TY - JOUR
T1 - There Is No Way to Avoid Systematic Prostate Biopsies in Addition to Multiparametric Magnetic Resonance Imaging Targeted Biopsies
AU - Dell'Oglio, Paolo
AU - Stabile, Armando
AU - Soligo, Matteo
AU - Brembilla, Giorgio
AU - Esposito, Antonio
AU - Gandaglia, Giorgio
AU - Fossati, Nicola
AU - Bravi, Carlo Andrea
AU - Dehò, Federico
AU - De Cobelli, Francesco
AU - Montorsi, Francesco
AU - Karnes, R. Jeffrey
AU - Briganti, Alberto
N1 - Publisher Copyright:
Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - BACKGROUND: Whether or not adding systematic biopsies (transrectal ultrasound-guided biopsy [TRUS-Bx]) to targeted cores in patients with a lesion detected at multiparametric magnetic resonance imaging (mpMRI) is still a debated topic. OBJECTIVE: To identify patients who can avoid TRUS-Bx at the time of mpMRI targeted biopsy (MRI-TBx) relying on individual patient probability to harbour clinically significant prostate cancer (csPCa) outside the index lesion (IL). DESIGN, SETTING, AND PARTICIPANTS: A total of 339 European and 441 North American patients underwent fusion MRI-TBx and concomitant TRUS-Bx at two tertiary care referral centres between 2013 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The study outcome was csPCa, defined as a Gleason score at biopsy of ≥7, outside the IL. Multivariable logistic regression analyses (MVAs) were performed to develop a predictive model for the study outcome. Multivariable-derived coefficients were used to develop a novel risk calculator in each cohort. The models were evaluated using the area under the curve (AUC), calibration plot, and decision-curve analyses. RESULTS AND LIMITATIONS: In the European cohort, csPCa detection rate was 55%. The csPCa detection rate for TRUS-Bx was 41%. At MVAs, prostate volume, previous negative biopsy, and Prostate Imaging Reporting and Data System versions 4 and 5 were independent predictors for the presence of csPCa outside the IL. The multivariable model had an AUC of 0.78. Omitting TRUS-Bx in patients with a calculated risk of <15% would have spared 16% of TRUS-Bx at the cost of missing 7% of csPCa. Similar findings were obtained when the same analyses were performed in the North American cohort. No net benefit was observed for low-threshold probabilities (<15%) of the each model relative to the standard of care (performing TRUS-Bx in addition to MRI-TBx to all patients) in both cohorts. The study is limited by its retrospective design. CONCLUSIONS: We failed to identify those patients who might safely benefit from MRI-TBx alone. The combination of MRI-TBx and TRUS-Bx should strongly be considered the best available approach. PATIENT SUMMARY: In the presence of positive multiparametric magnetic resonance imaging (mpMRI) of the prostate, physicians should always perform systematic sampling of the prostate in addition to mpMRI targeted biopsy.
AB - BACKGROUND: Whether or not adding systematic biopsies (transrectal ultrasound-guided biopsy [TRUS-Bx]) to targeted cores in patients with a lesion detected at multiparametric magnetic resonance imaging (mpMRI) is still a debated topic. OBJECTIVE: To identify patients who can avoid TRUS-Bx at the time of mpMRI targeted biopsy (MRI-TBx) relying on individual patient probability to harbour clinically significant prostate cancer (csPCa) outside the index lesion (IL). DESIGN, SETTING, AND PARTICIPANTS: A total of 339 European and 441 North American patients underwent fusion MRI-TBx and concomitant TRUS-Bx at two tertiary care referral centres between 2013 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The study outcome was csPCa, defined as a Gleason score at biopsy of ≥7, outside the IL. Multivariable logistic regression analyses (MVAs) were performed to develop a predictive model for the study outcome. Multivariable-derived coefficients were used to develop a novel risk calculator in each cohort. The models were evaluated using the area under the curve (AUC), calibration plot, and decision-curve analyses. RESULTS AND LIMITATIONS: In the European cohort, csPCa detection rate was 55%. The csPCa detection rate for TRUS-Bx was 41%. At MVAs, prostate volume, previous negative biopsy, and Prostate Imaging Reporting and Data System versions 4 and 5 were independent predictors for the presence of csPCa outside the IL. The multivariable model had an AUC of 0.78. Omitting TRUS-Bx in patients with a calculated risk of <15% would have spared 16% of TRUS-Bx at the cost of missing 7% of csPCa. Similar findings were obtained when the same analyses were performed in the North American cohort. No net benefit was observed for low-threshold probabilities (<15%) of the each model relative to the standard of care (performing TRUS-Bx in addition to MRI-TBx to all patients) in both cohorts. The study is limited by its retrospective design. CONCLUSIONS: We failed to identify those patients who might safely benefit from MRI-TBx alone. The combination of MRI-TBx and TRUS-Bx should strongly be considered the best available approach. PATIENT SUMMARY: In the presence of positive multiparametric magnetic resonance imaging (mpMRI) of the prostate, physicians should always perform systematic sampling of the prostate in addition to mpMRI targeted biopsy.
KW - Clinically significant prostate cancer outside the index lesion
KW - Fusion biopsy
KW - Multiparametric magnetic resonance imaging
KW - Random biopsy
KW - Targeted biopsy
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U2 - 10.1016/j.euo.2019.03.002
DO - 10.1016/j.euo.2019.03.002
M3 - Article
C2 - 31411973
AN - SCOPUS:85076190434
SN - 2588-9311
VL - 3
SP - 112
EP - 118
JO - European Urology Oncology
JF - European Urology Oncology
IS - 1
ER -