Value of systematic sampling in an mp-MRI targeted prostate biopsy strategy

Abstract

The clinical utility of systematic prostate biopsy in addition to multi-parametric magnetic resonance imagining (mp-MRI) targeted biopsy pathways remains unclear. Despite radiological advancements in mp-MRI and utilisation of international standardised reporting systems (i.e., PI-RADS, LIKERT), undetected clinically significant prostate cancer (csPCa) on imaging persists. This has prevented the widespread adoption of an exclusively targeted biopsy approach. The current evidence on csPCa cancer detection rates in mp-MRI targeted alone and combined with a non-targeted systematic sampling is presented. Arguments for and against routine limited systematic sampling as an adjunct to an mp-MRI targeted biopsy are discussed. Our review will report the clinical utility of a combined sampling strategy on csPCa detection rate. The available evidence suggests that we are yet to reach a stage where non-targeted systematic prostate biopsy can be routinely omitted in mp-MRI targeted prostate biopsy pathways. Research should focus on improving the accuracy of mp-MRI, prostate biopsy techniques, and in identifying those men that will most benefit from a combined prostate biopsy. Such strategies may help future urologists reduce the burden of non-targeted cores in modern mp-MRI prostate biopsy pathways.

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

“…Studies evaluating the added value of SBx to mpMRI‐US fusion‐guided biopsy report a wide range of 1.3% to 11% [14]. In our study, 145/944 (15%) patients were diagnosed with csPCa by SBx, while mpMRI‐US fusion‐guided biopsy showed ciPCa or no malignancy.…”

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)

“…It is essential that we balance the advantages of concurrent sampling of the prostate during targeting against the risk of side effects and increased detection of clinically insignificant prostate cancers. Avoiding or adding systematic random biopsy at the time of TB remains a challenge for physicians, as knowledge and evidence of decision-making contributing factors still remains known [ 20 ]. Our outcomes from the nomogram indicated the excellent advantage (C-index 78% vs. 70%) of using a multivariable prediction model adjusting for clinical and radiological features (age, PSAD and PIRADS).…”

Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer

“…It is now recommended that mpMRI be the cornerstone of imaging in both planning and follow up of focal therapy, and that MRI-targeted biopsy be performed for all visible lesions [23]. Systematic biopsies are currently still required for focal therapy planning in biopsy-naive patients, and for patients with residual prostate cancer after focal therapy, although this might change with development of risk calculators that might allow us to identify those who have a higher risk of harbouring significant cancer in nontargeted areas [24].…”