Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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

Subjects

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.

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

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.

References

  1. 1.

    Scattoni V, Zlotta A, Montironi R, Schulman C, Rigatti P, Montorsi F. Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: a critical analysis of the literature{A figure is presented}. Eur Urol. 2007;52:1309–22.

    Article  Google Scholar 

  2. 2.

    Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378:1767–77.

    Article  Google Scholar 

  3. 3.

    Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389:815–22.

    Article  Google Scholar 

  4. 4.

    Elkhoury FF, Felker ER, Kwan L, Sisk AE, Delfin M, Natarajan S, et al. Comparison of targeted vs systematic prostate biopsy in men who are biopsy naive: the prospective assessment of image registration in the diagnosis of prostate cancer (PAIREDCAP) study. JAMA Surg. 2019;154:811–8.

    Article  Google Scholar 

  5. 5.

    Rouvière O, Puech P, Renard-Penna R, Claudon M, Roy C, Mège-Lechevallier F, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol. 2019;20:100–9.

    Article  Google Scholar 

  6. 6.

    van der Leest M, Cornel E, Israël B, Hendriks R, Padhani AR, Hoogenboom M, et al. Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective Mu. Eur Urol. 2019;75:570–8.

    Article  Google Scholar 

  7. 7.

    Porpiglia F, Manfredi M, Mele F, Cossu M, Bollito E, Veltri A, et al. Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: results from a randomized prospective study in biopsy-naïve patients with suspected prostate cancer. Eur Urol. 2017;72:282–8.

    Article  Google Scholar 

  8. 8.

    Pokorny MR, De Rooij M, Duncan E, Schröder FH, Parkinson R, Barentsz JO, et al. Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent mr-guided biopsy in men without previous prostate biopsies. Eur Urol. 2014;66:22–9.

    Article  Google Scholar 

  9. 9.

    Tonttila PP, Lantto J, Pääkkö E, Piippo U, Kauppila S, Lammentausta E, et al. Prebiopsy multiparametric magnetic resonance imaging for prostate cancer diagnosis in biopsy-naive men with suspected prostate cancer based on elevated prostate-specific antigen values: results from a randomized prospective blinded controlled trial. Eur Urol. 2016;69:419–25.

    Article  Google Scholar 

  10. 10.

    Goldberg H, Ahmad AE, Chandrasekar T, Klotz L, Emberton M, Haider MA, et al. Comparison of magnetic resonance imaging and transrectal ultrasound informed prostate biopsy for prostate cancer diagnosis in biopsy naıve men: a systematic review and meta-analysis. J Urol. 2020;203:1–9.

  11. 11.

    Elwenspoek MMC, Sheppard AL, McInnes MDF, Merriel SWD, Rowe EWJ, Bryant RJ, et al. Comparison of multiparametric magnetic resonance imaging and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer: a systematic review and meta-analysis. JAMA Netw Open. 2019;2:e198427.

    Article  Google Scholar 

  12. 12.

    Epstein JI, Zelefsky MJ, Sjoberg DD, Nelson JB, Egevad L, Magi-Galluzzi C, et al. A contemporary prostate cancer grading system: a validated alternative to the gleason score. Eur Urol. 2016;69:428–35.

    Article  Google Scholar 

  13. 13.

    Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al. ESUR prostate MR guidelines 2012. Eur Radio. 2012;22:746–57.

    Article  Google Scholar 

  14. 14.

    Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016;69:16–40.

    Article  Google Scholar 

  15. 15.

    Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MGM. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. 2015;68:438–50.

    Article  Google Scholar 

  16. 16.

    Wegelin O, van Melick HHE, Hooft L, Bosch JLHR, Reitsma HB, Barentsz JO, et al. Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique? Eur Urol. 2017;71:517–31.

  17. 17.

    Kasivisvanathan V, Stabile A, Neves JB, Giganti F, Valerio M, Shanmugabavan Y, et al. Magnetic resonance imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer: a systematic review and meta-analysis. Eur Urol. 2019;76:284–303.

  18. 18.

    Valerio M, Donaldson I, Emberton M, Ehdaie B, Hadaschik BA, Marks LS, et al. Detection of clinically significant prostate cancer using magnetic resonance imaging-ultrasound fusion targeted biopsy: a systematic review. Eur Urol. 2015;68:8–19.

  19. 19.

    Panebianco V, Barchetti G, Simone G, Del Monte M, Ciardi A, Grompone MD, et al. Negative multiparametric magnetic resonance imaging for prostate cancer: what’s next? [Figure presented]. Eur Urol. 2018;74:48–54.

    Article  Google Scholar 

  20. 20.

    Venderink W, van Luijtelaar A, van der Leest M, Barentsz JO, Jenniskens SFM, Sedelaar MJP, et al. Multiparametric magnetic resonance imaging and follow-up to avoid prostate biopsy in 4259 men. BJU Int. 2019;124:775–84.

    Article  Google Scholar 

  21. 21.

    Padhani AR, Weinreb J, Rosenkrantz AB, Villeirs G, Turkbey B, Barentsz J. Prostate imaging-reporting and data system steering committee: PI-RADS v2 status update and future directions. Eur Urol. 2019;75:385–96.

    Article  Google Scholar 

  22. 22.

    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71:618–29.

    Article  Google Scholar 

  23. 23.

    Costa DN, Kay FU, Pedrosa I, Kolski L, Lotan Y, Roehrborn CG, et al. An initial negative round of targeted biopsies in men with highly suspicious multiparametric magnetic resonance findings does not exclude clinically significant prostate cancer—Preliminary experience. Urol Oncol Semin Orig Investig. 2017;35:149–e15.

  24. 24.

    Pagniez M, Kasivisvanathan V, Puech P, Drumez E, Villers A, Olivier J. Predictive factors of missed clinically significant prostate cancers in men with negative MRI: a systematic review and meta-analysis. J Urol. 2020;204:24–32.

    CAS  Article  Google Scholar 

  25. 25.

    Luzzago S, Petralia G, Musi G, Catellani M, Alessi S, Di Trapani E, et al. Multiparametric magnetic resonance imaging second opinion may reduce the number of unnecessary prostate biopsies: time to improve radiologists’ training program? Clin Genitourin Cancer. 2018;17:88–96.

    Article  Google Scholar 

  26. 26.

    Moldovan PC, Van den Broeck T, Sylvester R, Marconi L, Bellmunt J, van den Bergh RCN, et al. What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. Eur Urol. 2017;72:250–66.

Download references

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Stefano Luzzago.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Search

Quick links