TY - JOUR
T1 - Assessing the need for systematic biopsies in addition to targeted biopsies according to the characteristics of the index lesion at mpMRI. Results from a large, multi-institutional database
AU - Barletta, Francesco
AU - Mazzone, Elio
AU - Stabile, Armando
AU - Scuderi, Simone
AU - Brembilla, Giorgio
AU - de Angelis, Mario
AU - Cirulli, Giuseppe Ottone
AU - Cucchiara, Vito
AU - Gandaglia, Giorgio
AU - Karnes, R. Jeffrey
AU - Roupret, Morgan
AU - De Cobelli, Francesco
AU - Montorsi, Francesco
AU - Briganti, Alberto
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/11
Y1 - 2022/11
N2 - Purpose: We hypothesized that systematic biopsies (SBx) value for clinically significant PCa (csPCa) detection, in addition to mpMRI targeted biopsies (TBx), may vary significantly according to mpMRI index lesion (IL) characteristics. Methods: We identified 1350 men with an mpMRI suspicious lesion (PI-RADS ≥ 3), defined as IL, who underwent TBx and SBx at three referral centres. The outcome was SBx added value in csPCa (grade group ≥ 2 PCa detected at SBx and missed by TBx) detection. To this aim, we performed multivariable logistic regression analyses (MVA). Furthermore, we explored the interaction between IL volume and SBx csPCa added value, across different PI-RADS categories, using lowess function. Results: Overall, 569 (42%) men had csPCa at TBx and 78 (6%) csPCa were identified at SBx only. At MVA PSA (OR 0.90; p < 0.05) and IL volume (OR 0.58; p < 0.05) were associated with SBx csPCa added value. At interaction analyses, a nonlinear correlation between PI-RADS and SBx csPCa added value was identified with a decrease from roughly 10 to 4% followed by a substantial plateau at 1.2 ml and 0.6 ml for PI-RADS 3 and 4, respectively. For PI-RADS 5 lesions SBx csPCa added was constantly lower than 4%. Conclusions: Increasing IL volume in PI-RADS 3 and 4 lesions is associated with reduction in SBx csPCa added value. For diagnostic purposes, SBx could be omitted in men with IL larger than 1.2 ml and 0.6 ml for PI-RADS 3 and 4, respectively. Conversely, for PI-RADS 5, SBx csPCa added value was minimal regardless of IL volume.
AB - Purpose: We hypothesized that systematic biopsies (SBx) value for clinically significant PCa (csPCa) detection, in addition to mpMRI targeted biopsies (TBx), may vary significantly according to mpMRI index lesion (IL) characteristics. Methods: We identified 1350 men with an mpMRI suspicious lesion (PI-RADS ≥ 3), defined as IL, who underwent TBx and SBx at three referral centres. The outcome was SBx added value in csPCa (grade group ≥ 2 PCa detected at SBx and missed by TBx) detection. To this aim, we performed multivariable logistic regression analyses (MVA). Furthermore, we explored the interaction between IL volume and SBx csPCa added value, across different PI-RADS categories, using lowess function. Results: Overall, 569 (42%) men had csPCa at TBx and 78 (6%) csPCa were identified at SBx only. At MVA PSA (OR 0.90; p < 0.05) and IL volume (OR 0.58; p < 0.05) were associated with SBx csPCa added value. At interaction analyses, a nonlinear correlation between PI-RADS and SBx csPCa added value was identified with a decrease from roughly 10 to 4% followed by a substantial plateau at 1.2 ml and 0.6 ml for PI-RADS 3 and 4, respectively. For PI-RADS 5 lesions SBx csPCa added was constantly lower than 4%. Conclusions: Increasing IL volume in PI-RADS 3 and 4 lesions is associated with reduction in SBx csPCa added value. For diagnostic purposes, SBx could be omitted in men with IL larger than 1.2 ml and 0.6 ml for PI-RADS 3 and 4, respectively. Conversely, for PI-RADS 5, SBx csPCa added value was minimal regardless of IL volume.
KW - Biopsy
KW - Diagnosis
KW - MRI
KW - Prostate cancer
KW - Targeted biopsy
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U2 - 10.1007/s00345-022-04155-4
DO - 10.1007/s00345-022-04155-4
M3 - Article
C2 - 36149448
AN - SCOPUS:85138751571
SN - 0724-4983
VL - 40
SP - 2683
EP - 2688
JO - World Journal of Urology
JF - World Journal of Urology
IS - 11
ER -