Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?

Anastay, Vassili; Gondran-Tellier, Bastien; McManus, Robin; Delonca, Raphaelle; Akiki, Akram; Gaillet, S.; Delaporte, V.; André, Marc; Daniel, Laurent; Karsenty, G.; Lechevallier, É.; Boissier, R.; Baboudjian, Michael

doi:10.1007/s00261-020-02728-8

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…A total of 72 studies including 36 366 patients with suspected csPCa who underwent prostate MRI and subsequent biopsy were included (Figure 1). Details of the included study and patient characteristics are summarized in Table 1 and eTables 3 to 5 in Supplement 1. Studies were published between 2016 and 2022.…”

Section: Resultsmentioning

confidence: 99%

“…None of the included studies enrolled patients with prior csPCa. Among the 72 included studies, 19 solely included patients with low to moderate risk of csPCa (ie, PI-RADS≤3 and/or transitional zone index lesion and/or total PSA <10 ng/mL), 1 study solely included high-risk patients with PI-RADS 4 or greater, and the remaining 52 studies included all suspected patients regardless of the prostate MRI results or clinical parameters . The most frequently used imaging was 3.0 T (92.6%) and multiparametric MRI (80.3%).…”

Section: Resultsmentioning

confidence: 99%

“…16,19,20,26,28,30,36,81 No potential source of bias was identified for the other 64 (89%) studies. [10][11][12][13][14][15]17,18,[21][22][23][24][25]27,29,[31][32][33][34][35] Retrospective study design and concern regarding the selection domain (ie, studies only noted that patients with suspected csPCa were included rather than providing detailed inclusion and/or exclusion criteria)…”

Section: Quality Assessment and Publication Biasmentioning

confidence: 99%

“…As such, ancillary clinical data have been proposed to complement MRI to minimize the number of unnecessary biopsies. This concept has been recently expanded by numerous studies, and several MRI-based risk models and strategies have been developed to guide decisions on prostate biopsy . However, it has been challenging to integrate the proposed approaches into clinical practice owing to considerable inconsistencies among them.…”

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Haj-Mirzaian,

Burk,

Lacson

et al. 2024

JAMA Netw Open

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ImportanceMultiple strategies integrating magnetic resonance imaging (MRI) and clinical data have been proposed to determine the need for a prostate biopsy in men with suspected clinically significant prostate cancer (csPCa) (Gleason score ≥3 + 4). However, inconsistencies across different strategies create challenges for drawing a definitive conclusion.ObjectiveTo determine the optimal prostate biopsy decision-making strategy for avoiding unnecessary biopsies and minimizing the risk of missing csPCa by combining MRI Prostate Imaging Reporting &amp; Data System (PI-RADS) and clinical data.Data SourcesPubMed, Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to July 1, 2022.Study SelectionEnglish-language studies that evaluated men with suspected but not confirmed csPCa who underwent MRI PI-RADS followed by prostate biopsy were included. Each study had proposed a biopsy plan by combining PI-RADS and clinical data.Data Extraction and SynthesisStudies were independently assessed for eligibility for inclusion. Quality of studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and the Newcastle-Ottawa Scale. Mixed-effects meta-analyses and meta-regression models with multimodel inference were performed. Reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.Main Outcomes and MeasuresIndependent risk factors of csPCa were determined by performing meta-regression between the rate of csPCa and PI-RADS and clinical parameters. Yields of different biopsy strategies were assessed by performing diagnostic meta-analysis.ResultsThe analyses included 72 studies comprising 36 366 patients. Univariable meta-regression showed that PI-RADS 4 (β-coefficient [SE], 7.82 [3.85]; P = .045) and PI-RADS 5 (β-coefficient [SE], 23.18 [4.46]; P &lt; .001) lesions, but not PI-RADS 3 lesions (β-coefficient [SE], −4.08 [3.06]; P = .19), were significantly associated with a higher risk of csPCa. When considered jointly in a multivariable model, prostate-specific antigen density (PSAD) was the only clinical variable significantly associated with csPCa (β-coefficient [SE], 15.50 [5.14]; P &lt; .001) besides PI-RADS 5 (β-coefficient [SE], 9.19 [3.33]; P &lt; .001). Avoiding biopsy in patients with lesions with PI-RADS category of 3 or less and PSAD less than 0.10 (vs &lt;0.15) ng/mL2 resulted in reducing 30% (vs 48%) of unnecessary biopsies (compared with performing biopsy in all suspected patients), with an estimated sensitivity of 97% (vs 95%) and number needed to harm of 17 (vs 15).Conclusions and RelevanceThese findings suggest that in patients with suspected csPCa, patient-tailored prostate biopsy decisions based on PI-RADS and PSAD could prevent unnecessary procedures while maintaining high sensitivity.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Quality Assessment and Publication Biasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Haj-Mirzaian,

Burk,

Lacson

et al. 2024

JAMA Netw Open

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“…PSAD was associated with csPCa, and BD combined with PSAD could increase the csPCa detection rate in our result. In fact, it had been reported that the PSA density was correlated with csPCa detection, and lower PSAD offered the avoidance of prostate biospy in MRI-negative patients in many studies ( 11 , 27 , 28 ). The PSA density was an important indicator for deciding whether to perform prostate biopsy in MRI-negative patients.…”

Section: Methodsmentioning

confidence: 99%

The Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS<3

Zhu

Ding

et al. 2022

Front. Oncol.

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BackgroundIn patients with multiparameter magnetic resonance imaging (mpMRI) low-possibility but highly clinical suspicion of prostate cancer, the biopsy core is unclear. Our study aims to introduce the biopsy density (BD; the ratio of biopsy cores to prostate volume) and investigates the BD-predictive value of prostate cancer and clinically significant prostate cancer (csPCa) in PI-RADS<3 patients.MethodsPatients underwent transperineal template–guided prostate biopsy from 2012 to 2022. The inclusion criteria were PI-RADS<3 with a positive digital rectal examination or persistent PSA abnormalities. BD was defined as the ratio of the biopsy core to the prostate volume. Clinical data were collected, and we grouped the patients according to pathology results. Kruskal–Wallis test and chi-square test were used in measurement and enumeration data, respectively. Logistics regression was used to choose the factor associated with positive biospy and csPCa. The receiver operating characteristic (ROC) curve was used to evaluate the ability to predict csPCa.ResultsA total of 115 patients were included in our study. Biopsy was positive in 14 of 115 and the International Society of Urological Pathology grade groups 2–5 were in 7 of all the PCa patients. The BD was 0.38 (0.24-0.63) needles per milliliter. Binary logistics analysis suggested that PSAD and BD were correlated with positive biopsy. Meanwhile, BD and PSAD were associated with csPCa. The ROC curve illustrated that BD was a good parameter to predict csPCa (AUC=0.80, 95% CI: 0.69-0.91, p<0.05). The biopsy density combined with PSAD increased the prediction of csPCa (AUC=0.90, 95% CI: 0.85-0.97, p<0.05). The cut-off value of the BD was 0.42 according to the Youden index.ConclusionIn PI-RADS<3 patients, BD and PSAD are related to csPCa. A biopsy density of more than 0.42 needles per millimeter can increase the csPCa detection rate, which should be considered as an alternative biopsy method when we perform prostate biopsy in patients with PI-RADS<3.

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Prostate cancer in PI-RADS scores 1 and 2 version 2.1: a comparison to previous PI-RADS versions

et al. 2022

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Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?

Cited by 6 publications

References 26 publications

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

The Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS<3

Prostate cancer in PI-RADS scores 1 and 2 version 2.1: a comparison to previous PI-RADS versions

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