Perilesional Biopsies Increase Detection of Significant Prostate Cancer in Men with PI-RADS 4/5 Lesions: Validation of the PI-RADS Steering Committee Recommendation
“…A further explanation, offered by van der Leest et al [7], is that some of the cancer-containing ''systematic'' cores were actually obtained from regions near the MRI lesion (perilesional). A retrospective review of systematic cores, by other authors, similarly demonstrated csPCa in perilesional cores [8,9]. That the perilesional radius is often a site of cancer is consistent with Priester et al's [10] finding that MRI-visible lesions underestimate actual tumor volume.…”
Section: Introductionsupporting
confidence: 56%
“…That the perilesional radius is often a site of cancer is consistent with Priester et al's [10] finding that MRI-visible lesions underestimate actual tumor volume. In a consensus statement, perilesional sampling was recommended [11] and validated to an extent by Lahoud et al [9]. However, data to define and quantify the value of perilesional biopsies are not yet available.…”
“…A further explanation, offered by van der Leest et al [7], is that some of the cancer-containing ''systematic'' cores were actually obtained from regions near the MRI lesion (perilesional). A retrospective review of systematic cores, by other authors, similarly demonstrated csPCa in perilesional cores [8,9]. That the perilesional radius is often a site of cancer is consistent with Priester et al's [10] finding that MRI-visible lesions underestimate actual tumor volume.…”
Section: Introductionsupporting
confidence: 56%
“…That the perilesional radius is often a site of cancer is consistent with Priester et al's [10] finding that MRI-visible lesions underestimate actual tumor volume. In a consensus statement, perilesional sampling was recommended [11] and validated to an extent by Lahoud et al [9]. However, data to define and quantify the value of perilesional biopsies are not yet available.…”
“…These findings add to a growing body of research supporting a ‘target/focal saturation’ approach (i.e. extra perilesional biopsy cores), instead of SB [32,33]. Focal saturation instead of SB minimises the number of cores and thus biopsy‐related morbidity, and also reduces the detection of GG 1 cancers without affecting the GG ≥2 cancer detection rate [34].…”
Objective
To assess the outcomes of pre‐biopsy magnetic resonance imaging (MRI) pathways, as a tool in biopsy‐naïve men with suspicion of prostate cancer, in routine clinical practice. Secondary outcomes included a comparison of transrectal MRI‐directed biopsy (TR‐MRDB) and transperineal (TP)‐MRDB in men with suspicious MRI.
Patients and Methods
We retrospectively assessed a two‐centre cohort of consecutive biopsy‐naïve men with suspicion of prostate cancer who underwent a Prostate Imaging‐Reporting and Data System version 2 (PI‐RADS v2) compliant pre‐biopsy MRI in a single, high‐volume centre between 2015 and 2019 (Centre 1). Men with suspicious MRI scans underwent TR‐MRDB in Centre 1 and TP‐MRDB with additional random biopsies (RB) in Centre 2. The MRI and histopathology were assessed in the same institution (Centre 1). Outcomes included: (i) overall detection rates of Grade Group (GG) 1, GG ≥2, and GG ≥3 cancer in men with suspicious MRI; (ii) Biopsy‐avoidance due to non‐suspicious MRI; and (iii) Cancer detection rates and biopsy‐related complications between TR‐ and TP‐MRDB. To reduce confounding bias for MRDB comparisons, inverse probability weighting (IPW) was performed for age, digital rectal examination, prostate‐specific antigen (PSA), prostate volume, PSA density, and PI‐RADS category.
Results
Of the 2597 men included, the overall GG 1, GG ≥2, and GG ≥3 prevalence was 8% (210/2597), 27% (697/2597), and 15% (396/2597), respectively. Biopsy was avoided in 57% (1488/2597) of men. After IPW, the GG 1, GG ≥2 and GG ≥3 detection rates after TR‐ and TP‐MRDB were comparable at 24%, 57%, and 32%; and 18%, 64%, and 38%, respectively; with mean differences of −5.7% (95% confidence interval [CI] −13% to 1.4%), 6.1% (95% CI −2.1% to 14%), and 5.7% (95% CI −1.7% to 13%). Complications were similar in TR‐MRDB (0.50%) and TP‐MRDB with RB (0.62%; mean difference 0.11%, 95% CI −0.87% to 1.1%).
Conclusion
This high‐volume, two‐centre study shows pre‐biopsy MRI as a decision tool is implementable in daily clinical practice. Compared to recent trials, a substantially higher biopsy avoidance rate was achieved without compromising GG ≥2/GG ≥3 detection and coinciding with lower over detection rates of GG 1 cancer. Prostate cancer detection and complication rates were comparable for TR‐ and TP‐MRDB.
“… Fig. 2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram showing the search outcome and selection of full studies included in the review [3] , [9] , [10] , [11] , [12] , [13] , [18] , [19] and the studies excluded [38] , [39] , [40] . …”
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