Clinically significant prostate cancer detection rate in biopsy-naïve patients with mpMRI and microultrasound topographically discordant lesions: A single-center retrospective analysis

• Published in: Urologic oncology 2024-12, Vol.42 (12), p.447.e11-447.e16
• Main Authors: Dagnino, Filippo, Avolio, Pier Paolo, Fasulo, Vittorio, Piccolini, Andrea, Aljoulani, Muhannad, Moretto, Stefano, Maffei, Davide, Finocchiaro, Alessio, Beatrici, Edoardo, Paciotti, Marco, Saita, Alberto, Lazzeri, Massimo, Hurle, Rodolfo, Buffi, Nicolò M., Casale, Paolo, Lughezzani, Giovanni
• Format: Article
• Language: English
• Subjects: Aged; Clinically significant prostate cancer; Humans; Image-Guided Biopsy - methods; Male; micro-US; Middle Aged; mpMRI; Multiparametric Magnetic Resonance Imaging - methods; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retrospective Studies; Systematic biopsy; Targeted biopsy; Ultrasonography - methods
• ISSN: 1078-1439; 1873-2496; 1873-2496
• DOI: 10.1016/j.urolonc.2024.06.021

•Combined micro-US and mpMRI-target biopsy optimally identified prostate cancer in discordant lesions.•Addition of systematic biopsy allowed to increase the detection of clinically insignificant prostate cancer.•Given that the addition of nontargeted systematic biopsies did not identify any additional patients with clinically significant prostate cancer, the necessity of SBx in csPCa detection might be worth reevaluating. Multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer (csPCa), and microultrasound (micro-US) shows promise in enhancing detection rates. We compared mpMRI-guided targeted biopsy (MTBx) and micro–US-guided targeted biopsy (micro–US-TBx) in biopsy-naïve patients with discordant lesions at micro-US and mpMRI to detect csPCa (grade group ≥2) and clinically insignificant PCa (ciPCa; grade group 1) and assessed the role of nontargeted systematic biopsy (SBx). We analyzed 178 biopsy-naive men with suspected PCa and discordant lesions at mpMRI and micro-US. All patients underwent mpMRI followed by micro-US, the latter being performed immediately before the biopsy. Imaging findings were interpreted blindly, followed by targeted and SBx. Median age was 63 years (IQR, 57–70), median prostate-specific antigen level was 7 ng/mL (IQR, 5–9 ng/mL), and median prostate volume was 49 cm^3 (IQR, 35–64 cm^3). Overall, 86/178 (48%) patients were diagnosed with PCa, 51/178 (29%) with csPCa. Micro-USTBx detected csPCa in 36/178 men (20%; 95% CI: 26–46), and MTBx detected csPCa in 28/178 men (16%; 95% CI: 36–50), resulting in a -8% difference (95% CI: −10, 4; P = 0.022) and a relative detection rate of 0.043. Micro-USTBx detected ciPCa in 9/178 men (5%; 95% CI: 3, 15), while MTBx detected ciPCa in 12/178 men (7%; 95% CI: 5, 20), resulting in a −3% difference (95% CI: −2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 (16%) men. mpMRI plus micro-US detected csPCa in 51/178 men, with no additional cases with the addition of SBx. Similarly, MTBx plus micro-USTBx plus SBx detected ciPCa in 35/178 men (20%; 95% CI: 18, 37) compared to 9 (5%) in the micro-US pathway (P = 0.002) and 14/178 (8%; 95% CI: 6, 26) in the mpMRI plus micro-US pathway (P = 0.004). In conclusion, a combined micro-US/mpMRI approach could characterize primary disease in biopsy-naïve patients with discordant lesions, potentially avoiding SBx. Further studies are needed to validate our findings and asse