Optimizing prostate-targeted biopsy schemes in men with multiple mpMRI visible lesions: should we target all suspicious areas? Results of a two institution series

• Published in: Prostate cancer and prostatic diseases 2021-12, Vol.24 (4), p.1137-1142
• Main Authors: Stabile, Armando, Barletta, Francesco, Motterle, Giovanni, Pellegrino, Francesco, Sorce, Gabriele, Mazzone, Elio, Scuderi, Simone, Cirulli, Giuseppe Ottone, Cucchiara, Vito, Esposito, Antonio, Gandaglia, Giorgio, Fossati, Nicola, De Cobelli, Francesco, Montorsi, Francesco, Karnes, R. Jeffrey, Briganti, Alberto
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/699/67/589/466; Aged; Biomedical and Life Sciences; Biomedicine; Biopsy; Cancer Research; Contrast Media; Diagnosis; Humans; Image-Guided Biopsy - methods; Italy; Lesions; Magnetic resonance imaging; Male; Methods; Middle Aged; Minnesota; Multiparametric Magnetic Resonance Imaging; Neoplasm Grading; Prostate; Prostate cancer; Prostatic Neoplasms - pathology; Regression models; Reproductive Medicine; Risk factors
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-021-00371-y

Background To assess the diagnostic added value of sampling secondary lesions at prostate mpMRI (SL) in addition to index lesion (IL) in detecting significant prostate cancer (csPCa) when also systematic biopsy (SBx) is performed. Methods We relied on a cohort of 312 men with two suspicious lesions at prostate mpMRI who underwent subsequent targeted biopsy of each lesion (TBx) and concomitant SBx at two tertiary-referral centers between 2013 and 2019. The study outcome was the added value of targeting SL (i.e., the one with a lower PI-RADS score and/or the smaller size compared to IL) in the detection of csPCa. To this aim, we compared different biopsy strategies (SBx + overall TBx vs SBx + IL-targeted biopsy vs SBx + SL-targeted biopsy) and assessed whether SL features could be correlated with detection of csPCa at overall TBx in a multivariable logistic regression model (MVA). Results Overall, 44% of men had csPCa at TBx of all lesions while 39% and 23% of men had csPCa found in IL and SL, respectively. The rate of csPCa found at SBx, IL-TBx, and SL-TBx only was 5%, 6%, and 2%, respectively. The detection rate of csPCa for SBx + IL-TBx was 47%. The addition of SL-TBx increased csPCa detection by only 2% ( p  = 0.12). At MVA, neither PI-RADS of SL nor the number of cores targeting SL was associated with an increased detection of csPCa (all p  > 0.3). Conversely, age (OR: 1.07), PSA (OR: 1.07), prostate volume (OR: 0.98), and PI-RADS of the IL (OR: 2.36) were independently associated with csPCa detection at TBx (all p