju.0000000000001424

Cited by 30 publications

(24 citation statements)

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“…Concordant to our findings Meng et al established that 88/497 (18%) of patients with a PIRADS 4 or 5 lesion prior to initial biopsy had no cancer in TB 27 due to a PI-RADS downgrading in 73% of men on repeat MRI 27 . The prospective study by Meng 27 over 4 years included 497 men with a negative biopsy out of a cohort of 1595 men (overall 31% of men), whereas in our consecutive cohort only 14% (222/1546) of PI-RADS 4/5 cases presented with a negative biopsy result. This finding may be explained by our single center experience with a high primary detection rate 6 .…”

Section: Discussionsupporting

confidence: 92%

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Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy

Kornienko

Reuter

Maxeiner

et al. 2022

Sci Rep

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Magnetic resonance imaging/Ultrasound (MRI/US) fusion targeted biopsy (TB) in combination with a systematic biopsy (SB) improves cancer detection but limited data is available how to manage patients with a Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 4 lesion and a negative biopsy. We evaluate the real-world management and the rate of clinically significant Prostate Cancer (csPCa) during follow-up. 1546 patients with a multi-parametric MRI (mpMRI) and a PI-RADS ≥ 3 who underwent SB and TB between January 2012 and May 2017 were retrospectively analyzed. 222 men with a PI-RADS ≥ 4 and a negative biopsy were included until 2019. For 177/222 (80%) complete follow-up data was obtained. 66/84 (78%) had an initial PI-RADS 4 and 18 (22%) a PI-RADS 5 lesion. 48% (84/177) received a repeat mpMRI; in the follow-up mpMRI, 39/84 (46%) lesions were downgraded to PI-RADS 2 and 11 (13%) to PI-RADS 3; three cases were upgraded and 28 lesions remained consistent. 18% (32/177) men underwent repeated TB and csPCa was detected in 44% (14/32). Our study presents real world data on the management of men with a negative TB biopsy. Men with a positive mpMRI and lesions with high suspicion (PI-RADS4/5) and a negative targeted biopsy should be critically reviewed and considered for repeat biopsy or strict surveillance. The optimal clinical risk assessment remains to be further evaluated.

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Section: Discussionsupporting

confidence: 92%

“…Persistent PI-RADS 4/5 lesions are at high risk of missed PCa, but false positive findings still exist as e.g. PCa in the transitional zone is still challenging 23 , 27 , 28 . Prostate deformation, patient movement, mismatch in imaging may be other reasons for failure in TB 24 .…”

Section: Discussionmentioning

confidence: 99%

Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy

Kornienko

Reuter

Maxeiner

et al. 2022

Sci Rep

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“…Should the ROI be inappropriately sampled, the patient may be offered re-biopsy via similar or alternative approach (i.e., transperineal for anterior lesions or after prior transrectal approach, in-bore technique). Furthermore, multidisciplinary case-by-case review provides comprehensive The possible role of pathology review has been considered previously, with one study finding that initial histology was poorly associated with PCa on follow-up biopsy [12]. At our institution, the small amount of total submitted tissue from a biopsy allows for near-complete histologic analysis.…”

Section: Discussionmentioning

confidence: 97%

Reconciling Discordance Between Prostate Biopsy Histology and Magnetic Resonance Imaging Suspicion – Implementation of a Quality Improvement Protocol of Imaging Re-review and Reverse-fusion Target Analysis

Kotamarti

Gupta

Wang

et al. 2022

European Urology Oncology

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“…We have previously reported that many ROI that are negative on biopsy show downgrading of the PI-RADS ROI on follow-up mpMRI [ 19 , 20 ]. In the present study, 14 of the 38 initial mpMRI ROI were downgraded to a PI-RADS 1 or 2 lesion.…”

Section: Discussionmentioning

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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Followup of Men with PI-RADS™ 4 or 5 Abnormality on Prostate Magnetic Resonance Imaging and Nonmalignant Pathological Findings on Initial Targeted Prostate Biopsy

Cited by 30 publications

References 0 publications

Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy

Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy

Reconciling Discordance Between Prostate Biopsy Histology and Magnetic Resonance Imaging Suspicion – Implementation of a Quality Improvement Protocol of Imaging Re-review and Reverse-fusion Target Analysis

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

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