Systematic biopsy does not contribute to disease upgrading in patients undergoing targeted biopsy for PI-RADS 5 lesions identified on magnetic resonance imaging in the course of active surveillance for prostate cancer.

Abstract

OBJECTIVE\nTo compare the utility of the systematic 12-core prostate biopsy (SB) combined with magnetic resonance imaging (MRI)-targeted lesion biopsy (MRI-TB) versus MRI-TB alone in the diagnosis of high PI-RADS lesions.\n\n\nMATERIALS AND METHODS\nPatients undergoing MRI-TB+SB for suspicious MRI lesions were retrospectively reviewed. These patients had a previous prostate biopsy and were evaluated with MRI to assess the need for a repeat biopsy. Pathological findings of MRI-TB combined with a SB were compared to those of the patients previous SB. An upgrade was defined as an increase in the Gleason Score (GS) of any prior biopsy. A no-upgrade (NU) MRI-TB was defined as a MRI-TB that did not lead to disease upgrading when compared to SB.\n\n\nRESULTS\nA total of 148 patients were analyzed in this study. Of the 255 total lesions (247 lesions with PI-RADS ≥ 3), 141 were upgraded from the previous biopsy (55.3%). Of these, 104 were upgraded by the MRI-TB (40.8%), and 87 lesions were upgraded by the SB (34.1%). The MRI-TB had a NU rate of 26.2% for all lesions. On sub-analysis, the NU rates of PI-RADS 3, 4, and 5 MRI-TBs were 39.3%, 21.2%, and 3.4%, respectively.\n\n\nCONCLUSIONS\nThe NU rate for the MRI-TB in a PIRADS-5 lesion is meager. Men with a PI-RADS 5 lesion may be safely managed with the MRI-TB alone without combining with SB.Men with PI-RADS 3 and 4 lesions should benefit from SB in addition to MRI-TB for accurate management of their disease.