An Magnetic Resonance Imaging–directed Targeted-plus-perilesional Biopsy Approach for Prostate Cancer Diagnosis: “Less Is More”

• Published in: European urology open science (Online) 2022-09, Vol.43, p.68-73
• Main Authors: Hagens, Marinus J., Noordzij, M. Arjen, Mazel, Jan Willem, Jager, Auke, Boellaard, Thierry N., Tielbeek, Jeroen A.W., Henebiens, Margot, Schoots, Ivo G., van Leeuwen, Pim J., van der Poel, Henk G., Rynja, Sybren P.
• Format: Article
• Language: English
• Subjects: Cognitive fusion; Perilesional systematic biopsies; Prostate biopsies; Prostate Cancer; Transperineal
• ISSN: 2666-1683; 2666-1691; 2666-1683
• DOI: 10.1016/j.euros.2022.07.006

This retrospective study found arguments to limit systematic biopsies only to ipsilateral prostate lobe sectors directly adjacent to the magnetic resonance imaging (MRI)-positive lesion. An MRI-directed targeted-plus-perilesional biopsy approach detects clinically significant prostate cancer cases equivalent to the recommended practice of an MRI-directed targeted-plus-systematic biopsy approach, while reducing overdiagnosis rates and the number of biopsy cores. Considering that most men benefit diagnostically from increased sampling of index lesions, limiting systematic biopsy (SBx) to the region around the index lesion could potentially minimize overdetection while maintaining the detection of clinically significant prostate cancer (csPCa). To evaluate the diagnostic performance of a hypothetical magnetic resonance imaging (MRI)-directed targeted-plus-perilesional biopsy approach. This single-center, retrospective analysis of prospectively generated data included all biopsy-naïve men with unilateral MRI-positive lesions (Prostate Imaging Reporting and Data System category ≥3), undergoing both MRI-directed targeted biopsies and SBx. Grade group 2–5 cancers were considered csPCa. The diagnostic performance of a targeted-plus-perilesional biopsy approach was compared with that of a targeted-plus-systematic biopsy approach. The primary outcome was the detection of csPCa. Secondary outcomes included the detection of clinically insignificant prostate cancer (ciPCa) and the number of total biopsy cores. A total of 235 men were included in the analysis; csPCa and ciPCa were detected, respectively, in 95 (40.4%) and 86 (36.6%) of these 235 men. A targeted-plus-perilesional biopsy approach would have detected 92/95 (96.8%; 95% confidence interval [CI] 91.0–99.3%) csPCa cases. At the same time, detection of systematically found ciPCa would be reduced by 11/86 (12.8%; 95% CI 6.6–21.7%). If a targeted-plus-perilesional biopsy approach would have been performed, the number of biopsy cores per patient would have been reduced significantly (a mean difference of 5.2; 95% CI 4.9–5.6, p