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MRI-targeted or systematic random biopsies for prostate cancer diagnosis in biopsy naïve patients: follow-up of a PRECISION trial-like retrospective cohort

Prostate Cancer and Prostatic Diseases volume 24, pages 406–413 (2021)Cite this article

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Abstract

Background

To test clinically significant prostate cancer (csPCa) rates during follow-up in biopsy naïve patients that underwent two different diagnostic pathways: (1) SB GROUP (n = 354): systematic random biopsies (SB) vs. (2) TB GROUP (n = 264): multiparametric magnetic resonance imaging (mpMRI) and only targeted biopsies (TB) of PI-RADS ≥ 3 lesions. Patients with PI-RADS ≤ 2 score avoided prostate biopsies.

Methods

Retrospective single centre study of 618 biopsy naive patients (2015–2018). Two different definitions of csPCa were used: (1) csPCa ISUP GG ≥ 2 (ISUP grade group [GG] ≥ 2) and (2) csPCa ISUP GG ≥ 3. Kaplan–Meier plots and univariable Cox regression models tested rates over time of csPCa ISUP GG ≥ 2 and caPCa ISUP GG ≥ 3 in SB GROUP vs. TB GROUP.

Results

At initial biopsy, TB achieved higher rates of csPCa ISUP GG ≥ 2 (35.3 vs. 18.9%; p < 0.001) and csPCa ISUP GG ≥ 3 (12.6 vs. 6.2%; p = 0.04), relative to SB. After a median time follow-up of 36 months, the rates of csPCa ISUP GG ≥ 2 (6.1 vs. 4.4%; p = 0.6) and csPCa ISUP GG ≥ 3 (3.3 vs. 1.1%; p = 0.2) were similar in SB GROUP vs. TB GROUP. Moreover, in TB GROUP patients that avoided prostate biopsies because of negative baseline mpMRI (n = 145), only 4.1% exhibited csPCa ISUP GG ≥ 2 during follow-up. Moreover, none of these patients (PI-RADS ≤ 2) had csPCa ISUP GG ≥ 3.

Conclusions

In biopsy naïve setting, a diagnostic pathway including pre-biopsy mpMRI and TB of only PCa suspicious lesions is not associated with higher rates of csPCa during follow-up, relative to a diagnostic pathway of SB. Moreover, patients with negative baseline mpMRI could safely avoid prostate biopsies and could be followed with repeated PSA testing, since only a small proportion of them would harbor csPCa.

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Fig. 1: Stacked barplots depicting clinically significant prostate cancer (csPCa) rates according to Prostate Imaging Reporting and Data System (PI-RADS) category at baseline multiparametric magnetic resonance imaging (mpMRI) in TB GROUP patients (mpMRI ± targeted biopsies).
Fig. 2: Kaplan–Meier plots depicting clinically significant prostate cancer (csPCa) rates during follow-up in SB GROUP (systematic random biopsies) and TB GROUP (multiparametric magnetic resonance imaging ± targeted biopsies) patients.

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Acknowledgements

This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds. SL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy

    Stefano Luzzago, Ottavio de Cobelli, Francesco A. Mistretta, Mattia Luca Piccinelli, Vito Lorusso, Michele Morelli, Roberto Bianchi, Michele Catellani, Gabriele Cozzi, Ettore Di Trapani, Matteo Ferro, Deliu-Victor Matei & Gennaro Musi

  2. Università degli Studi di Milano, Milan, Italy

    Stefano Luzzago, Mattia Luca Piccinelli, Vito Lorusso & Michele Morelli

  3. Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan, Italy

    Ottavio de Cobelli, Giulia Marvaso, Barbara Alicja Jereczek-Fossa & Giuseppe Petralia

  4. Precision Imaging and Research Unit – Department of Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, Milan, Italy

    Paola Pricolo, Sarah Alessi & Giuseppe Petralia

  5. Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy

    Giulia Marvaso & Barbara Alicja Jereczek-Fossa

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  1. Stefano Luzzago
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Correspondence to Stefano Luzzago.

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Luzzago, S., de Cobelli, O., Mistretta, F.A. et al. MRI-targeted or systematic random biopsies for prostate cancer diagnosis in biopsy naïve patients: follow-up of a PRECISION trial-like retrospective cohort. Prostate Cancer Prostatic Dis 24, 406–413 (2021). https://doi.org/10.1038/s41391-020-00290-4

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