Which protocol for prostate biopsies in patients with a positive MRI? Interest of systematic biopsies by sectors.

Abstract

BACKGROUND Current prostate biopsy (PBx) protocol for prostate cancer (PCa) diagnosis is to perform systematic biopsies (SBx) combined with targeted biopsies (TBx) in case of positive MRI (i.e PI-RADS ≥3). To assess the utility of performing SBx in combination with TBx, we determined the added value of SBx brought to the diagnosis of PCa according to their sextant location and MRI target characteristics. METHODS In our local prospectively collected database, we conducted a single-center retrospective study including all patients with a suspicion of PCa, who underwent transrectal ultrasound guided (TRUS) prostate biopsies (PBx) with a prior MRI and a single lesion classified as PI-RADS ≥3. We have characterized the SBx according to their location on MRI: same sextant (S-SBx), adjacent sextant (A-SBx), ipsilateral side (I-SBx) and contralateral side (C-SBx). The added value of SBx and TBx was defined as any upgrading to significant PCa (csPCa) (ISUP ≥2). RESULTS 428 patients were included in the study. The added value of SBx was 10% overall. Regarding the lesion location and the SBx sextant, the added value of SBx was: 5.1% for S-SBx, 5.6% for A-SBx, 4.9 % for I-SBx and 2.1% for C-SBx. The overall added value of SBx was 6.0% for PI-RADS 3 lesions, 15% for PI-RADS 4 lesions and 6.7% for PI-RADS 5 lesions (p = 0,017). The added value of SBx for contralateral side was 1.7% (2/117), 3.1% (6/191) and 0.8% (1/120) for PI-RADS 3, PI-RADS 4 and PI-RADS 5 lesions, respectively (p = 0,4). The added value of SBx was lower when the number of TBx was higher (OR 0.56; CI95% 0.38-0.82; p = 0.003). CONCLUSIONS Our results suggest that the utility of performing SBx in the contralateral lobe toward the MRI lesion was very low, supporting that they might be avoided.

A novel biopsy scheme for prostate cancer: targeted and regional systematic biopsy

“…Recently, research has explored MRI-TB combined with only regional SB as an optimized approach to reduce biopsy cores [12][13][14][15][16]. Additionally, terms like focal saturation biopsy, perilesional biopsy, regional TB, and targeted sector biopsy have appeared in the literature [14,15,[17][18][19][20]. All these studies aimed to reduce the number of unnecessary SB cores while maintaining detection rates for clinically significant PCa (csPCa).…”