Predicting the Performance of Concurrent Systematic Random Biopsies during Image Fusion Targeted Sampling of Multi-Parametric MRI Detected Prostate Cancer. A Prospective Study (PRESET Study)

Abstract

The study was aimed to develop a predictive model to identify patients who may benefit from performing systematic random biopsies (SB) in addition to targeted biopsies (TB) in men suspected of having prostate cancer. A total of 198 patients with positive pre-biopsy MRI findings and who had undergone both TB and SB were prospectively recruited into this study. The primary outcome was detection rates of clinically significant prostate cancer (csPCa) in SB and TB approaches. The secondary outcome was net clinical benefits of SB in addition to TB. A logistic regression model and nomogram construction were used to perform a multivariate analysis. The detection rate of csPCa using SB was 51.0% (101/198) compared to a rate of 56.1% (111/198) for TB, using a patient-based biopsy approach. The detection rate of csPCa was higher using a combined biopsy (64.6%; 128/198) in comparison to TB (56.1%; 111/198) alone. This was statistically significant (p < 0.001). Age, PSA density and PIRADS score significantly predicted the detection of csPCa by SB in addition to TB. A nomogram based on the model showed good discriminative ability (C-index; 78%). The decision analysis curve confirmed a higher net clinical benefit at an acceptable threshold.

Added value of randomised biopsy to multiparametric magnetic resonance imaging‐targeted biopsy of the prostate in a contemporary cohort

“…Studies defined nomograms to predict the detection rate of csPCa by SBx. In a prospective study by Alqahtani et al [6] evaluating 198 patients undergoing mpMRI-targeted biopsy and SBx, the authors retrospectively defined a nomogram with a discriminative ability by a C-index of 78%. In line with our results, patients with a high clinical likelihood of PCa showed the highest added value according to the calculated nomogram [6].…”

“…In a prospective study by Alqahtani et al [6] evaluating 198 patients undergoing mpMRI-targeted biopsy and SBx, the authors retrospectively defined a nomogram with a discriminative ability by a C-index of 78%. In line with our results, patients with a high clinical likelihood of PCa showed the highest added value according to the calculated nomogram [6]. In a retrospective evaluation of 398 patients undergoing mpMRI-targeted biopsy and SBx, Sathianathen et al [17] defined a nomogram with a discriminative ability by a C-index of 70%.…”

“…However, studies showed that, highest detection rates are gained with the combination of mpMRI-US fusion-guided biopsy and SBx [3,4]. In efforts to safely omit SBx studies established nomograms, expressing the risk of missing csPCa [5,6]. These nomograms do not play a role in clinical practice to date.…”

“…In efforts to safely omit SBx studies established nomograms, expressing the risk of missing csPCa [5,6]. These nomograms do not play a role in clinical practice to date.…”