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

Prostate Cancer and Prostatic Diseases volume 24, pages 1137–1142 (2021)Cite this article

Subjects

Abstract

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 < 0.01).

Conclusions

There is no significant benefit in terms of csPCa detection when an adequate SBx is performed in combination with IL-TBx in patients with multiple mpMRI lesions. In these men target biopsy of secondary lesions can be safely omitted.

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Acknowledgements

Study conception and design: AS and AB. Acquisition of data: FB, GM, FP, GS, EM, SS, and GOC. Analysis and interpretation of data: AS, FB, GM, FP, GS, EM, SS, GOC, VC, AE, GG, NF, FDC, FM, RJK, and AB. Drafting of the manuscript: AS and FB. Critical revision of the manuscript for important intellectual content: AS, GG, NF, FM, RJK, and AB. Statistical analysis: AS. Obtaining funding: None. Administrative, technical, or material support: None. Supervision: FM, RJK, and AB. Other: None.

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Authors and Affiliations

  1. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Armando Stabile, Francesco Barletta, Francesco Pellegrino, Gabriele Sorce, Elio Mazzone, Simone Scuderi, Giuseppe Ottone Cirulli, Vito Cucchiara, Giorgio Gandaglia, Nicola Fossati, Francesco Montorsi & Alberto Briganti

  2. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Giovanni Motterle & R. Jeffrey Karnes

  3. Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Antonio Esposito & Francesco De Cobelli

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  1. Armando Stabile
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Correspondence to Armando Stabile.

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Stabile, A., Barletta, F., Motterle, G. et al. Optimizing prostate-targeted biopsy schemes in men with multiple mpMRI visible lesions: should we target all suspicious areas? Results of a two institution series. Prostate Cancer Prostatic Dis 24, 1137–1142 (2021). https://doi.org/10.1038/s41391-021-00371-y

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